Chemotherapy is a powerful cancer treatment that uses drugs to destroy cancer cells. It can shrink a primary tumor, kill cancer cells that may have broken off the primary tumor, and stop cancer from spreading.
But it doesn’t work for everyone. Some types of cancer are more resistant to chemo than others, and others can become resistant to it over time.
Here are some signs that chemotherapy may not be working as well as expected:
- tumors aren’t shrinking
- new tumors keep forming
- cancer is spreading to new areas
- new or worsening symptoms
If chemotherapy is no longer effective against cancer or in minimizing symptoms, you might want to weigh your options. Choosing to stop chemotherapy is an important decision that should be carefully considered, but it’s a valid option.
Chemotherapy is usually given in cycles over a period of weeks, months, or even years. Your exact timeline will depend on the type of cancer you have, the kinds of chemotherapy drugs used, and how the cancer responds to those drugs.
Other factors that affect your personal timeline include:
- stage at diagnosis
- previous cancer treatments, as cancer often responds best the first time and some treatments are too harsh to be repeated
- other potential treatment options
- age and overall health, including other medical conditions
- how well you’re coping with side effects
Along the way, the timeline may have to be adjusted due to:
- low blood counts
- adverse effects to major organs
- severe side effects
Depending on your particular circumstances, chemotherapy may be given before, after, or in conjunction with other treatments, such as surgery, radiation therapy, and targeted therapies.
If you feel like chemo isn’t working for you, you might have other options. Not all cancers respond to these therapies, so they may not be a good fit for you. Be sure to discuss all the potential benefits and risks of other therapies with your healthcare provider.
Targeted therapies focus on specific changes in cancer cells that allow them to thrive.
These therapies, which aren’t yet available for all types of cancer, can:
- make it easier for your immune system to find cancer cells
- make it harder for cancer cells to divide, grow, and spread
- stop the formation of new blood vessels that help cancer grow
- directly destroy targeted cancer cells
- prevent cancer from accessing the hormones it needs to grow
Immunotherapies, also known as biological therapy, use the power of the immune system to fight cancer. These prompt the immune system to attack the cancer directly while others boost the immune system in general.
Types of immunotherapies include:
- adoptive cell transfer
- Bacillus Calmette-Guerin
- checkpoint inhibitors
- monoclonal antibodies
- treatment vaccines
Certain cancers, including some types of breast and prostate cancers, are fueled by hormones. Hormone therapy, also known as endocrine therapy, is used to block these hormones and starve the cancer.
High doses of radiation can destroy cancer cells. Radiation therapy isn’t a systemic treatment like chemo, but it can slow tumor growth or shrink tumors in a targeted area of your body, which can also relieve pain and other symptoms.
If you’re starting to wonder if chemotherapy is still the right option for you, it’s important to bring these concerns up to your healthcare provider. You’ll want their full attention, so make an appointment for this specific purpose.
Gather your thoughts in advance and make of list of questions. If you can, bring someone along to help with follow-up questions.
Starting the conversation
The following questions can help you start a conversation with your healthcare provider about whether chemo is still the right option for you:
- How advanced is the cancer? What’s my life expectancy with chemo and without chemo?
- What’s the best I can expect if I continue chemo? What is the goal?
- How do we know for sure if chemo is no longer working? What additional tests, if any, would help us make this decision?
- Should we switch to another chemo drug? If so, how long will it be before we know that one is working?
- Are there any other treatments I haven’t tried yet? If so, what are the potential benefits and harms of those treatments? What’s involved in getting the treatment?
- Am I a good fit for a clinical trial?
- If we’re getting to the end of my chemo options anyway, what happens if I just stop now?
- If I stop treatment, what are my next steps? What kinds of palliative care can I get?
Besides getting your doctor’s opinion, you’ll want to explore your own feelings, and maybe those of some loved ones.
Here are some things to think about:
- Are side effects of chemo — and treatment for those side effects — affecting your overall quality of life? Would quality of life improve or worsen if you were to stop chemo?
- Do you clearly understand the potential pros and cons of stopping chemo at this time?
- Do you plan on replacing chemo with other treatments or will you move toward quality-of-life treatment?
- Are you satisfied with your doctor’s recommendations or would you feel more confident if you got another opinion?
- How are your loved ones coping with this decision? Can they provide additional insights?
Maybe you have advanced cancer and have already exhausted all other treatment options. Maybe you have a type of cancer that doesn’t respond to certain therapies. Or, maybe you find your remaining options lacking in benefits, not worth the physical and emotional toll, or too disruptive to your quality of life.
According to the American Society of Clinical Oncology (ASCO), if you’ve had three different treatments and the cancer is still growing or spreading, more treatment isn’t likely to make you feel better or increase your lifespan.
Choosing to stop chemotherapy or other cancer treatment is a big decision, but it’s your decision to make. No one understands the reality of your life better than you do. So, consult with your doctor, talk to your loved ones, and give it a lot of careful thought — but make the choice that’s best for you.
Either way, it’s important to remember that the decision to stop chemo — or any therapy — isn’t giving up or giving in to cancer. It doesn’t make you a quitter. It’s a reasonable and perfectly valid choice.
Should you decide to stop undergoing treatment, you still have some options for care.
Palliative care is an approach that focuses on minimizing your symptoms and relieving stress. Keep in mind that you can have palliative care regardless of your stage of cancer or whether you’re in active cancer treatment.
A palliative care team focuses on easing symptoms and side effects so you can continue to do the things you enjoy for as long as possible.
In hospice care, the focus is on you as a whole person, not on the cancer. A hospice care team works to improve quality of life rather than length of life. You can continue to receive treatment for pain and other physical symptoms, but your emotional and spiritual needs can be addressed as well.
Hospice care doesn’t only help you — it can give caregivers a break and provide counseling for family and friends.
Some therapies that may be a helpful component of palliative or hospice care include:
- deep breathing and other relaxation techniques
- exercises like tai chi and yoga
- music therapy
If you’re wondering if it’s time to stop chemotherapy, there are several crucial things to consider. Among them are your oncologist’s recommendations, prognosis, and overall quality of life.
Think about what your next steps will be if you do stop, and how that will affect you and the people you love.
When it comes right down to it, it’s your decision.