Choices for Care When Treatment May Not Be an Option
When dealing with advanced cancer, patients have different goals for their care. These goals may change over time. Some patients want to keep trying aggressive treatments. Others decide to choose other paths for care, such as controlling the symptoms of the disease. You may wonder: "Have we done everything possible to treat the cancer, or should we try another treatment?"
Decisions for care are very personal and it's natural to want to do all you can. But you should weigh these feelings against the risks and benefits of available treatments as well as your own feelings about life and death. You should ask all the questions you need to. If you choose not to go through active cancer treatment, you will continue to receive care and be made comfortable.
There’s a part of me that wants to keep fighting and try a clinical trial; the other part wants to stop fighting. I’m just so tired of it all. Yet I can’t help but wonder if there are other options.
Palliative care is care that makes patients feel better but doesn't treat the disease itself. Palliative care should begin when the cancer is diagnosed. It continues through treatment and beyond. Research shows that palliative care improves the quality of life of patients and family members. All patients have a right to comfort and quality of life throughout their care.
Palliative care is especially important if you choose to stop treating your cancer. It includes:
- Treating or preventing cancer symptoms and the side effects caused by treatment
- Getting help with emotional and spiritual problems
- Addressing the practical concerns of patients and families
Palliative treatment: Many of the same methods that are used to treat cancer, such as medicines and certain treatments, can also be used to reduce pain or other symptoms, and help a patient feel more comfortable. In advanced cancer, palliative treatment may be given to help a person feel better, even if it isn't intended to treat the cancer. For example, doctors may give chemotherapy to slow the growth of a tumor that is causing pain. Or surgery may be performed to remove a mass that is pressing on certain nerves and causing pain.
To receive palliative care, members of your health care team may be able to help. However a palliative care specialist may be the best person to treat problems. Ask your doctor or nurse if there is a specialist you can see.
For more about palliative care, see the NCI fact sheet Palliative Care.
We have to let patients and their family members truly understand that if they choose not to do chemo or some other aggressive therapy, there are other options where they will receive support, comfort care, and assistance from the health care team.
I wish I’d found out earlier about hospice care. But you don’t know what you need at the beginning. And I didn’t realize they could help me sooner rather than later.
Hospice is a special type of care in which medical, psychological, and spiritual support are given to patients and their loved ones when cancer therapies can no longer control the disease. The goal of hospice is to help you live each day to the fullest by making you as comfortable and as symptom-free as possible. Choosing hospice care doesn't mean that you've given up. It means that the treatment goals are different at this point. It also doesn't mean that you, your family, or your health care team are giving up hope. Instead, hospice care means you are changing what you hope for.
Hospice care most often takes place at home, but it can also be provided in special in-patient facilities, hospitals, and nursing homes. It can also take place along with professional home care if necessary. Hospice services may include:
- Doctor and nursing services
- Medical supplies and equipment
- Drugs for managing cancer-related symptoms and pain
- Short-term inpatient care
- Volunteers to give caregivers a break
- Counseling and spiritual care
- Social work services
- Grief counseling and support
Hospice professionals and volunteers are specially trained. They are dedicated to supporting the emotional needs of both patients and their families, and are trained to deal with medical symptoms. The goal of hospice care is to neither hasten nor postpone death. If your condition improves or the cancer goes into remission, hospice care can be stopped and active treatment may resume.
Hospice can provide support for months. Even though many people believe that hospice is only available in the last days or weeks of life, it can provide support for months. Many people have said that they wished hospice care had begun earlier. They were surprised by the expert care and understanding that they got from hospice caregivers.
Medicare, Medicaid, and most private insurance companies cover hospice services. Medicare will cover hospice care for people with a life expectancy of 6 months or less. But you can still get hospice care after 6 months with a doctor’s approval. To learn more, call the National Hospice and Palliative Care Organization at 1-800-658-8898. Or visit their website to find a hospice program in your community.
Patients with advanced cancer may be offered the option to participate in early-phase clinical trials. These trials are designed to look at the safety of a new treatment and to identify the best dose.
The chance that the new treatment will benefit a patient in such a trial is low, but some patients join these trials because they have hope that the treatment may help slow the growth of their cancer. Another reason may be that they want to benefit future patients by taking part in a trial.
Clinical trials have both benefits and risks. Your doctor and the study doctors should fully explain these before you decide to join a trial.
To learn more about clinical trials, see Learn About Clinical Trials.
To find a trial that you might be eligible for, see Find a Clinical Trial.