When Cancer Returns : Treatment Choices

by National Cancer Institute

(Page 2 of 7)

There are many treatment choices for recurrent cancer. Your treatment will depend partly on the type of cancer and the treatment you had before. It will also depend on where the cancer has recurred. For example:

A local recurrence may be best treated by surgery or radiation therapy. This means that the doctor removes the tumor or destroys it with radiation.

A distant recurrence may need chemotherapy, biological therapy, or radiation therapy.

It's important to ask your doctor questions about all your treatment choices. You may want to get a second opinion as well. You may also want to ask whether a clinical trial is an option for you.

Should I Get A Second Opinion?

Some patients worry that doctors will be offended if they ask for a second opinion. Usually the opposite is true. Most doctors welcome a second opinion. And many health insurance companies will pay for them.

If you get a second opinion, the doctor may agree with your first doctor's treatment plan. Or the second doctor may suggest another approach. Either way, you have more information and perhaps a greater sense of control. You can feel more confident about the decisions you make, knowing that you've looked at your options.

Clinical Trials

Treatment clinical trials are research studies that try to find better ways to treat cancer. Every day, cancer researchers learn more about treatment options from clinical trials.

Each study has rules about who can take part. These rules include the person's age and type of cancer. They also cover earlier treatments and where the cancer has returned.

Clinical trials have both benefits and risks. Your doctor should tell you about them before you make any decisions about taking part.

There are different phases of clinical trials. They include:

Phase I trials test what dose of a treatment is safe and how it should be given.

Phase II trials discover how cancer responds to a new drug or treatment.

Phase III trials compare an accepted cancer treatment (standard treatment) with a new treatment that researchers hope is better.

Taking part in a clinical trial could help you and others who get cancer in the future. But insurance and managed care plans do not always cover the costs. What they cover varies by plan and by study. If you want to learn more about clinical trials, talk with your health care team.

Questions to Ask Your Doctor or Nurse About Treatment Choices

Decide on the most important things you need to ask your doctor or nurse. Some ideas:

• What are my treatment choices?
• Which do you suggest for me?
• How is this treatment the same as or different from my last treatment?
• How successful is the treatment you recommend? Why is it best for me?
• Will I still be able to do things I enjoy with the treatment? Without the treatment?
• How long will I be on this treatment?
• Will I have side effects? If so, how long will they last?
• How can I manage the side effects?
• Will I have to stay in the hospital?
• Is a clinical trial available to me?
• Will I have to pay any costs in a clinical trial?
• If the treatment doesn't work, then what will I do?

Making Your Wishes Known

When cancer returns, the treatment goals may change, or they may be the same as they were for your first cancer. But for many people, it's the second cancer diagnosis that finally prompts them to make their wishes known. Although it can be tough to think about, and maybe even tougher to talk about, having recurrent cancer may prompt you to make certain decisions about what you want done for you if you are unable to speak for yourself.

Everyone should make a will and talk about end-of-life choices with loved ones. This is one of the most important things you can do. Also, think about giving someone you trust some rights to make medical decisions for you. You give these rights through legal documents called advance directives. These papers tell your loved ones and doctors what to do if you can't tell them yourself. They let you decide ahead of time how you want to be treated. These papers may include a living will and a durable power of attorney for health care. Setting up an advance directive is not the same as giving up. Making such decisions at this time keeps you in control. You are making your wishes known for all to follow. This can help you worry less about the future and live each day to the fullest.

It's hard to talk about these issues. But it often comforts family members to know what you want. And it saves them from having to bring up the subject themselves. You may also gain peace of mind. You are making these hard choices for yourself instead of leaving them to your loved ones.

Make copies of your advance directives. Give them to your family members, your health care team, and your hospital medical records department. That way, everyone will know your decisions.

About the Author

www.nci.nih.gov
The National Cancer Institute's research programs are extensive and contain many innovative initiatives. I invite you to explore our Web site to find out more about the exciting work being conducted here at NCI and by NCI-supported scientists throughout the country.