Chemotherapy Speeds Up Physical Decline in Older Women—But Certain Interventions Can Help

A multicenter clinical trial conducted at over a dozen academic medical centers in the U.S. found that chemotherapy can speed up physical decline in older women. However, the researchers say that interventions such as physical therapy and emotional and social support can help reduce the negative effects of the treatment.

The study, published recently in the Journal of Cancer Survivorship, found many older women who had early-stage breast cancer and underwent chemotherapy experienced a significant decline in their ability to perform daily tasks like walking or climbing stairs compared to those who didn’t have chemotherapy and women without cancer who were the same age. 

The clinical trial compared the changes in physical function over time in women aged 65 and older. Participants included 444 women with early-stage breast cancer receiving chemotherapy, 98 women with early-stage breast cancer not receiving chemotherapy, and 100 women who did not have cancer.

The researchers found that almost 35% of older adults who received chemotherapy for breast cancer had a significant decline in physical function, compared to 8% of those who didn’t receive chemotherapy and 5% of those without cancer. In women who had a substantial decline, stair climbing, walking a mile, and moderate activity were especially difficult.

The new study is important because doctors have known that older women can face physical challenges when treated for breast cancer, but they weren’t sure whether it was the cancer or the treatment that caused these issues. The new study is the first to compare functional decline in older adults receiving chemotherapy to older breast cancer patients not receiving chemo. This allowed the researchers to see that the physical challenges, in many cases, were linked to chemo.

“The study provides a lens on the impact of common cancer treatment on the health and well-being of our patients, and it raises awareness that we should be doing more to support outpatients so that we can improve both the quantity and quality of their survival,” Mina Sedrak, MD, director of the Cancer and Aging Program at the Jonsson Comprehensive Cancer Center at UCLA and the first author of the study, told Verywell. 

The findings don’t necessarily mean you should avoid chemo after a certain age, especially since it can be an extremely effective treatment. The researchers were able to highlight certain interventions that could help improve the difficulties women experience during and after chemotherapy.

Geriatric Assessments Are a Crucial Tool for Older Cancer Patients

As part of the trial, all of the participants completed questionnaires about demographics and health status. They also agreed to a geriatric assessment: an evaluation to look at a person’s physical and mental functioning as well as medical conditions, medications, nutrition, and social support, Sedrak said. 

Another geriatric assessment was conducted 30 days after women finished chemotherapy and at established points during the study for women who were not having cancer treatment. Updated geriatric assessment guidelines were published by the American Society for Clinical Oncology (ASCO) in July of 2023, which the researchers consider to be critical for older adults facing treatment for breast or any other kind of cancer. 

“We know that there are significant survival advantages for patients who are evaluated with the geriatric assessment, which enables us to provide interventions to help prevent negative outcomes of cancer treatment,” William Tew, MD, clinical director of the Gynecologic Medical Oncology Service at Memorial Sloan Kettering Cancer Center in New York City, told Verywell.

The study also noted that given the expected rise in the number of older survivors with breast cancer—projected to reach more than six million by 2040—understanding the mechanisms of accelerated aging and finding ways to prevent it is critical.

Tew said doctors should discuss the risk of decline with patients and family members and let them know what can be done to help alleviate it. Two examples of interventions include physical therapy and encouraging movement to help reduce the risk of neuropathy, or nerve pain.

The research team is continuing their work by looking at the interaction between cancer treatment and the aging processes to identify “mechanisms that can be targeted by drugs to potentially reverse these processes,” Sedrak said.

What Else Can Make Cancer Treatment Manageable? 

Breast cancer treatment is quite individualized these days, and may not require chemotherapy at all. 

“A woman’s breast cancer may respond to a particular regimen which can make it harder to choose a less toxic therapy [than chemo],” Tew said. But depending on the type of cancer, radiation or other medication may be just as effective, which can help reduce physical decline.

A combination of physical, emotional, and social support can help keep older chemo patients in the best physical condition possible. Especially at an academic cancer center, your doctor is likely to refer you to specialists for social support and physical therapy of some kind. If they don’t, ask them about it, Liz Farrell, LICSW, lead social worker at the Dana-Farber Cancer Institute in Boston, told Verywell. She added that a medical center’s website should list a description of these types of services and a directory for accessing them.

Miranda Zinn, LMSW, a breast care helpline specialist at the Susan G. Komen Foundation, told Verywell she advises women diagnosed with breast cancer to ask if they have access to a social worker or navigator. This person can help them determine what support is available to them, including help with medical costs and transportation.

The researchers are committed to mitigating the physical decline that comes with chemotherapy treatment.

“There is a lot of work being done around the world on this topic, ranging from efforts to find chemotherapy agents that are tolerable to help with decision making around treatment,” study author Rachel Freedman, MD, MPH, founder and director of the Program for Older Adults with Breast Cancer at the Dana-Farber Cancer Institute, told Verywell. “We’re also exploring early interventions in those who are frail, test exercises in this population as a way to improve outcomes, and ways of making chemotherapy and other treatments more manageable. There is a lot of work being done as well to better understand who needs chemotherapy and who doesn’t.”