I'm Deborah, survivor of everything from multiple cancer battles to major business setbacks. Join my search for ways to move the mountains, big & small, that block your path to success.

Have cancer? Ask these questions

School Girl Raising Her Hand to Answer a Question

The only sad thing about surviving three cancer battles is that people think you’ve unlocked the mystery, discovered the secret that will keep them or their loved ones alive.

It doesn’t work that way.

Cancer is complicated. It exists in multiple forms, manifests in varied ways, grows in different patterns. Even if they’re the same type of cancer, our diseases may have nothing in common. The medical treatments used to fight my cancer may not be right for someone else’s, and treatments are changing daily. Besides, survival isn’t about making one right move. My formula also included a heavy dose of dogged determination and constant infusions of prayer.

So when people come to me asking for medical advice, my rule is to pass. I’m not qualified to give it, and I don’t want the responsibility. Struggling with my own decisions was enough.

But all rules have exceptions. Mrs. P was my exception.

She was in her late 80s when she was diagnosed with inoperable pancreatic cancer. Her doctor was pressuring her to begin an aggressive regimen of chemotherapy, but she wasn’t sure that was in her best interest. Her son was a friend of my parents and through them she asked if I’d stop by to discuss it with her. It was a request I couldn’t refuse.

While I couldn’t and wouldn’t tell Mrs. P what to do, I could tell her what questions to ask the next time she met with her doctor. They’re the same questions any cancer patient should ask when weighing the difficult decisions about treatment options:

• What is the purpose of this treatment? Many cancer patients assume that when a doctor starts talking about chemotherapy and radiation, the treatments are necessary to their survival. That’s not always the case. Often these treatments are given as “adjuvant” therapy—preventive measures to kill any lingering cancer cells that may or may not be left behind once the visible cancer has been surgically removed.

Yes, adjuvant therapy can save your life by decreasing the risk of a cancer recurrence. But it’s not always necessary and is more effective in preventing recurrences of some cancers than others. You should also be aware that some treatments do have significant and even dangerous side-effects. For instance, certain chemotherapy drugs are cardio toxic—they can cause permanent heart damage. So as you weigh your options, be sure to ask your doctor whether the treatments you’ll be taking are intended to kill cancer that can’t be surgically removed or whether they’re simply a post-surgical measure aimed at preventing a recurrence. And make sure you ask not only the short-term but also the long-term side-effects involved.

• What can I expect from this treatment?

This is the most important question you can ask. Sadly, many patients wrongly assume chemo or radiation treatments will permanently cure their cancer and make them well again. That’s probably not the case. When oncologists tell you “This drug has a 42 percent success rate,” they do not mean cure rate. Usually what they mean is that clinical trials found those taking the drug were 42 percent less likely to experience a recurrence of their cancer within a specified period. That period may be one year, two years, or at the most, five years.

Yes, there are drugs that can lead certain cancers to go into remission and the patients might never have to deal with them again. Yes, there are other drugs that can give patients extra quality years with their families that they otherwise wouldn’t have. But, the key is having a full understanding of the offer on the table so you can accurately weigh the cost versus benefit.

Mrs. P. had terminal pancreatic cancer. After asking this question, she discovered the chemotherapy could buy her a few extra months—perhaps another year. That’s all. But the toxicity of the aggressive treatment would make her violently ill and leave her bedridden during that extra time.

• What’s most important to me? Health problems have plagued me since long before my first cancer diagnosis, and I was 19 the first time I had to make back-to-back life-and-death medical decisions. A lot of hard things led to those decisions so when they came, I knew the stakes and was prepared. And as much as they may have wanted to step in and direct me, my parents held back when—in both cases—I opted for the more dangerous path. At the time, I took that support for granted. Today as I watch people grapple with family members for control of their own treatment decisions, I realize how extraordinarily brave and unselfish they were.

To me, the patient is the only person who can logically make a treatment decision because the patient is the only one who can answer the question: What’s most important to me?

Family members have one priority: to keep you alive. And sometimes that priority conflicts with what you want and need. You may want to fight for your life no matter the cost. You may want to die a peaceful death without having to endure the side-effects of aggressive medical treatment. You may want to focus on spending quality time with your family so you can leave them with good memories. You may want to take every precaution to decrease the odds of a cancer recurrence. You may want to forgo adjuvant therapy and take a natural path to healing. Yesterday I met a woman whose aunt suffered a cancer recurrence just after learning she was pregnant. She wanted to forgo treatment, trading her life in order to carry her child to term.

In my own cancer battles, I opted once for chemo and radiation, and twice against. During a debate about my discontinuing another adjuvant drug treatment, I finally closed the discussion by telling my doctor, “Look, God gave this body to me. I’m the one who has to make the decisions for it and I’m the one who’ll live or die by them.” It’s a good thing to remember when the cacophony of voices gets too loud while you’re trying to think about what you really want to do.

The celebration

After asking a few more questions, Mrs. P. learned her doctors expected her to succumb to the cancer—with or without treatment. In fact, given her age and physical frailty, aggressive chemotherapy could do her as much harm as the disease itself. So she opted against it. She was a spirited woman and spent her last months enjoying the company of her family and friends free from the side-effects she’d have suffered if she’d taken the other path. On her last night, her family threw a large celebration in honor of her 90th birthday. After a wonderful evening surrounded by loved ones, she died peacefully in her sleep.

May all our decisions turn out so well.

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