Hester Hill Schnipper 

Photo courtesy of Beth Israel Deaconess Medical Center

PEOPLE WHO ARE DIAGNOSED WITH CANCER must face their fair share of challenging decisions, whether choosing the right doctor or hospital, or considering the pros and cons of different treatments. Navigating these options can be especially challenging for patients living with metastatic disease who may not have an established standard-of-care treatment plan.

A painful reality for these patients is that metastatic cancer is very rarely curable. The goals of treatment, therefore, are for patients to live as long as possible and as well as possible during the months or years that follow their diagnosis.

With that in mind, it’s important for patients to explore the potential benefits and risks of treatments with their physicians. Here are some ways for people with advanced cancer to approach their treatment options:

1) Think carefully about what is important to you. Share your values and hopes with your doctor. You might, for example, want to tell your doctor about your wish to attend an important future event.

2) Consider getting a second and even a third opinion to explore all available avenues. Since there can be different treatment options for metastatic disease, having more than one recommendation may help crystallize which approach makes the most sense for you.

3) Consider the time and effort required for potential treatments in the context of your goals. The basic plan for patients with metastatic cancer is serial treatment. Although it may be possible to take treatment breaks, patients will cycle through each available option until the cancer starts to grow.

4) Explore clinical trials, but keep in mind that not all clinical trials lead to better treatment options. Experimental treatments may be less effective and more toxic than currently approved treatments.

5) Inquire about potential side effects of treatments. Some people accept nausea, fatigue, pain, hair loss or other side effects as a fair trade for possibly staying alive longer. Other people would rather not have these side effects.

6) Give your doctor permission to be frank about the data on the benefits of a suggested treatment. While none of us has a crystal ball, your doctor can focus on what is known about a drug to help you decide on next steps.

7) Ask your doctor about treatment costs and explore how much health insurance covers. A new, costlier drug may not necessarily be better than an existing, less costly one.

8) Hope for the best, but be pragmatic, including thinking about worst-case scenarios. Ultimately, there are no right and wrong answers, but having information can help you make the right choice for you. 

Hester Hill Schnipper, a licensed independent clinical social worker, is a breast cancer survivor who served as the manager of oncology social work at Beth Israel Deaconess Medical Center in Boston.