When Cancer Looms, Consider Your Options

As the vast majority of family physicians do, I try to provide care that is oriented toward prevention as well as care for immediate concerns. Sometimes these well-intended efforts take my patients and me to what is new territory for the both of us.

Mrs. S. is one of my favorite patients. I look forward to her visits. She is funny, laughs at my corny jokes, and brings me Lifesavers. Over the last several years I have treated her emphysema, arthritis, and high blood pressure all in an effort to maintain as much independence as possible in order to effect a quality of life satisfactory to her. In so doing, after a normal breast exam, I ordered a routine screening mammogram in line with recommendations from recognized authorities. Although there is less certainty regarding the utility of mammography after the age 75, I followed my inclination to make a decision based on the vitality of her existence and not her chronological age or disease state.

Unfortunately, an area of “suspicion” (one of those code words physicians use to hedge while waiting for the definitive answer) was seen in one of her breasts. A biopsy followed that confirmed a small localized cancer was present. I consulted a surgeon colleague who recommended that her entire breast be removed, to be followed by irradiation. As she, her daughter and I processed that recommendation in concert with the surgeon’s desire to schedule the procedure, we decided to wait and look at other options that might be available.

The collective decision was made to get a second opinion with the intent to look at other treatment options. As there was no evidence that the cancer had spread beyond the breast, the surgery was cancelled while other alternatives were being pursued.

Her new consultant had significant experience in the care of patients with breast cancer, especially those situations where there was time to pursue a variety of treatment options. We all learned that the removal of her breast was not a necessity, that radiation alone might be sufficient, and that if she so chose, no immediate treatment was required.

I am offering this account on behalf of readers and their families who maybe struggling with a new cancer diagnosis. Despite the fear that strikes when the diagnosis of cancer is made, the situation calls for very careful and clear decision making. It is rare that a short delay in initiating treatment will result in any loss of life or increased harm inflicted by the cancer.

Here are some suggestions that may help you cope with a new cancer diagnosis:

1. Align yourself with a friend or family member who is willing to invest time and energy in helping you get the care you need. If you are an elderly person whose spouse is still alive, look for a child or friend to accompany you to the doctor’s office and with whom you can review the information available.
2. Unless absolutely necessary due to impending death or disability, avoid making abrupt treatment decisions. Take some time to let the initial shock subside. This is a journey that may take a long time to complete regardless of the outcome. Planning now is an investment in the quality of the time the disease will require to address.
3. Learn all you can about your cancer and share that information with your medical team. There is no question that informed patients and their families can play a meaningful role in the cancer care team.
4. Seek out a second opinion. Often this will affirm the recommendations made at the time of the initial diagnosis and increase your confidence in your team of cancer care givers.
5. Be on guard for unscrupulous individuals who provide treatments that are unfounded and usually coupled with a request for cash in advance.
6. Make an effort to assess your current quality of life and ask your doctor to propose the likely outcomes depending on the choices that you make with a realistic picture of the potential for a cure, life expectancy, and likely pain and suffering.
7. Lastly, when you make a decision, inform your dearest friends and family members so that they can prepare to help in whatever way will complement the plan you have mapped out, whether the most aggressive treatment approach possible to choosing only comfort care leaving the cancer alone to complete its course.

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