The conversation you should have with your doctor if you have metastatic cancer

Tuesday, April 30, 2013

By: Erik Johnson, MD

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A cancer diagnosis is extremely shocking news, but it is even more difficult when the cancer has come back after you thought it was gone, or if it spread somewhere else. When it spreads, it is called "metastatic," because it is no longer in the organ that it started in. Most cancers spread in the blood stream, but they can also grow into organs around the site of the original tumor. When someone has cancer in other areas of the body, the usual treatment is chemotherapy. We use drugs that go throughout the bloodstream (intravenous chemotherapy), because we want the medicine to circulate throughout the body and kill any cancer cells that may be present in all areas of the body. When someone receives all of this shocking news, it is very difficult to be able to think about all the questions one may have.



There was a recent research study in a very well respected medical journal where the authors polled patients who had metastatic colon cancer or lung cancer, and they asked them about what they expected the chemotherapy to do. Most people expected that the drugs would work completely and that they would be cancer-free, or completely cured of their disease.


Unfortunately, the reality of cancer treatment is that most people really never become fully cancer free. The chemotherapy slows down the growth of the cancer, but the patient still has cancer, and it usually comes back at some point. The authors felt that because the patients didn't understand this, they weren't able to prepare for it and might have made different decisions if they had more realistic expectations about their treatment.



So for patients who are faced with such difficult news, the first step is to take a moment and really think about what is important to you. You first need to identify what your goals of the treatment are, and then you can approach your doctor with some questions. In those first appointments, you may want to ask about whether this treatment is expected to cure you completely of cancer, or just slow it down. How will the treatment affect me, will it make me sick? Will I be confused or sleepy from the medicine? How much time am I going to be in the hospital receiving treatment or at home recovering from the strong medications? Can I travel or am I expected to stay close to the hospital? Will this be expensive for me? How much time am I really gaining and what will be the quality of my life during those extra months or years? If the medicine won't cure the cancer, will it help me in other ways, such as improving pain or making me feel stronger? What is hospice and how can they help me?



Physicians believe that a strong, optimistic attitude is a great asset to have when patients are dealing with difficult situations. However, we also believe that patients should understand their treatment to be able to make decisions that are best. If we are aware of a patient's preferences, we can truly work in partnership with our patients to achieve their end of life goals.

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