“Gina” is 36. She is married to “Logan,” 38, and is the mother of two sons, ages 12 and 8. Gina has been battling aggressive breast cancer for the past 2 years. Over the last 6 months, Gina’s tumors have become less responsive to increasingly intensive treatment. Last week, Gina, her oncologist, and Logan came to the decision that to pursue even more aggressive treatment had more risks than benefits. Gina has spent much of the past few months in bed, feeling too tired or nauseated to really be able to do anything with her sons. She doesn’t know how much time she has left, but she does know that she wants to be able to enjoy it and live it on her own terms.
Not everyone in Gina’s shoes would make the choice she did. Some people would continue aggressive treatment until they died, considering anything less to be giving up. The important point is that everyone gets to make that choice for themselves, and no one else has the right to criticize it or second-guess it.
How does one decide how to proceed when treatment doesn’t seem to be providing a benefit anymore? A number of factors come into consideration. First and foremost are the patient’s (and his or her support system, if there is one) and the oncologist’s views of what the endpoint is.
Some oncologists are very upfront with their patients and tell them early on that at a point in time where the toxicity of the treatment outweighs any potential benefit they will stop treatment. Other oncologists are less direct and will continue treatments as long as patients continue to come into their offices. What some people don’t realize in the latter situation is that they have the choice to stop going in for treatment. If they are feeling pressured by their oncologist to continue when they would rather stop, they need to speak up. Sadly, there are some physicians who have people keep coming in because the only way they can continue to bill them is if they have an office visit. Many people now know they can advocate for themselves and direct how they would like their health care to be delivered. However, there are still people who feel the physician has sole power in determining what care they should receive and how they should receive it.
The next factor to consider is what stopping active treatment of your cancer means to you. Many people think it means they are forgotten about; they are simply sent home to crawl into bed and die a painful death. This is not the case. Treatment does not stop; rather, the focus of treatment shifts to being more all-encompassing. All physical and emotional needs are dealt with. For Gina, it meant focusing on the quality of her life. The quality versus quantity of life debate is highly significant at this juncture. Often people are told they may have a few additional months to live if they continue treatment. The question then arises regarding what the quality of those months will be like, and does that make the time worth it? For many people, it doesn’t.
Lastly, stopping active treatment requires you to come face to face with the fact that your life is finite. Our society is profoundly death phobic, and most of us do our best to pretend we will never die. Yet, in reality, no one has beaten death yet. Some people come to this realization when they are diagnosed with cancer. They have already done a fair amount of work to prepare themselves emotionally and spiritually for this time. For others, this will be an extremely difficult fact to face, so much so that they refuse to believe it. And that’s okay. Everyone has to do things on their own terms. Not only is it not someone else’s job to change that person’s mind, it is not their place to try to do so.
You are braver than you believe, stronger than you seem, and smarter than you think.
–A. A. Milne
© Copyright 2012 GoodTherapy.org. All rights reserved. Permission to publish granted by Norma Lee, MA, MD, LMFT, therapist in Bellevue, Washington
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