Making Difficult Cancer Treatment Decisions: What Are Your Priorities?

For many patients, there may come a point where you need to make some difficult cancer treatment decisions. Depending on your case, you may have gone through multiple rounds of treatment, possibly including chemo, radiation, maybe even surgery, and your doctor will likely recommend something else if the previous treatments haven’t worked. 

But at that point, you may be wondering if you want to continue treating the cancer, or would you rather focus on making your remaining time as enjoyable as possible? 

This is one of the most important conversations you can have with yourself and your medical team. Yet for some reason, it doesn’t always happen. Not everyone is comfortable bringing these concerns to their medical team. But it’s so important to speak up about this if it’s on your mind. 

Understanding Cancer Treatment Decisions: Why Doctors Keep Treating

Oncologists are trained to treat your cancer. Their job is to offer you every possible option to fight the cancer, and they'll continue recommending treatments because that's their expertise and their mission. 

But it also means they may not be initiating conversations about what's actually important to you. They're not typically asking, "Do you want to continue aggressive treatment, even if it means months of side effects and recovery? Or would you prefer to focus on living as comfortably as possible for however much time you have left?" Instead, they’re recommending the next phase of treatment and proceeding as if you’re on board. 

It can be hard to speak up in this case, but remember that it’s your life and your body, so consider having the conversation if you can. 

Taking Control of Your Cancer Treatment Decisions: What Matters Most to You?

You may not actually know for sure how you feel about proceeding with treatment. You may have some sense that you’re uncertain about it, but you may feel definitively that it’s not for you. 

If you’re in this situation, you can ask yourself: What are my actual priorities right now?

They might be:

• Making it to a specific milestone (such as a grandchild's graduation, an anniversary, or a wedding)

• Spending quality time with people you love without the burden of treatment side effects

• Traveling, creating memories, doing things that bring you joy

• Simply feeling as good as possible, for however much time that is

There’s no “right” answer, but I encourage you to think about these things and really consider what your priorities are. Do the benefits of the treatment outweigh the effects? Or vice versa? 

A Real Story About Making Cancer Treatment Decisions

In his book Being Mortal, Dr. Atul Gawande shares the story of a woman with a complex case of stage 4 cancer. She wound up with a bowel obstruction and needed emergency surgery, or the obstruction would eventually kill her. The medical team was preparing for surgery as if it were an automatic yes for her—as if, of course, she would want to have the surgery.

But then when actually asked what she wanted, she shared that she really wanted to go to a wedding that was a few days later. If she had the surgery, she would have to miss the wedding and would be stuck in the hospital recovering for quite a while. And her cancer would still be there, regardless. 

So she chose to go to the wedding. She chose quality of life in that moment over the surgery. It was more important to her to spend the time she had doing something valuable to her–spending time with the people she loved. 

The Domino Effect of Complications

Another reality is that if you keep treating the cancer, complications will likely inevitably come. And with each complication, your medical team will offer solutions to treat them. You’ll be presented with more treatments, more interventions, or more procedures.

Take a patient with metastatic breast cancer, for example. The cancer has spread to her bones, which means she keeps having fractures. And each time, there’s a recommendation for another surgery or intervention. Each one more extreme than the last.  

At some point, it’s important to ask, when is enough, enough? Is quality of life the priority instead? 

How to Have This Conversation With Your Doctor

Be honest about your hesitations. If you're not comfortable with a recommended treatment, say so. Don't just go along with it because it's what your doctor is recommending.

Ask clarifying questions. Will this treatment cure my cancer, or extend my life? By how much? What are the side effects? How will this affect my quality of life during and after treatment? Is there an alternative approach?

Share your priorities. Tell your doctor what matters most to you right now. They can't factor that into their recommendations if they don't know.

Remember that you have a say. You're not being difficult or ungrateful by questioning treatment. You're being an active participant in your own care. I wrote all about how to speak up and advocate for yourself with your care team in this recent post.

Cancer Counselor

Doctors will always continue to treat your cancer because that's what they're trained to do.

But remember that at the end of the day, you get to decide what you want. If you want to prioritize your quality of life, or say no to treatment that doesn’t align with your values and priorities, that is okay. And that doesn’t always have to mean refusing all treatment, either–there may be alternative options.  

But most importantly, start by having the conversations with your doctor about what you actually want, and then make decisions together to honor that. 

If you're struggling with these decisions, or if you need support navigating these conversations with your medical team, I'm here to help. As a cancer counselor, I work with clients to understand their priorities, process the emotions that come with these choices, and feel good about the decisions they make.