How Overall Health Affects Cancer Treatment Options

Your care team looks at many factors when recommending cancer treatment options. Your general health can help determine which treatment may work best for you.

“We treat not only the cancer, but the whole person. If you have pre-existing conditions, your options depend on the number, nature, and severity of those conditions, how long you have had them, and your history of treatments for them,” said Petros Grivas, MD, PhD, FASCO, an American Society of Clinical Oncology (ASCO) expert and researcher at Fred Hutch Cancer Center and the University of Washington.

Cancer treatment and your health

Making treatment decisions means weighing the benefits and risks carefully. Depending on the type and stage of cancer, your treatment goal may be to cure the cancer, control the cancer, or improve symptoms and manage problems caused by the cancer. Treatment should also take into account your preferences, physical abilities, work and family needs, financial situation, and overall lifestyle.

In some cases, other health problems or medications can affect treatment options, how well the treatment works, your risk for side effects, and how quickly you recover. Your doctor may advise against a certain cancer treatment if:

• You have a health condition that could make treatment less safe or effective. For example, having liver, kidney, lung, or heart problems can make it harder for the body to handle some cancer medications. Autoimmune diseases can make cancer immunotherapy treatment harder to manage.
• You’re taking a medication that could interact with a cancer treatment. Make sure your care team knows all your current prescribed and over-the-counter medications and supplements.
• Side effects of the treatment could make existing health problems worse. For example, some cancer treatments can cause numbness and tingling in the hands and feet (neuropathy). People with significant neuropathy may prefer a different treatment option.
• You might have trouble taking or tolerating the treatment. Treatment decisions should consider your medical needs and abilities. For example, someone who has trouble swallowing or keeping food down might not do well with an oral cancer treatment (pill) if one is an option for them.

Deciding whether a certain cancer treatment is an option can be much more complicated than “yes” or “no.” Your doctor may be able to reduce treatment risks by lowering the dose, going longer between treatments, skipping a dose, or stopping treatment.

“If more than one treatment option is available, you and your doctor should have a thoughtful, well-balanced discussion about the reason and goals of the treatment, logistics, and pros and cons of each option,” said Dr. Grivas. “We’re here to help people with cancer have enough information to make a well-informed decision that they’re comfortable with.”

Assessing your health before cancer treatment

Your cancer care team will want a clear picture of your health before recommending treatment. They will consider your:

• Age
• Physical fitness, stamina, balance, memory, and mobility
• Physical, mental, and emotional health
• Signs and symptoms
• Vital signs and physical exam results
• Bloodwork, pathology (tissue examination), scans, and other diagnostic test results
• Pre-existing medical conditions other than cancer
• Personal and family health history
• Medications and allergies
• Tobacco, alcohol, or recreational drug use
• Lifestyle, living and caregiver situation, nutrition, and support system

“Your care team spends a lot of time capturing and thinking through every detail about your health. All that context is highly relevant for individualized decision-making,” said Dr. Grivas.

Your primary care doctor or a specialist, such as a cardiologist, nephrologist, rheumatologist, or ophthalmologist, may work with your oncologist to manage your care. They should all communicate with each other to make sure you get the best possible treatment, tests, and ongoing care.

“Cancer care is a team sport. You should have a group of experts working together to find the right treatment for you and watching you very closely for complications,” Dr. Grivas said.

Exploring other cancer treatment options

It can be disappointing to learn that a particular cancer treatment is not recommended because it may not be safe or appropriate for you. But that doesn’t mean you won’t get quality care or an effective treatment.

For example, cisplatin is a common intravenous (IV) chemotherapy known to cause kidney damage. Patients with muscle-invasive bladder cancer often can’t take cisplatin because of the risk to their kidney function. Instead, they are treated with enfortumab vedotin (EV) and the immunotherapy drug pembrolizumab (pembro), along with surgery to remove the bladder. Recent research has found that this combination also led to much better cancer outcomes than conventional chemotherapy combined with surgery, even for people who could take cisplatin.

In addition to standard cancer therapies, you may be eligible to enroll in a clinical trial or to apply for compassionate use to get access to a promising treatment that’s still being tested. Ask your doctor about clinical trials that may be a good fit for you.

Caring for your health during cancer treatment

Cancer treatment can last weeks, months, or years. Your health can change during this time, which may affect your cancer treatment options.

Taking care of your overall health can help you get the most benefit from treatment and can support your recovery and quality of life. Healthy habits and supportive care include:

• Tracking and managing side effects
• Eating well and staying active
• Avoiding tobacco and alcohol
• Staying hydrated
• Managing stress
• Staying on track with treatment and taking medications as prescribed
• Getting recommended vaccines and screening tests
• Getting regular checkups for any non-cancer health problems you may have

“Good physical, mental, and emotional health will give you the best chance to receive and be able to tolerate the best possible cancer therapy for your particular case,” Dr. Grivas said. “It will also help you live longer with less complications and a much better quality of life.”

Learn more from the American Cancer Society:

• When Cancer Isn’t Your Only Health Problem
• Treatment Types
• Understanding Your Treatment Options
• Questions To Ask About Treatment

Dr. Grivas is a member of ASCO’s Patient Information Advisory Committee