Deciding about your treatment for advanced cancer
Some people like to know as much as possible before deciding on any course of treatment.
You can talk to your doctors and nurses about what treatments may be suitable, taking into account your own preferences and how treatment may affect you. This will help you decide on the best course of treatment together.
You may be offered surgery, radiotherapy, chemotherapy, hormonal therapies, biological therapies or a combination of treatments. The treatment that’s appropriate for you will depend on the type of cancer and where it is in your body.
The aim of treatment for advanced cancer is usually to try to control the cancer and help you live longer. It may also help improve your symptoms and quality of life. Controlling the cancer might mean shrinking the size of the tumour or stopping it from growing for a while.
Sometimes you may need to have a few treatments before you and your doctor can decide whether to continue with a full course. For example, if you’re having chemotherapy to control or shrink the cancer, you may have a scan after two or three treatment cycles. This gives you and your doctors more information about how helpful this particular treatment is. You can carry on with the course of treatment if the scan results show it’s working. If the results show the treatment isn’t helping, you and your doctor can talk about other treatment options.
However, there may be a time when the treatment has little effect on the cancer, and you may get the side effects of the treatment without any of the benefits. Making treatment decisions in these circumstances is always difficult, and you may want to talk about it carefully with your cancer specialist (oncologist), specialist nurse and family. If you decide not to have treatment, you will be given supportive (palliative) care, with medicines to control any symptoms.
You may be given general medicines to control pain or feeling sick (nausea). You might also be given cancer treatments to ease symptoms. For example, radiotherapy can help with pain as well as being a cancer treatment. If you choose not to have any cancer treatments, you’ll still be offered palliative care, such as painkillers.
Talking about treatment options
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It’s usually possible to take a bit of time to think about your treatment options. It can help to discuss it with your family and the doctors and nurses looking after you. Your cancer specialist will have the most information about treatments. In many hospitals, specialist nurses are available to talk to you about all the possible benefits and side effects of treatment.
Remember that treatment is for your benefit. It’s important to make the decision that feels right for you about which treatment, if any, you want to have.
It can be difficult to remember the questions you want to ask your doctor. It may help to make a list before your next appointment. Some people find it useful to record the discussion with their doctor (with their doctor’s permission). Recordings can also be helpful for family and friends to listen to, so that you don’t have to keep repeating information. Or you could take a family member or friend with you to your appointment. As well as giving support, they may be able to take notes for you, or remind you of any questions you want to ask.
Questions you could ask your specialist
What are my treatment options?
Is this treatment aimed at helping me live longer or controlling my symptoms?
How long will it be before I feel the benefit of any treatment?
What are the side effects?
Can I carry on working?
Will I need to stay in hospital and, if so, for how long?
Getting a second opinion
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Your multidisciplinary team (MDT) uses national treatment guidelines to decide on the most suitable treatment for you. Even so, you may want another medical opinion. If you feel it will be helpful, you can ask either your specialist or your GP to refer you to another specialist for a second opinion.
Getting a second opinion may delay the start of your treatment, so you and your doctor need to be confident that it will give you useful information. If you do go for a second opinion, it may be a good idea to take a relative or friend with you and have a list of questions ready. That way you can make sure your concerns are covered during the discussion.
Current treatments can be helpful for many people with advanced cancer. But cancer doctors are always looking for better ways of treating cancer and controlling its symptoms. One of the ways doctors do this is through cancer research trials, often called clinical trials. Trials help to improve knowledge about cancer and develop new treatments. Any new drug that’s developed will go through trials to check it’s safe and effective.
Taking part in a trial
You may be invited to take part in a clinical trial, and there can be many benefits to doing this. If you decide to take part, you will be carefully monitored during and after the study. It’s important to bear in mind that some treatments that look promising at first are often later found to be less effective than existing treatments. They may also have side effects that outweigh the benefits.
If you start taking part in a trial and then change your mind, you can leave the trial at any time. You may then be offered the standard treatment for your situation.
If you decide not to take part in a trial, your decision will be respected and you won’t have to give a reason. There will be no change in the way you’re treated by the hospital staff, and you’ll be offered the standard treatment for your situation.
Our section on clinical trials describes this type of treatment in more detail.
Complementary and alternative therapies
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Complementary therapies are most often used alongside conventional therapies such as chemotherapy and radiotherapy. They aren’t used to treat cancer, but they can play an important part in reducing anxiety and helping control symptoms.
The term alternative therapy is often used to refer to treatments that are used instead of conventional medical treatments. Some alternative therapists claim that their therapies can cure cancer even if conventional medicines haven’t been able to. But no alternative therapies have been proven to cure cancer or slow its growth. Unfortunately there have been cases where false claims made about alternative therapies have led patients to refuse conventional treatments that could have helped them.
Some alternative therapies may do no harm, but some can cause serious side effects and make people feel unwell. Many alternative therapies can also be expensive. If you decide to use an alternative therapy, it’s important to check it’s safe and to check the credentials of the therapist offering the treatment.
It’s important to tell your doctor if you’re using any complementary or alternative therapies. This is because some therapies may make conventional cancer treatments less effective or increase their side effects.
Asking about life expectancy (prognosis)
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For many people, the most important question to ask is, ‘How long will I live?’
Doctors can’t be certain what will happen to an individual person, so they may not be able to answer your questions fully. But they can usually give you some guidance based on the type of cancer and your situation. For example, how well the cancer responds to treatment and how quickly the cancer grows will affect how long you might live. Some people will live with their advanced cancer for a long time – sometimes years. For others, the cancer develops more quickly.
Because different things can affect how long you might live, your doctor’s guidance may change over time.
Talking to your doctor about this may be an ongoing discussion, rather than a one-off question. For some people it’s important to have an idea of how long they might live. Others prefer to focus on their quality of life, and choose to never ask the question.
Your medical team and your loved ones may wait for you to talk about life expectancy, or they may talk about it straight away. If you’re not comfortable discussing this, it's fine to say so. It’s important to do whatever feels best for you.
Who can give you information?
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It may be difficult to collect your thoughts during your hospital appointments, and you’ll probably think of lots of questions between appointments. You may have a specialist nurse who you can contact when you’re not at the hospital.
Our cancer support specialists can give you information and emotional support. People with cancer and their relatives sometimes find it helpful to talk to someone they don’t know and who isn’t emotionally involved in their situation.
David Plume explains the benefits and disadvantages of getting a second opinion about your treatment.