How to Choose End of Life Care

From the WebMD Archives

Cancer doesn’t always get better even when you’ve tried a series of treatments. What’s the next step when your disease is advanced or when there isn’t a cure?

  • You might try to join a clinical trial. It’s a test of a treatment that’s under research. It might work for your illness when nothing else has.
  • You could get radiation or chemotherapy to shrink or slow down your cancer. This can help you live longer or feel better for a while.
  • You can choose therapy that improves your quality of life but doesn’t cure or treat your cancer.

Your choices depend on what’s most important to you. Your care should be tailored to your goals and needs, says Bryan McIver, MD, head of the Endocrine Oncology Program at Moffitt Cancer Center in Tampa, FL.

“Your personal wishes should be taken into account when decisions are made at any stage of cancer treatment, including late-stage,” he says.

Your oncologist, or cancer specialist, should be honest with you about the pros and cons of each treatment. We want to try to treat your disease in a way that has the least possible effect on your quality of life and does minimal harm to your body, McIver says.

Discuss Every Option

Even if there’s no cure for your cancer, you do have treatment choices. But treatments that may extend your life could also lower your quality of life.

“Some people may want to try therapy to drive their tumor into a stable state even though that’s not consistent with a focus on quality of life,” McIver says.

Radiation or medications that shrink or slow tumor growth are also called disease-directed therapies. “Balancing your priorities can be a challenge. It comes down to a question of: If we treat, what are the consequences, and if we don’t treat, what are those consequences?” he says.

Radiation to shrink a tumor in your neck may make it painful to swallow food, so you'd have to use a feeding tube to eat. “If I put a patient on any treatment, I’m very honest with them about what they’re facing so they understand the risks in clear terms,” McIver says.

No treatment is guaranteed to work. Even newer cancer therapies may offer a few more months, rather than years, of life. If a therapy is more likely to do more harm than good, your doctor may advise you to avoid it.

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Quality of Life vs. Longer Life

If your cancer is advanced, you can have treatment to improve the quality of life ahead of you, McIver says. This is called supportive or palliative care.

These options focus on relief of physical, spiritual, or psychological symptoms, says Judith Nelson, MD, chief of palliative medicine service at Memorial Sloan Kettering Cancer Center in New York City. You might take medications to treat nausea from drugs that shrink your tumor, or something to help you sleep better or ease depression.

You can get palliative care at any time, with or without cancer treatment. Your doctors and nurses can help you create a plan of care that balances the level of care with side effects you’re willing to put up with.

Think about your symptoms or possible drug side effects, and how they might affect the lifestyle you want to lead. “I call this living maximally. Be sure that you understand the potential benefits of any treatment, and if they outweigh the potential burdens,” Nelson says.

Clinical Trials

When no other treatments work for advanced, incurable cancer, the next step is almost always a clinical trial, McIver says.

Trials may offer free medications and intense care from a team of doctors and nurses, but you still might have to pay for lab tests or travel if the clinic isn’t where you live, he says. Let your doctor know any questions or concerns you have about the costs of any cancer treatment, or what your insurance will cover.

You aren’t alone if you worry that you and your family can’t afford the cancer treatments you want to try. High costs do affect how many people with cancer choose to treat their disease.

You’re Not Giving Up

Putting the focus on quality of life doesn’t mean you’ve lost a battle with cancer.

“You may fear palliative care if you associate it only with end-of-life care or giving up on treating your cancer. Living longer is important to many, if not most people with cancer. That’s how we’re wired. But we’re focused on living with the most quality, not just quantity,” Nelson says.

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Hospice is another option. It’s round-the-clock medical care and treatments to ease your pain, anxiety, and any symptoms you have until the end of your life. If your disease goes into remission at any point, you can stop or leave hospice care.

“In hospice or palliative care, you can also have treatments that delay your cancer’s progress even if your disease may not be curable,” McIver says.

When she talks about end-of-life treatment options with cancer patients, Nelson says, “I ask them, 'What should I know about you to take good care of you?’ It’s about your dignity. Your goals may be based on your faith, your children or family, or your career. Think about what gives you strength.”

WebMD Feature Reviewed by Neha Pathak, MD on October 23, 2017

Sources

SOURCES:

National Cancer Institute: “Coping With Advanced Cancer,” “Palliative Care in Cancer.”

Bryan McIver, MD, deputy physician-in-chief, Moffitt Cancer Center, Tampa, FL.

Journal of Clinical Oncology: “American Society of Clinical Oncology Statement: Toward Individualized Care for Patients With Advanced Cancer.”

Judith Nelson, MD, chief, Palliative Medicine Service, Memorial Sloan Kettering Cancer Center, New York City.

Journal of Oncology Practice: “Impact of the Cost of Cancer Treatment: An Internet-Based Survey.”

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