Many factors are considered when it comes to your chemotherapy treatment plan. Your oncology team will think about which drugs to use and how many cycles of treatment are necessary. They’ll also consider the possible side effects of treatment and take into consideration any of your other health issues. Even with these considerations, chemotherapy isn’t always successful.
If your cancer recurs after curative treatment, or if your cancer is incurable at diagnosis, there will likely come a time when you need to make decisions about continuing your cancer treatment. Unfortunately, cancer biology differs from person to person and not everyone will benefit from chemotherapy to the same degree.
Sometimes you’ll hear your oncology provider talk about response rate. This refers to the percentage of people that will respond to a given chemotherapy regimen. For example, a 20 percent response rate means that if 100 people with the same cancer get the same treatment, then 20 percent will benefit from treatment.
In general, your oncologist will choose the chemotherapy regimen with the highest response rate first. This is called “first-line treatment.” You’ll continue this treatment until it’s no longer effectively treating your cancer or until the side effects are intolerable. At this point your oncologist may offer to start you on a new regimen called a “second-line treatment” plan.
If your oncologist suggests trying a second treatment plan, you may want to ask the following questions:
- What is the current status of the cancer? Has it spread since my first treatment?
- What are the odds that the second-line treatment will work better than the first?
- What is my prognosis currently and how will a new treatment change my overall prognosis?
- What are the possible side effects of this second course of treatment?
- What happens if I choose not to have the second treatment?
Sometimes, patients at this point in their cancer care need to make the difficult choice of declining to undergo a new line of cancer treatment. Talk over all the possibilities with your oncologist, other members of your treatment team, and your family so you can make the most informed decision.
At some point, ending your cancer treatment may be the best decision. Patients respond to this ultimate decision differently. While some feel relief that the pain and suffering of chemotherapy will be over, others may have guilt about giving up. Remember, though, that making the decision on whether to end treatment is your choice and your choice alone.
Ending chemotherapy treatment doesn’t mean that you’ll stop getting care. Rather than focusing on cancer treatment, the focus of your care will now be on treating your symptoms of cancer and giving you the best quality of life possible. At this point in your care, your team may suggest palliative and/or hospice care.
Palliative care is care that’s directed at symptom control and the psychosocial aspects of your cancer including physical symptoms, like pain or nausea, as well as your, emotional and spiritual needs. It ideally starts long before you stop your cancer directed treatment.
Hospice care is care that supports you after you stop cancer directed treatment and you no longer want or are unable to receive care at your treatment facility. Hospice care is encouraged when it’s predicted that you have about six months or less to live. Studies show that patients who receive hospice care have improved quality of life and sometimes live longer compared to those who don’t receive hospice care. Many patients who are nearing the end of life prefer to spend their final weeks to months surrounded by family and friends rather than in the hospital.
Hospice care can be given in your home, a hospital, or a private hospice facility. Most people choose to receive hospice at home. Nurses, doctors, social workers and spiritual guides work as a team to deliver hospice care. The focus isn’t just on the patient, but the entire family. The hospice team members will visit a few times during the week, but are available by phone 24/7. However, the majority of day-to-day care will be up to the family.
This may be difficult for people who live alone or those whose partners work away from home. Many cancer patients get through this time by depending on their support network of other family members and friends who take shifts around the clock so that someone is with you around the clock.
Some of the specific services provided by the hospice care team include:
- Pain management and symptom control
- Discussing and documenting end of life plans and wishes
- Family meetings and support services to keep everyone informed about your health
- Respite care that gives you time to stay in a hospital for a few days to give your caregivers at home time to rest
- Spiritual care that helps you say goodbye or plan a religious ceremony
Hospice care is paid for by Medicare, There are also organizations that provide free hospice care to patients in financial need who may not have insurance coverage.
Your oncologist, or another member of your treatment team, can help you find hospice facilities in your area. You and your family members can also do your own research with national organizations like the Hospice Foundation of America and Compassion & Choices.
Documenting Your Wishes
Before you become too sick, consider completing an advanced directive. This is a legal document that states how you want to be cared for at the end of life. Advanced directives also allow you to choose a person who can make decisions about your care if you're not able to decide for yourself.
Writing down your end-of-life wishes beforehand relieves your family of the pressure from guessing what type of care you want to receive. It can give them peace of mind at a time of grief. And it can also ensure that your wishes are respected and that you get the care you want at the end of your life.
In your advanced directive, you can include specifics like whether you want a feeding tube or intravenous fluids at the end of life. You can also say whether you want to be resuscitated with CPR or put on a ventilator if your heart stops beating.
It’s also a good idea to share your plan with your family once you’ve made your choices. Although it’s a difficult conversation to have with loved ones, an open and honest talk about your end-of-life will help everyone in the long run.
As for any tough decision you face during your battle with cancer, keep in mind that you’re not alone. Many people have been in the same place as you are now. Find a support group in your area or go online to chat with others who are coping with stopping their chemotherapy and planning end of life care.