Are You Sure You Want to Take Your Chances Without Treatment?

by Jane Ashley

What did you think when you first heard the words, “You have cancer”?

Our Loved Ones Decision

Shock, fear, anger, denial, overwhelmed – even Oh, no…WhatNext?

And for most of us, we wonder if they can treat what we have. Most of us want it cut out, zapped with radiation or killed by chemo – we want it gone – and most of us are willing to go the distance in the pursuit of a successful treatment.

But not everyone feels that way.

Some people might ask, “If I do treatments, how much time will I have left?” Depending on that answer, they may then ask, “Well, if I don’t have treatments, how much time will I have left?” No oncology professional is a fortuneteller – if they were, they would be a billionaire and be retired on some island in Paradise.

Virtually every study shows that having treatment prolongs our lives. Early stage cancer is most likely curable. Even if a person has a late stage cancer, many people have an increased lifespan and good quality of life. Even if the 5-year survival rate is only 10 percent, some people react by saying, “I might be one of those 10 percent!”

What to do if you or a loved one is considering “no treatment.”

Yet, some people choose to decline treatment.

When someone decides not to seek treatment, they should explain to their family and their doctor why they made that decision. They should also be certain that they understand themselves why they chose to decline treatment.

Cancer is a serious disease, one of the most serious diagnoses possible. It’s important to understand exactly why you made that decision should there have been a misunderstanding. Perhaps you didn’t understand all of your treatment options. Perhaps you didn’t understand that you really have a good chance of a cure or long period of remission.

Get Another Opinion

Since the decision not to pursue treatment is a life-altering decision (actually a life-or-death decision), any person contemplating forgoing treatment should seek a second and third opinion. Since their decision affects the lives of their family, this decision should not be reached lightly or in that brief period immediately after diagnosis. Find out your options by getting at least three opinions about treatment options. The reason to get three is that your first opinion may suggest one pathway … your second opinion may be 180 degrees opposite. The third opinion would be your tie-breaker.

However, ultimately, in the end, it is up to the person diagnosed with cancer to make the decision. Whatever their decision is, we, as loved ones, must support their decision and continue to love them.

Reasons that people give when they forgo treatment.

Quality of Life versus Projected Survival Time. Patients diagnosed with aggressive cancer and advised that chemotherapy might only give them a month or two longer may decide to refuse treatment. However, it might be possible that a targeted therapy or immunotherapy might offer relief of symptom pain without debilitating side effects. A patient and their caregiver need to be certain that they have asked enough questions.

Reasons To Refuse Treatment

I am always reminded of President Jimmy Carter’s diagnosis of a brain tumor, and he thought that he just had weeks to live. But his oncologist at Winship Cancer Institute at Emory University recommended trying the newly-available immunotherapy drug, Keytruda. Three years later, he is alive and thriving at 94.

Financial. Some newly-diagnosed cancer patients might not have health insurance and don’t want to “burden” their family with debts. There are many sources of financial help for the uninsured and the underinsured. Talk to the social worker at the cancer center or at the hospital, should you need expensive surgery.

Fear that it’s not cancer that kills, but the treatment. Don’t believe this myth. Compelling evidence for multiple reliable sources dispels this “old wives tale.”

Cancer survivors are pleased to witness to you that they are still here due to modern, medical intervention and not alternative remedies from clinics which insurance does not cover. The truth is that if this “clinic” offered potentially curative treatment, it would be covered by insurance. That’s a sure tip-off of a hoax, money-making scheme or “miracle cure.”

Religious. Jehovah's Witnesses don’t believe in blood transfusions – their religious belief would be in conflict with treatments (such as stem cell transplants) for many blood cancers. Christian Scientists refuse almost every medical treatment, trusting on prayer from their practitioners. Immigrants may have radically different beliefs based on their country of origin.

Some patients are well-educated and find deep meaning in life and have come to terms with the implications of refusing treatment. Perhaps, this unique subset of patients are those who require “patient-centered care.”

Options for a person with cancer who refuses treatment.

Eventually, untreated cancer will progress, that is, spread to other organs of the body. The person who has untreated cancer and their family will have to face this – what will they do about the pain and other physical side effects of end-stage cancer?

Supportive care, palliative care, and hospice care are options to help a patient remain comfortable. This care helps their family manage a difficult situation where their loved one might no longer be able to get up to go to the bathroom or no longer be able to eat or drink. Arranging for this care is the only option that most families have.

Some of these patients continue to see their trusted family physician and are at peace with their decision. Refusing treatment is difficult for both family members and physicians. It can be uncharted territory.

Social media rallied around a patient who refused treated – some of you may have followed her story on Facebook – Driving Miss Norma. Her situation was unique, and one that is impossible for most. She was 90 when diagnosed with Stage IV uterine cancer two days after the death of her husband of 67 years. She refused treatment. Her son and daughter-in-law offered that she could come live with them; the only catch was that they lived in an RV and traveled full-time. She immediately accepted. They visited 32 states and stayed in 75 different locations. She remained active until about a year after diagnosis. Hospice was called in, and she died peacefully about two months later.

Many people lack the financial resources and family members to be able to embark on a great adventure like Miss Norma was afforded.

For most people who decide to forego treatment, it’s best to make plans ahead of time to help with their late-stage cancer symptoms. There is no right-or-wrong decision because every person’s circumstances are different. In the end, it is our loved one’s decision, and we have to support their decision.

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