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Deciding when not to treat cancer
Bob Riter
bob@ibca.net
Patients sometimes wonder but hesitate to ask, “What if I don’t
want to treat my cancer? Is that OK? Is that a reasonable thing to do?”
The answer is rarely simple and the ultimate decision is intensely personal,
but a few general comments may be helpful.
First, you have the absolute right to refuse to begin treatment or to stop treatment
once it’s underway.
Second, every treatment has an expected benefit (e.g., undergoing this chemotherapy
will improve your odds of survival by 13 percent), and an expected “cost”
(e.g., the chemotherapy will cause you to feel lousy and lose your hair).
We don’t always do it consciously, but we have to decide if the expected
benefits outweigh the expected costs.
What makes the calculations tricky is that the costs and benefits often involve
uncertainty. A specific treatment might be very effective for 30 percent of
people with your cancer, but we may not know if you’ll be in that 30 percent.
When first diagnosed with cancer, most people pursue treatment without giving
much thought to the possibility of not doing so. This generally makes sense
because this is when you have the greatest chance of a cure.
With some cancers, not treating - also known as watchful waiting – may
be the best course of action from the very beginning. An example of this is
slow growing prostate cancer in older men.
If cancer metastasizes or spreads, people often weigh the costs and benefits
in a more explicit manner. If a treatment will prolong your life for five years,
it’s one thing. If the treatment will prolong your life for five months,
it’s something else.
There is no right or wrong decision. It’s what you want.
Keep in mind that not all treatment is designed to cure or to extend life. Radiation
therapy, chemotherapy, and even surgery may be undertaken to reduce pain or
otherwise make your life more comfortable.
You always have the right to ask your doctors for information to help you with
these decisions. They can’t say with certainty how much benefit you’ll
receive from the next treatment, but they can offer guidance based on the patients that came before you.
I encourage people to talk with their family physicians as well. They may be
able to provide a helpful and balanced perspective.
If you’re depressed (which is common with cancer), please get treatment
for the depression before deciding to stop being treated for the cancer.
If you’re a family member or other loved one, please listen and support
rather than impose what you think is best or what you would
do.
An excellent resource is the Palliative Care Program of Hospicare and Palliative
Care Services (272-0212). Unlike hospice which is for the terminally ill, palliative
care is open to anyone with a life-threatening illness. One of its functions
is to help families and patients talk about these difficult issues.
If the possibility of stopping treatment is running through your head, share
those thoughts - even if they’re not fully formed - with your loved ones
and with your health care team. People often misinterpret symptoms and make
incorrect assumptions as to what others are thinking. It’s your decision
to make, but don’t make it alone.
From the Ithaca Journal, October 18, 2007
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