“We all know in our heads that nobody gets out of life alive, yet in our hearts, we retain the optimism that we might just be the first,” says Brian D. Madden, MD, medical director of palliative care at Providence Saint John’s Health Center in Santa Monica, CA. “The decision to stop treatment and accept this inevitability is when one loses that optimism. Beyond the obvious sadness this decision brings, I have also seen patients for whom it brought a sense of relief.”
If you are at a crossroads in your cancer treatment, you should know that the decision to stop treatment is yours alone. There are many valid reasons to make this choice.
Reasons to Stop Treatment
Cancer treatment is intense on purpose. Doctors use every tool they have to get rid of, or at least control, your cancer. But choosing to stop treatment isn’t the same as “giving up.”
“Deciding to stop treatment, when it may be causing more harm or suffering than good, is incredibly courageous,” says Philip A. Bialer, MD, a psychiatrist at Memorial Sloan Kettering (MSK) in New York City.
Some reasons why you might consider stopping include:
- Your cancer is advanced, and further treatment won’t make a big difference in how long you live.
- You’ve tried multiple treatments that haven’t worked.
- The risks or side effects of treatment outweigh the benefits.
If any of these apply to you, you may decide to focus on being comfortable and enjoying the time that you have.
Talk to Your Doctor
“First and foremost, if a patient is considering stopping their cancer treatment, they need to have a discussion with their primary oncologist,” Bialer says.
Some questions you can ask your doctor are:
- How is my cancer responding (or not responding) to my current treatment?
- What’s the outlook for my health if I go ahead with treatment?
- What do you predict will happen with my health if I stop?
- If I stop treatment, what can I expect, in terms of symptoms and quality of life?
- What is the treatment for my symptoms if I stop cancer treatment?
Your doctor’s answers to these questions may steer you in one direction or the other.
Making the Choice
As you think about what’s best for you:
Consider your state of mind. If you’re depressed, you may lose focus on your goals. Before you decide, speak to a counselor, ask your doctor about starting depression medication, or both.
Look at other options. Some people like to exhaust all possible avenues for treatment before they make up their mind. You may want to get a second opinion from another doctor or see if you can find a clinical trial that tests new treatments.
Get support. Seek counseling to talk through your thinking about this decision. You can ask a member of your care team for a referral to a counselor. You may also look for support from your religious organization or from a hospital chaplain. “For some, spiritual guidance may be helpful, especially when dealing with end-of-life issues,” says Bialer. Hospital chaplains talk to people of various religions and beliefs.
Realize this is your choice. Some loved ones may not want you to stop treatment. They may not be ready to let you go. Still, put yourself first. “Although this may be a difficult conversation to have, patients and their families should be talking about this, preferably earlier rather than later,” Bialer says.
If this topic brings up a lot of tension in your family, ask your doctor about an ethics consult. Many treatment centers have ethics experts who can help you and your family resolve these types of conflicts.
Keep an open mind. “This is not a contract — you can always change your mind,” says Jack Jacoub, MD, medical director of MemorialCare Cancer Institute at Orange Coast Medical Center in Fountain Valley, CA.
For instance, after you stop treatment, a new drug may come to the market, a clinical trial could open, or you may hear of a doctor who has a new way of treating the cancer you have. If so, you can always decide to start treatment again.
No matter what you choose, your health care team can provide emotional and physical comfort and care along the way.
“The most powerful moment is to see a family together with a courageous patient admitting they’re ready to pass on,” Madden says. “Rather than a failure, it’s accepted as simply the last step in the journey.”