Your cancer treatment involves many complex decisions. Perhaps the most difficult thing is to stop.
“We all know in our heads that no one comes out of life alive, but in our hearts we keep the optimism that we could be the first,” says Brian D. Madden, MD, medical director of palliative care at Providence Saint John’s. Health Center in Santa Monica, California. “The decision to stop treatment and accept this inevitability is when you lose that optimism. Beyond the obvious sadness that this decision brings, I have also seen patients for whom it has brought relief.
If you are at a crossroads in your cancer treatment, know that the decision to stop treatment is up to you. There are many valid reasons for making this choice.
Reasons for stopping treatment
Cancer treatment is intentionally intense. Doctors are using every tool at their disposal to get rid of your cancer, or at least control it. But choosing to stop treatment is not the same as “giving up”.
“Deciding to stop treatment, when it may cause more harm or suffering than good, is incredibly courageous,” says Philip A. Bialer, MD, psychiatrist at Memorial Sloan Kettering (MSK) in New York City.
Here are some reasons why you might consider quitting:
- Your cancer is at an advanced stage and additional treatment won’t make a big difference in the length of your life.
- You have tried several treatments which did not work.
- The risks or side effects of treatment outweigh the benefits.
If any of these situations apply to you, you may decide to focus on your comfort and make the most of the time you have available.
Talk to your doctor
“First and foremost, if a patient is considering stopping their cancer treatment, they should have a discussion with their primary oncologist,” Bialer says.
Some questions you can ask your doctor are:
- How is my cancer responding (or not responding) to my current treatment?
- What is the outlook for my health if I continue the treatment?
- What do you think will happen to my health if I stop?
- If I stop treatment, what can I expect in terms of symptoms and quality of life?
- What is the treatment for my symptoms if I stop the cancer treatment?
Your doctor’s answers to these questions may point you one way or the other.
To make a choice
As you think about what’s best for you:
Consider your state of mind. If you are depressed, you may lose your focus on your goals. Before you decide, talk to a counselor, ask your doctor to start treatment for depression, or both.
Look at other options. Some people like to exhaust all possible treatment options before making a decision. You may want to get a second opinion from another doctor or see if you can find a clinical trial that is testing new treatments.
Acquire help. Look for tips to talk about your thinking about this decision. You can ask a member of your healthcare team to refer you to a counselor. You can also seek support from your religious organization or a hospital chaplain. “For some, spiritual counseling can be helpful, especially when dealing with end-of-life issues,” Bialer says. Hospital chaplains speak to people of various religions and beliefs.
Realize that it is your choice. Some relatives may not want you to stop treatment. They may not be ready to let you go. Yet put yourself first. “While this conversation can be difficult to have, patients and their families should talk about it, preferably sooner rather than later,” Bialer says.
If this topic is causing a lot of tension in your family, ask your doctor for an ethics consultation. Many treatment centers have ethics experts who can help you and your family resolve these types of conflicts.
Keep an open mind. “It’s not a contract – you can always change your mind,” says Jack Jacoub, MD, medical director of MemorialCare Cancer Institute at Orange Coast Medical Center in Fountain Valley, Calif.
For example, after stopping treatment, a new drug may come on the market, a clinical trial may open, or you may hear from a doctor who has a new way of treating the cancer you have. If this is the case, you can always decide to start the treatment again.
No matter what you choose, your healthcare team can provide emotional and physical comfort and care along the way.
“The most momentous moment is seeing a family with a brave patient admit they are ready to die,” says Madden. “Rather than failure, it is accepted as simply the last leg of the journey.”
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