Cancer treatment options should include switching to comfort care. The National Comprehensive Cancer Network has developed guidelines of when an oncologist should switch to comfort care. These guidelines have been developed according to type of cancer and options of available treatments. These guidelines are initiated when a person has already been through several courses of chemotherapy and how well a patient’s function in daily life.
The guidelines are encouraged to be initiated when a person becomes confined to a bed or chair for more than half a day. If you are receiving palliative cancer treatment and your oncologist has not had an extensive discussion about your goals and the risks and benefits of palliative chemotherapy, you or a family member, should initiate that conversation early in the treatment cycle.
I think it is important to get your treatment plan in writing, addressing things such as:
- the goals of quantity versus quality of life
- what to expect with treatment
- what to expect without treatment
- at what stage you would consider moving to palliative treatment to comfort care
This is to make sure that everyone is on the same page and have an understanding that you have a choice how to spend your remaining time. Addressing these issues eliminate the risk of a patient or family member remaining in denial about the situation.
Some patients want to do any thing to live a few moments longer, enduring frequent hospitalizations, blood transfusions, artificial ventilation and tube feedings. These are the patients that die in the institutional hospital setting, receiving CPR and IV’s to prolong life.
The studies show that there comes a time when palliative chemotherapy becomes unlikely to help and more likely to harm.
What would you like to do with your remaining time? For most people, their time would be best spent putting their paper work in order, making funeral arrangements, reaching out to those that are important to you, leaving a lasting legacy, and saying good-bye.
Our next article will address the Questions patients Should Ask.
Part One in our series In Cancer Therapy, There is a Time to Treat and a Time to Let Go part 1
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