Making Decisions About Cancer Treatment

February 19, 2019

Taking the right steps can help patients handle the stress of cancer treatment selection.

The doctor-patient relationship has changed. In times past, patients dutifully followed doctors’ orders with few questions. Today, more patients are making medical decisions in partnership with their health care teams. It’s not easy, due in part to the ever-increasing number of treatment options available.

Questions to Ask

Before deciding on a treatment plan, it’s important to understand the expected benefits, side effects and risks of each option. Patients should take written questions to each appointment. Start with the following:

Would special tumor tests, imaging or a second opinion be helpful in establishing the diagnosis and making treatment decisions?

What is the goal of treatment? Is it curative, or will it extend life or help with symptoms?

What are the chances that the treatment will work?

How will doctors determine if a treatment is working?

If the treatment does not work, are there other options?

What are the potential risks and side effects of the treatment? How do side effects of this treatment compare with side effects of other treatments?

How will the treatment be given, how often and for how long?

Are there ways to prepare for treatment and decrease the chance of side effects?

Will daily activities be restricted in any way? Diet? Work? Exercise? Sexual activities?

Are there any clinical trials to consider?

How much will treatment cost? Will it be covered by insurance?

After treatment, what are the chances of being cured, in remission or relieved of symptoms?

For some people, the right choice is treatment with a goal of cure, as long as there is some chance that outcome is possible, and regardless of the risks and costs of treatment. For others, cure is not the best goal because the chance of achieving that outcome is low and the price (discomfort, travel, expense, risk of death or complications) is high.

Doctors can provide patients statistical data for each treatment option regarding chances of remission, cure rates, complications, side effects and mortality. They might be able to give some idea of what the treatment experience will be like. Survivors who have been through similar treatments can usually provide insight into what to expect, and doctors can refer patients who are willing to share their recollections and advice.

As patients weigh their options and discuss them with their doctors, they should consider these steps:

Know the options. Patients shouldn’t try to decide which choice is best at the time they receive their diagnosis—just identify as many options as possible, even if some seem far-fetched. Research indicates that most patients want complete medical information from doctors and to share the decision-making authority with them by creating a true partnership. Different doctors could recommend different chemotherapy combinations at various intervals or other combinations of chemotherapy, surgery and radiation. Then again, the best treatment might be no treatment. Patients who receive a diagnosis of a slow-growing cancer are often given the option of being closely monitored (“watchful waiting”) if there are no serious symptoms.

Learn the trade-offs. Once patients have a list of options, they should weigh the positives and negatives about each one. The goal is to know the risk versus the benefit of each option.

Discover the data. Patients should find out as much as they can about each option by talking with their doctors and doing research. For a crash course in any cancer, as well as news of cutting- edge treatments, visit cancer.org, cancer. net or cancer.gov.

Words of Wisdom

CURE asked survivors to offer their tips for patients who recently received a cancer diagnosis. Here are some of their suggestions:

  • Bring someone along to take notes at all appointments.
  • Learn how to evaluate websites and be wary of blogs.
  • Get a second opinion.
  • Consider a clinical trial.
  • Don’t be afraid to ask questions.
  • Stay active.
  • Be open to experimental options because new treatments and therapies are coming up all the time.
  • Ask for help and accept it when it is offered.
  • Join a support group.
  • Get counseling to cope.
  • Ask about long-term and late effects.
  • Make a treatment plan.

Be vigilant. Patients should make sure the resources they check are credible.

Consider the meaning. A medical decision can mean different things to different people. Patients should understand how a medical decision can affect their quality of life and how it will potentially impact their loved ones.

Act with confidence. It can be a tremendous relief for both patient and doctor once they settle on a treatment plan, but in the world of cancer, each decision carries a measure of uncertainty. Patients soon come to understand what oncologists have always known: The treatment might or might not be effective. But in all cases, it is important that patients follow through with their plan, knowing that they are making the wisest choice they can at that time.


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