Goals Can Change

When diagnosed with cancer, many people assume that therapy will help, no matter the circumstances, and they pursue that therapy. Some people insist that they can be cured, even if they are told that cure is not possible.

While the patient believes one thing, for example that he or she can be cured or, perhaps, that he or she will die, the oncologist may see things very differently. The doctor may foresee cure because the cancer is very localized and the treatments are effective.  Or the doctor may see that the cancer is not curable because the disease is too extensive in the body, or the location of the cancer makes it untreatable, or the treatments themselves are not effective.  Often, patients, friends, and family will understand better what the combined effects of the disease and therapy are as time passes. If there are problems, however, it’s often difficult to distinguish if the disease or the therapy is causing them.  

There are many reasons why patients may accept therapy at first but think otherwise as the therapy continues. At first, the patient may not understand the risk(s) of therapy. With time, some patients may see that their disease is not curable, that the side effects are taking too great a toll on them, or both.   Sometimes, the patient, friends, and family will want to stick with the previously set plan to get better. Other patients, friends, and family may not; they may instead develop different goals and want to make different plans.

Ideally, the patient should be listened to. Patients may remain silent because they realize how dependent they are upon those around them. Even those around them may remain silent because they presume someone else will tell them if the patient’s therapy isn’t working. Some may not discuss these things with the patient for fear they’ll hurt the patient’s feelings.

What is the best way to approach this situation, which has the potential to lead to misguided therapy and anxiety for the patient? The patient has a few options.

He or she can bring up their concerns with family and friends. 

Usually, if that is done, the patient should talk with the oncologist first about what is occurring. What is the best scenario? What is the worst? Am I curable? What kinds of side effects can I expect      from any new therapy? What if I take no more active therapy, but set my highest goals on symptom control? A need to change chemotherapy is a chance to discuss overall goals.

The oncologist may use this opportunity to re-state the goals of care with the patient. Alternatively. the oncologist may speak with the individuals around the patient whose perceptions may differ from the patient’s. Some friends and family are resistant to less or no therapy. The oncologist may choose to call everyone together to restate the goals based on the newly recognized facts about the patient's disease.