Does Age Affect Mesothelioma Treatment Options?
Treatment options for older adults with mesothelioma depend on several factors, including their mesothelioma cell type and how far the cancer has progressed. For systemic therapies such as chemotherapy and immunotherapy, doctors consider whether the cancer is epithelioid or sarcomatoid when recommending treatment. Some people may receive chemotherapy, immunotherapy or a combination of both.
When it comes to surgery, doctors consider age with other factors such as co-existing conditions like heart disease, medications taken regularly and how you may have reacted to anesthesia in the past. Your doctor will also perform a functional assessment for surgery that measures your body’s ability to handle the physical stress of an operation.
Survivor Susan D. spoke with us 12 years after her firsthand experience exploring her mesothelioma surgery options. She shared that when she was 72, specialists recommended against surgery because of her age, but she was determined. She met with leading peritoneal mesothelioma specialist Dr. Edward Levine who performed her cytoreductive surgery with HIPEC.
Physical fitness can vary widely among people of the same age. Lifestyle also plays a role. Exercise, nutrition and whether or not a patient smokes are factors. The availability of caregiving support during recovery also plays a role in treatment plans.
Mesothelioma Survivor Stays Active at 84 Years Old
Peritoneal mesothelioma survivor Susan D. underwent an intense 11-hour surgery at 72. At age 84 she spoke with us about meeting with doctors who told her they were against her having surgery because of her age. But Susan was determined to have the surgery and ensure her health post-surgery.
When Surgery May Not Be an Option
Doctors may not recommend major mesothelioma surgery for some older adults because these procedures are physically demanding and require someone to have enough overall fitness to tolerate the operation and recovery. Co-existing conditions, lung, heart and kidney function and other health factors all play a role in determining whether surgery is appropriate.
If your doctor determines surgery isn’t the right option for you, your treatment plan may include systemic therapies such as chemotherapy or immunotherapy. Palliative care can help manage pain and discomfort, and supportive care addresses quality of life holistically, including mental and emotional health.
Nonsurgical Treatment Options for Older Adults With Mesothelioma
Nonsurgical treatments for older adults with mesothelioma may include chemotherapy, immunotherapy, Tumor Treating Fields, radiation therapy and palliative care. These treatments may be used alone or in combination.
Some treatments focus on slowing or controlling cancer growth, while others focus on managing symptoms and supporting quality of life. Doctors consider the potential benefits and risks of each option when recommending treatment.
Treatment Options for Older Adults
| Treatment | What It Does | Why It’s Used for Nonsurgical Patients | Main Goal |
|---|---|---|---|
| Chemotherapy (dose-adjusted) | Destroys cancer cells, tailored specifically to the patient’s body and bloodwork to maximize effectiveness/minimize severe side effects | Doctors can lower doses for tolerability | Slow/control cancer |
| Immunotherapy | Boosts body’s natural defenses to fight cancer cells | Many patients tolerate it better than chemo | Slow/control cancer |
| Tumor Treating Fields | Disrupts the cell division process and prevents cancer growth by alternating electric fields on a tumor site | Noninvasive; FDA-approved for tumors that can’t be surgically removed | Slow tumor growth |
| Radiation | Targeted, high-energy beams damage the DNA of cancer cells to prevent them from growing/dividing | Targeted, symptom-focused | Symptom relief |
| Palliative Care | Specialized medical and emotional support to improve a patient’s quality of life, relieving symptoms and stress associated with mesothelioma | Any stage, paired with other treatments | Improve comfort and quality of life |
Chemotherapy (Dose-Adjusted for Older Adults)
Chemo is generally the first line of treatment for older adults with mesothelioma, and doctors can adjust doses to improve tolerability. Health care professionals typically prefer the chemo drug carboplatin rather than cisplatin for its usually milder side effects. Continued dose adjustment and monitoring with chemo for mesothelioma helps keep side effects manageable.
Immunotherapy
Immunotherapy can be a good option for older adults with mesothelioma because it’s often easier to tolerate than chemotherapy. Mesothelioma immunotherapy often uses checkpoint inhibitor drugs to help boost the immune system to fight cancer.
FDA-approved checkpoint inhibitors, including the immunotherapy drugs Opdivo (nivolumab) and Yervoy (ipilimumab), work differently from chemo. Chemo directly attacks and kills cancer cells, but it also attacks healthy cells in the process, often resulting in nausea, hair loss and a compromised immune system. Checkpoint inhibitors, however, block proteins that cancer cells use to shield themselves from the body’s immune system, making it a more targeted approach.
Tumor Treating Fields (Optune Lua)
Tumor Treating Fields, or Optune Lua, is an FDA-approved, noninvasive therapy for pleural mesothelioma that uses electric fields to slow tumor growth. In 2019, the FDA approved this wearable device in combination with chemotherapy for people with pleural mesothelioma tumors that doctors can’t surgically remove. In 2024, the FDA also approved Tumor Treating Fields for use with immunotherapy.
Radiation Therapy
Doctors mainly use radiation therapy for older adults with mesothelioma to control symptoms such as pain and shortness of breath, rather than to cure the cancer. Since a cure is seldom possible, this treatment focuses on keeping people comfortable instead. Modern techniques, including intensity-modulated radiation therapy, minimize damage to healthy tissue, helping reduce side effects.
Palliative and Supportive Care
Palliative care for mesothelioma provides relief from symptoms and improves quality of life. Health care professionals can use this type of supportive care, including pain management, fluid drainage and breathing support, with any other treatments at any stage. It isn’t just for end-of-life hospice care. It’s helpful paired with active treatment as well.
Multimodal (Combination) Nonsurgical Treatment
Many older adults with mesothelioma receive a combination of nonsurgical treatments. For example, doctors may pair chemo with immunotherapy or Tumor Treating Fields, tailoring treatments to the patient’s tolerance level. When surgery isn’t an ideal option, doctors focus on a patient’s individual fitness stage and goals to determine the sequence and combination of treatments.
Are Older Adults With Mesothelioma Undertreated?
Research shows that older adults with advanced malignant pleural mesothelioma may have low treatment rates and poor overall survival. A 2022 study in the journal Cancer Reports found that although most older patients received treatment consistent with guidelines, their outcomes highlighted the need for more effective treatment options for this population.
Access to care can also affect treatment decisions. Factors such as the cost of cancer care, insurance coverage, transportation and availability of specialists may create barriers to receiving recommended care. Research shows that cost can affect access to cancer screenings, even before a diagnosis, and cancer treatment costs can create additional challenges for people managing a diagnosis.
A mesothelioma specialist can help you understand your treatment options based on your diagnosis and individual circumstances. Seeking a second opinion may help you learn more about available approaches and connect with doctors who have experience treating mesothelioma.
How Families and Caregivers Can Help With Treatment Decisions
Families and caregivers can play an important role in supporting older adults diagnosed with mesothelioma. They can advocate for clear communication with the care team, ask questions about treatment options and help ensure the person’s preferences are part of the discussion.
Questions to Ask Your Oncologist
- Is age or fitness driving this recommendation?
- What is the goal of this treatment: control, comfort or cure?
- What are the side effects, and how will they affect daily life?
- Is a clinical trial an option?
- What is the recommended timeline?
A second opinion from a mesothelioma specialist can help people with mesothelioma better understand their diagnosis and treatment options. Because mesothelioma is rare, specialists may have experience with treatment approaches that a general oncologist may not regularly use. Our Patient Advocates can help connect you with mesothelioma specialists who can review your diagnosis and treatment options.
A primary care physician can help manage general health concerns, but they may not have experience with mesothelioma. Even a general oncologist may not have experience treating this rare cancer or using the latest mesothelioma therapies. A second opinion from a mesothelioma specialist can provide additional insight into your diagnosis and potential treatment options.
Survival and What to Expect
Survival for older adults with mesothelioma varies widely and depends more on overall health, cancer stage and cell type than on age alone. The average age for a mesothelioma diagnosis is between 71 and 75, and many treatments can extend and improve quality of life, even nonsurgical ones.
All people with mesothelioma and their families can benefit from support after receiving a mesothelioma diagnosis. Online mesothelioma support groups can offer flexibility and community for those living with a diagnosis.
Frequently Asked Questions
- What treatment options are available for older adults with mesothelioma who can’t have surgery?
-
People who aren’t able to have surgery can still receive treatments like chemo, immunotherapy, Tumor Treating Fields, radiation and palliative care. These nonsurgical treatments can meaningfully extend life and improve comfort.
- Can older adults survive mesothelioma?
-
Yes, some older adults with mesothelioma are long-term survivors. The Mesothelioma Center has worked with older adults who continue to share their stories with the mesothelioma community years after their diagnoses. Survival depends on several factors, particularly how well an individual responds to treatment.
- What is the best mesothelioma treatment for patients over 75?
-
The best mesothelioma treatment for an elderly patient is the one their body can handle while meeting their goals. Depending on the patient’s overall fitness levels, a mesothelioma specialist may recommend surgery, dose-adjusted chemotherapy, immunotherapy or a combination of treatments.
- Does age affect mesothelioma treatment options?
-
While age can certainly influence treatment choices, a patient’s physical performance and overall health matter much more than their age. Doctors use standardized performance scores to evaluate a patient’s fitness and determine which treatment options are best for them.
- Is immunotherapy safe for elderly people with mesothelioma?
-
Elderly people with mesothelioma often tolerate immunotherapy well, and it may cause fewer side effects than chemotherapy. However, this treatment path will still require monitoring and possible adjustments.
- What is palliative treatment for elderly mesothelioma patients?
-
Palliative care for mesothelioma helps relieve elderly people with mesothelioma of their symptoms, like pain and breathlessness, to improve their quality of life. Providers can use it in combination with any active treatment at any stage.
