Cancer treatment decisions: 5 steps to help you decide

You've just been diagnosed with cancer. Your mind is reeling and you feel overwhelmed. And now your doctor wants you to sort through cancer treatment options and help decide on a plan.

But how do you decide on a cancer treatment plan? Here are five steps to guide you in becoming a partner with your doctor in determining and guiding your cancer treatment.

Step 1: Set your ground rules

Before exploring treatment options, establish some ground rules. You'll be more comfortable with any cancer treatment decisions you make if you:

• Decide how much you want to know. While most people want to know exactly what their treatment is and their survival chances, others don't. If you don't want to know all the details, let your doctor know.

  Make sure you let your doctor know if you want someone else who might be able to help you during this difficult time to hear the news. Bring that person with you to your appointments.

• Decide how you want to make your treatment decisions. You might want to take the lead in the decision-making process. Or you might want to turn all decisions over to your doctor. You might also be somewhere in the middle, sharing the decision process with your doctor.

  It may help to think about how you've handled difficult decisions in the past. And it may help to have a close friend or family member at your appointments to help you decide.

• Have realistic expectations. Your doctor can give you estimates about what you can expect to get from each type of treatment. Exactly what side effects you may be willing to put up with will depend on what the benefits of the treatment are likely to be. Communicate your preferences with your doctor.
• Keep the focus on you. Don't let yourself be pressured into a particular treatment option. Take your time and choose the option that you feel most comfortable with.

• Accept help. You'll need support throughout your treatment. Support can come from your doctor, your friends and your family.

  If you don't feel supported in your decision-making, contact advocacy groups such as the American Cancer Society, which can put you in touch with cancer survivors who may be able to help you through this process.

It might help to write down your expectations and preferences before you meet with your doctor. That might help you better express your hopes for and feelings about your cancer treatment.

Step 2: Decide on a goal

Deciding what you want out of treatment can help you narrow your treatment choices. Are you hoping for a cure, stabilization or solely symptom relief?

Depending on your cancer type and stage, your goals for treatment might be:

• Cure. When you're first diagnosed, it's likely you'll be interested in treatments that cure cancer. When a cure is possible, you may be willing to endure more short-term side effects in return for the chance at a cure. Ask your doctor about your chances for a cure to help you understand more about your situation.
• Control. If your cancer is at a later stage or if previous treatments have been unsuccessful, you might adjust your goal to controlling your cancer. Different treatments may attempt to temporarily shrink your cancer or stop it from growing. If this is your goal, you might not be willing to endure the side effects of harsher treatments.
• Comfort. If you have an advanced stage of cancer or a cancer that hasn't responded to treatments, you might decide that comfort is most important to you. You and your doctor will work together to make sure you are free of pain and other symptoms. Services such as hospice care and palliative care might be helpful for you.

Step 3: Research your treatment options

To make a reasonable treatment decision, keep in mind the type of cancer you have, its stage, what treatment options are available and how likely these treatments are to work under these circumstances. Talk to your doctor about trustworthy websites, books and patient education materials to supplement your discussions.

Step 4: Analyze the benefits versus the risks

Compare the benefits and risks of the different cancer treatments to decide which treatments fall within your goals. Rate the treatments you're considering based on the pros and cons of each.

Some aspects you'll want to consider for each treatment include:

• Side effects. Take time to review the side effects of each treatment and decide whether they'll be worth enduring or too much to handle. Your doctor can give you a good idea of how common the various side effects are for each treatment and explain options for managing side effects to make treatment more tolerable.
• How treatment affects your life. Consider how treatment will affect your everyday life. How will you get to your treatments? How often will you need to go? Will you need a day off work or several weeks off? How will your role in your family change? Will you need to travel for your treatment?
• The financial costs of treatment. Investigate the costs of each treatment option. Will you be required to pay some of or all of the costs? Can you afford it? Are assistance programs available? The clinic or hospital where you receive care may have a business office that can answer some of these questions.
• Your health in general. If you have other health conditions, ask your doctor how treatment will affect those conditions.

Your personal values and goals will make a difference in what treatments are best for you. Only you can decide what type of treatment will fit best in your life. But you don't have to make a choice and stick with it. It's very possible that you may change your mind during treatment, and that's fine.

Step 5: Communicate with your doctor

Effective communication with your doctor is the best way to make sure you're getting the information you need to make an informed decision. To make communicating with your doctor easier, try to:

• Speak up when you don't understand. If you need further explanation or clarification, tell your doctor. If you don't speak up, your doctor may think you understand.
• Write your questions in advance. Appointments can be stressful and emotional. Don't expect to remember all the questions you want to ask. Make note of a few questions that are most important to you in case your time with your doctor is limited. Ask whether your doctor or clinic has an online portal where you can ask additional questions.
• Record your conversations. Try to keep track of what your doctor tells you by taking notes. You might also ask if it's OK to record the conversation. This record will be a good reference if you have questions later.
• Bring someone with you. If you feel comfortable sharing your medical information with a friend or family member, bring along someone to take notes. Then you'll have another person you can talk through your treatment decisions with.
• Keep copies of your medical records. Ask for copies of your medical records and bring them to each appointment.

Don't expect you and your doctor to fully understand each other after one meeting — it may take a few conversations before you both feel as if you're on the same page.

Other things to consider

As you're making your treatment decisions with your doctor, consider these points:

• Take your time. Although a cancer diagnosis might make you feel as if you have to make immediate decisions to begin therapy, in most situations you have time to make choices. Ask your doctor how much time you have to decide. Delaying your decision and spending time worrying about it can drain your energy, so don't draw out the process too long.
• You can always change your mind. Making a treatment decision now doesn't bind you to that option. Tell your doctor if you're having second thoughts. Significant side effects may make you want to change your treatment plan and that's OK.
• You can seek a second opinion. Don't be afraid of offending your doctor if you want to get a second opinion. Most doctors understand the need for a second opinion when facing a major decision.
• You don't have to be involved with treatment decisions. If you prefer, tell your doctor you'd rather not be involved in the decision-making process. You can always get involved later when you feel more comfortable with the situation. Let your doctor know who you want to make decisions about your care. Also make sure the designated person is aware of your decision.
• You don't have to have treatment. People with very advanced cancers sometimes find they'd rather treat the pain and other side effects of their cancer so that they can make the best of the time they have remaining. If you choose not to be treated, you can always change your mind. Forgoing treatment doesn't mean you'll be left on your own — many ways of controlling side effects exist.

Which treatment is best for you? There's no right or wrong answer. But being involved with your treatment plan may give you greater peace of mind and can let you focus your energy on what you need to do most — keeping yourself healthy throughout your treatment.