For most people, the word ‘cancer’ brings feelings of uncertainty about the future: what to do next, what to expect, what is the best medical treatment, and last (perhaps the most important) what will be the outcome? Learning as much as you can about your diagnosis and choices for treatment is the first step in taking control of a disease that is commonly viewed with a sense of apprehension and dread.
Many cancers today are curable. Most people want to try treatments that result in curing the disease and/or adding many good quality years to their life. At the same time, most people want to know what other options are available if a cure is not possible or realistic and things do not progress as well as they hope.
Option 1 – Curative Therapies.
Attempts at a cure may include surgery, chemotherapy (drugs), and/or radiotherapy (radiation). Your oncologist will give you information specific to your type of cancer which includes potential cure rates, possible side-effects of each treatment, average five-year rate of survival, etc.
It’s important to remember that anyone can stop treatments at any time for whatever reason, or if they find the side-effects unacceptable, and want to focus on only comfort. Your doctors will continue to offer support regardless of your choice.[Read the article “Questions about Taking Cancer Chemotherapy” available at the website comfortcarechoices.com; it suggests questions you may want to ask, so that you can make better decisions.]
Option 2 – Palliative Therapies.
To palliate means to ‘comfort’: emphasizing ‘care’ when a ‘cure’ is no longer possible. Drugs, surgery, or radiation are still available for cancers which may not be curable but where treatment may prolong life and make living more comfortable.
Even while taking curative therapies [Option 1], there are palliative practices which can help you better tolerate what are sometimes miserable treatments. Ask your doctor about this. [for additional information about Palliative Care practices, go to the website comfortcarechoices.com]
Option 3 – Comfort Care Only.
This means do nothing which may add pain or possible suffering to your life: take only those drugs or other therapies which improve your comfort. Although chemotherapy, surgery, or radiotherapy are not usually helpful, that’s not necessarily true for everyone.
How do you ensure you receive only comfort-focused care? Follow the “Goal-Focused” process outlined below. Your doctor can suggest available treatments and drugs, as well as a referral to hospice when the time is right.
What’s the difference between Palliative Care and Hospice?
Palliative Care helps patients with any ‘life-limiting disease’ [a disease which normally would cause a person to eventually die, such as Alzheimer’s, end-stage heart or lung disease, kidney failure, some cancers] to live comfortably as long as possible – soothing symptoms such as pain, shortness-of-breath, nausea. It can be provided even while attempted cures are being made (as in Option 1). Then, when death nears, it ensures that a person dies peacefully, with dignity.
Hospice is a palliative care program provided by a community agency during the last six months of life. It is a legally defined service [for Medicare and most insurers], making available all the care you need in your home to ensure that you die there comfortably. You must have a disease which is certified by two doctors as likely to cause your death within six months if the disease runs its usual course.
How do you decide which option is best at this time [or later]?
It helps to use the following Goal-Focused process when making decisions:
- List all your health problems and the prognosis (meaning what’s the likely outcome for the problem – cure, chronic state, or death) for each [ask your doctor and search on-line].
- Clarify what your overall goal is: (a) to live as long as possible, regardless of the pain or suffering; (b) to live as long as possible but only if you can be kept comfortable at the same time; (c) to live comfortably, and ignore how much time you have left [‘quality more than quantity’].
- Find out what treatment options are available for each of the problems you have and which ones will help you achieve your goals.
- Ask you doctor for his recommendation, based on your goals.
- You can always change your mind if your condition changes or your goals change.
Additional Reading Materials/References:
1. The website comfortcarechoices.com [organized by a local Palliative Medicine physician] has several articles about choosing the goals and the care that’s right for you [such as It’s Your Life: finding the right healthcare goal], prognosis for some conditions; as well as links to other reputable sources.
2. A good article, available at the comfortcarechoices.com website under “Treatment Options & Dilemmas”, was written by Dr. Thomas Edes in the Journal of the AMA, titled “Waging Peace in the War on Cancer”; he describes a friend of his with cancer who made a choice to focus on family and comfort after she had a recurrence of her cancer following chemotherapy.
3. Your oncologist will have several handouts specific to your disease.