Quantity Versus Quality of Life: Why the Difficult Cancer Conversations Matter

A few weeks back, Alex Trebek made news when an excerpt from his then-upcoming book was released. Trebek was quoted as saying that if the treatment he was receiving at the time of writing failed, he would discontinue his care. Trebek noted that while his family had struggled with his decision, they had come to understand his choice. He shared that had he made that choice he would have done so for a better quality of life rather than focusing on the quantity of time.

Trebek later clarified that he was not in a good frame of mind when he wrote that portion of his book and that he was happy to report that his treatments were working, and he was doing better than when that passage was written. While challenging, Trebek’s original comments are a part of a larger conversation that I feel is important for those battling cancer. Be it incurable cancer or treatable cancers.

Ideally, when it comes to cancer, we hope that everybody diagnosed will one day gain a cure. Unfortunately, not all cancers are curable, and cancer remains deadly for so many. For those facing treatments that are no longer showing success or benefit and those who suffer complications that hinder their quality of life, discontinuing treatment should be a conversation. Albeit challenging, it must be discussed.

Trebek talked about these things with his family, and they were understanding and eventually supportive of his initial decision. While that was his experience, that is not always the case for all patients with cancer. It can be difficult for those closest to the patient to comprehend how they came to that decision. Some may view it as "giving up" or "quitting," when in truth, that is not what is happening. To make that choice, one has to come to an innate acceptance and understanding of the harsh reality they face.

When my sister was sickest, I was lucky to have her care team guide me in making seemingly impossible choices. There were numerous times that I did talk with her clinicians about discontinuing care. She was so young, and losing her to cancer was hard enough, harder even to think about losing her before the age of 30. At times though, her quality of life just was not there. She spent her time in clinics, receiving treatments that were not helping her but causing complications. She was rarely home, and with the prospect of her dying anyway, continuing care seemed like the wrong choice. There was a time when we stopped for a bit, and I took her on a trip so that she could get away and live while I contemplated what was next.

Like every patient with cancer, these choices should be made with your doctors and those you are closest to. I appreciate Trebek’s openness because he presented discontinuing care as an option and highlighted the emotions and complexities honestly associated with that choice. More than anything, I hope that Trebek sharing starts a much-needed dialogue within the cancer community regarding the equal importance of weighing the quality of life to the quantity of life that a patient is fighting for.

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