Deciding on a cancer treatment is not a straightforward process. Cancer diagnoses – and treatment plans themselves – are complicated, often making it difficult for doctors to definitively pinpoint the one treatment that will bring the best outcome. Doctors usually end up presenting more than one treatment option, and then patients and families have to make decisions about which treatment plan to accept, such as whether or not to have a complicated surgery. There are times that a patient leans toward one treatment plan, but their partner thinks another plan would be best – as you can imagine, this can create a great deal of distress for everyone.
Steve was diagnosed with colon cancer at 65 years old, and because of the location of the cancer, his oncologist recommended chemotherapy first, followed by surgery to remove a large section of his intestine which would leave him with an ostomy bag for life. Steve and his wife both agreed to this treatment plan, but as he went through chemotherapy, Steve began to wonder if he made the best decision. During chemo he lost his appetite, his weight fell over 50 pounds, he suffered from extreme fatigue, and lost interest in playing the banjo which had been his favorite hobby. When it came time for the surgery, Steve decided he did not want it, which panicked his wife. She would say, “He needs this surgery to survive! I can’t take this, him talking about giving up and not fighting cancer! He is the most important person in the world to me!” Steve would respond with, “The doctors told us the surgery may help, but they did not say it would definitely cure me. And I don’t think my quality of life would be good after the surgery. This ostomy bag would be horrible.”
To help manage the distress about making the treatment decision, Steve and his wife met with the oncology social worker for several counseling sessions. Steve was able to talk through some of his depressive symptoms he was experiencing (loss of interest in his favorite hobby) and his wife was able to share her anxiety about her husband staying alive (having cancer in the first place). When they joined a support group, Steve learned from other patients who had had this type of colon cancer surgery that his quality of life would likely be fairly good after the operation (for instance, he could swim with an ostomy). His wife met other caregivers who validated her anxiety about letting loved ones make treatment decisions that would not necessarily be the one she would make if she was the patient. The other caregivers also encouraged Steve’s wife to join a weekly card game and luncheon in her neighborhood that became a great source of comfort to her and helped decrease her distress about Steve’s cancer treatment. After recovering his appetite post-chemo, and gaining back some weight, Steve decided to go ahead with the surgery. Because his depressive symptoms had been addressed, he was able to see that he could have a good quality of life after the surgery, and he was able to get back to playing the banjo. Steve’s wife recently video recorded a couple of his songs and shared them with the oncology team during surgical follow up visit. Steve got a standing ovation in clinic!
When you have cancer, there are many treatment decisions to be made, and the process is more difficult when patients and families disagree about the best treatment plan. Keep in mind the key points below to help you and your loved one get through the treatment as smoothly as possible:
- Everyone’s goal is to manage cancer and live as fully as possible for as long as possible.
- Depression and anxiety can effect treatment decision making, so these symptoms should be identified and treated in both patients and caregivers.
- Ask questions, but take time to listen too. Try to hear where the other person is coming from.
- Being a good caregiver requires self-care. Get outside, block time for sleep, let other people help with appointments and errands.
- Remember your hobbies (like Steve’s banjo). Life is happening now, even during cancer treatment. Try to grab little bits of pleasure as you are able.