Concerned about Abraxane + Gemzar at age 82: Hospice vs treatment?

I am a month from 77 and was diagnosed last September with stage 2B pancreatic cancer. Began gemzar and abraxane in early November, my infusion scheduled complicated by C. diff brought on by too many IV antibiotics given to fight an infection that a GI procedure caused. Finished the 6 infusions, 7 weeks off to prepare for surgery which was a Robotic Whipple. It removed the Pylorus, the Duodenum, gall bladder and of course the cancer which was not on an artery, just on the head of the Pancreas. 6 weeks later the same infusion regimen was accomplished with the final chemo today. My CA-Antigen has gone from about 2,000 to this mornings reading of 28. I rang the bell gladly with hope of moving forward. CT will give more info on August 21st. Any input appreciated, or any questions. I ended up with 5 occurences of C. diff, and then had a fecal implant, which to this point has been successful.

My husband is in his late 70s and has Stage 4 pancreatic cancer with mets to the liver. He started Gemzar and Abraxane in February 2026. In 5 months, his tumors shrunk by 50 percent. We are truly happy that he chose these chemo drugs. The Mayo doctor recommended these chemo drugs because they have fewer side effects and they are just as effective as Folfirinox. The side effect he has had is fatigue for several days after chemo. He had pain and nausea before chemo and none with chemo. He says he feels better on the chemo drugs than before he was diagnosed with cancer. My husband started losing his hair after the second chemo treatment, but he doesn't mind the loss. He, too, was told by other doctors to get his affairs in order and that he had 6 months or less to live. He, me and his children are extremely happy that he agreed to take the chemo treatments. It is giving us more time to do things, go places, and be together as a family. With minimal side effects, he is still able to get around and live life. If these chemo drugs stop working, the next option is the new oral pill, daraxonrasib.

@cfrench48 my met cancer is in stomach, lungs, duodenum. My CA19-9 is 179 and climbing rapidly. I have neuropathy in my feet now and it will get worse under abraxane gemzar. I am 82. Had a great deal of trouble with original chemo so not inclined to do it. You are lucky you are connected with Mayo. I would not have that option.

You don't have to decide that chemotherapy means “fight at any cost,” or that hospice means “give up.” A very reasonable third option is excellent symptom control now, a carefully modified trial of treatment if you want it, and a predetermined point at which you stop if treatment is making your remaining time worse rather than better.

@mcharlesfrancis
That is true but the side effects of the chemo, increasing neuropathy, fatigue will happen immediately and worsen with cumulative time. Also oncology will deal with nausea but not the other symptoms. Can’t do both hospice and chemo. Not allowed. And when chemo stops working I’m back where I am now. Just don’t want to fight a loosing battle. I appreciate your comments.

Gemcitabine plus Abraxane can sometimes shrink pancreatic cancer and relieve symptoms caused by the cancer, but it can also cause fatigue, low blood counts, infection risk, nausea, appetite loss, neuropathy and weakness.

If you are already in significant discomfort, I think the important question isn't simply, “Can I tolerate chemotherapy?” It is, “What is the realistic chance this treatment will make me feel better or give me meaningful additional time, and how likely is it to make me feel worse?”

I would ask your oncologist very directly:

“For someone in my condition, what are the realistic chances that this treatment will shrink the cancer and improve how I feel? How much additional time might it give me, and what would you recommend if maintaining my quality of life is my highest priority?”

You could also ask whether starting with a reduced dose or modified schedule would be reasonable. Another possibility is agreeing with your oncologist to try treatment for a short period and reassessing. Starting chemotherapy doesn't mean you are committed to continuing it if the side effects become unacceptable or it isn't helping.

I would also consider getting a second opinion from a pancreatic cancer specialist before making an irreversible decision, particularly if you haven't already done so. Being told that a cancer is incurable doesn't necessarily mean there are no treatments capable of controlling it for a meaningful period of time.