Cancer treatment: How to be an active player in your treatment plan

By MayoClinic.com

You've just been diagnosed with cancer. Your mind is reeling. And now your doctor wants you to sort through the data and weigh in on a treatment plan.

As cancer research continues and more treatment options become available, it's true — your doctor will likely encourage you to become an active participant in the decision-making process.

But how do you decide upon a treatment plan? Explore your options and discuss them with your doctor. Working together is a good way to feel more in control of your disease and more comfortable as you move forward with your treatment.

Before you begin

Before exploring treatment options, establish some ground rules. You'll be more comfortable with any decisions you make if you:

• Decide how much you want to know. While most people want to know exactly what their treatment is and their survival chances, others don't. If you don't want to know all the details, let your doctor know, and you and your doctor can devise a strategy that's appropriate for you.

• Decide how you'll want to make your treatment decisions. You might want to gather all the information you can and take the lead in the decision-making process. Or you might want to turn all decisions over to your doctor. You might also be somewhere in the middle, sharing the decision process with your doctor.

• Have realistic expectations. Your doctor can give you estimates about what you can expect to get from each type of treatment. But what you do with these estimates is up to you. Exactly what side effects you may be willing to put up with will depend on what the benefits of the treatment are likely to be. Communicate your preferences with your doctor.

• Keep the focus on you. Don't let anyone pressure you into a particular treatment option. Pick what you feel most comfortable with.

• Accept help. You'll need support throughout your journey. Support can come from your doctor, your friends and your family. If you don't feel supported in your decision making, contact groups like the American Cancer Society, which can put you in contact with cancer survivors who can help support you through this process.

It might help to write down your expectations and preferences before you meet with your doctor. That might help you better express your hopes for and feelings about your cancer treatment.

Now, set your goals

What do you want out of treatment? A cure, stabilization or solely symptom relief? Deciding what you want out of treatment will help you narrow your treatment choices. Depending on your cancer type and stage, your goals for treatment might be:

• Cure. When you're first diagnosed, it's likely you'll be interested in treatments that cure cancer. When a cure is your goal, you may be willing to endure more short-term side effects in return for the chance at a cure.

• Control. If your cancer is at a later stage or if you've tried unsuccessful treatments, you might adjust your goal to controlling your cancer. Different treatments may attempt to temporarily shrink or stop your cancer from growing. If this is your goal, you might not be willing to endure the side effects of harsher treatments.

• Comfort. If you have an advanced stage cancer or one that hasn't responded to treatments, you might decide that comfort is most important to you. You and your doctor will work together to make sure you are free of pain and other symptoms.

Research your treatment options

To make a reasonable treatment decision, keep in mind the type of cancer you have, its stage, and what treatment options are available and how likely these treatments are to work under these circumstances. Talk to your doctor about Web sites, books and patient education materials to supplement your discussions.

The treatment you start with is known as primary therapy. Most people receive chemotherapy, radiation, surgery or a combination of the three as their primary therapy.

SurgerySurgery is used to remove a tumor, reduce the size of a tumor or control symptoms caused by a tumor. Surgery to remove a tumor is most helpful if your cancer is localized — meaning it hasn't spread to other parts of your body.

Chemotherapy

Rather than targeting one area of your body, chemotherapy is a systemic therapy — the drugs you take travel throughout your body, targeting and killing rapidly growing cells.

Radiation

Radiation most commonly treats one part of your body. It kills cancer cells by directing powerful X-rays at a tumor. Your doctor might recommend radiation to shrink a tumor or to prevent cancer from coming back once it's been surgically removed.

Other treatments

Although surgery, chemotherapy and radiation are the most common primary treatments, other types of treatment may apply to your situation. Hormone therapy is often used in cancers that are sensitive to hormone treatment, such as breast and prostate cancers. Some treatments are experimental and are only available through clinical trials — studies used to help researchers understand the safety and efficacy of new treatments.

Combining therapies

Cancer treatments are sometimes used in conjunction with each other. For example, it's common to pair surgery or radiation with chemotherapy. Combining treatments can:

• Help you prepare for primary treatment. Your doctor might recommend a treatment called neoadjuvant therapy to prepare you for your primary therapy. For example, your doctor might use chemotherapy or radiation to shrink a tumor to a more manageable size before surgery.

• Help ensure cancer hasn't spread. Adjuvant therapy is a treatment that comes after your primary treatment. It helps kill cancer cells that may have been left behind after your primary treatment — including undetectable cells that may have traveled elsewhere in your body.

• Help fight cancer side effects. Treatment that isn't used to cure cancer but to instead improve your quality of life is called palliative treatment. For example, surgery might be used to reduce the size of a tumor that's causing you symptoms, such as pain or trouble breathing. Or radiation can be used to treat the pain of cancer that has spread to the bone.

Analyze the benefits versus the risks

Compare the benefits and risks of the different cancer treatments to decide which treatments fall within your goals. Rate the treatments you're considering based on the pros and cons of each. Some aspects you'll want to consider for each treatment include:

• Side effects. Each treatment has its own set of side effects. Take time to review the side effects and decide whether they'll be worth enduring or too much to handle. Your doctor can give you a good idea of how common the various side effects are for each treatment. He or she can also explain options for managing side effects to make treatment more tolerable.

• How treatment affects your life. Will treatment mean a day off of work or several weeks off? How will your role in your family change? Will you need to travel far from home for your treatment? Look at how treatment will affect your everyday life.

• The financial costs of treatment. Investigate what types of treatment will be covered by your insurance provider. If a treatment or aspect of a treatment isn't covered, can you afford it? Call your insurance company if you're unsure.

• Your health in general. If you have other health conditions, ask your doctor how treatment will affect those conditions. For example, corticosteroids are commonly used in people with cancer. This could complicate diabetes treatment and affect your risk of cataracts, hypertension and osteoporosis.

Your personal values and goals will make a difference in what treatments are best for you. Only you can decide what type of treatment will fit best in your life. But don't feel as though you have to make a choice and stick with it — it's very possible that you may change your mind during treatment, and that's fine.

Communicate with your doctor

Effective communication with your doctor is the best way to make sure you're getting the information you need to make an salesrmed decision. To make communicating with your doctor easier, try to:

• Speak up when you don't understand. If you need further explanation or clarification, tell your doctor. If you don't speak up, your doctor may think you understand.

• Write your questions in advance. Appointments can be stressful and emotional. Don't expect yourself to remember all the questions you want to ask.

• Record your conversations. Whether you take detailed notes or bring a tape recorder, try to keep track of what your doctor tells you. This record will be a good reference if you have questions later.

• Bring someone with you. If you feel comfortable sharing your medical information with a friend or family member, bring along someone to take notes with you. Then you'll have another person you can talk through your treatment decisions with.

Don't expect you and your doctor to fully understand each other after one meeting — it may take a few conversations before you both feel as though you're on the same page.

Other things to keep in mind

As you're making your treatment decisions with your doctor, keep these points in mind:

• Take your time. Although a cancer diagnosis might make you feel you have to make immediate decisions to begin therapy, in most situations you have time to make choices. Ask your doctor how much time you have to decide so that you can weigh all aspects that go into such an important decision.

• You can always change your mind. Making a treatment decision now doesn't bind you to that option. Continue communicating with your doctor and tell him or her if you're having second thoughts. Significant side effects may make you want to change your treatment plan.

• You can seek a second opinion. Don't be afraid of offending your doctor if you wish to seek a second opinion. Most doctors understand the need for a second opinion when facing a major decision. Your doctor might even recommend a second opinion to help you gather more information to put your mind at ease.

• You don't have to be involved with treatment decisions. A cancer diagnosis can be overwhelming, and sorting through treatment information at a time like this may prove too much for you. If you would prefer, tell your doctor you'd rather not be involved in the decision-making process. You can always get involved later, when you feel more comfortable with the situation.

• You don't have to have treatment. Some people choose not to have treatment at all. People with very advanced cancers sometimes find they'd rather treat the pain and other side effects of their cancer so that they can make the best of the time they have remaining. If you choose not to be treated, you can always change your mind. Forgoing treatment doesn't mean you'll be left on your own — many ways of controlling side effects exist.

Making your decision

Which treatment is best for you? There's no 100 percent right or wrong answer. But being involved with your treatment plan may give you greater peace of mind and can let you focus your energy on what you need to do most — keep yourself healthy throughout your treatment.