Understanding Your Options and Making Treatment Decisions

When someone finds out they have cancer, or that cancer has come back, it’s very easy to feel overwhelmed. For many people, this news might come while still recovering from surgery to remove or diagnose a tumor. They might now need to decide what other treatment to get, too.

When you start to talk about treatment options, it's very important that you:

• Know all treatment options
• Talk about the details of each treatment option with your cancer care team
• Learn as much as you can and understand the information being given to you
• Are a partner with your doctor in making treatment decisions and planning your care

How your cancer care team determines your treatment options

Depending on the type of cancer, you might have a very limited number of treatment options, or you might have many. Your cancer care team uses established treatment guidelines to figure out what treatments should be offered to you. These treatment guidelines are based on research and are used all over the country. They use information about your tumor and your health to guide the cancer care team in knowing what treatment or treatments are recommended for your type and stage of cancer. If you want to know more about treatment guidelines, you can talk to your cancer care team about what guidelines they use to give you treatment options.

The treatment options you’re offered might be different from the options offered to someone else who has the same or similar type of cancer. This is because some cancers have subtypes and features that might have different treatment recommendations. For example, there are many types and subtypes of breast cancer and different ways to describe them. Some have special features that affect their treatment and outlook. There are also patient factors that tell the cancer care team what options may or may not work best, such as other health problems. 

In general, the treatment options you’re given will depend on:

• The type of cancer
• The stage of the cancer
• Other tests that might be done on the tumor to give more information about it (for example, biomarkers or hormone receptors)
• Other tests that might be needed to give more information (for example, blood tests, x-rays or other image tests, or genetic testing)
• Your overall health
• Any other medical problems you might have
• Your personal preferences

You can learn more about treatment options for specific types of cancer in Cancer A to Z.

Some common ways to treat cancer are:

• Surgery
• Radiation therapy
• Chemotherapy
• Hormone therapy
• Targeted therapy
• Immunotherapy
• Stem cell or bone marrow transplant

Sometimes treatment options include a clinical trial. A clinical trial is a research study that tests treatments on people. Sometimes these are new treatments that are being studied for the first time. Sometimes a clinical trial uses a treatment that’s already approved for a certain type of cancer and tests it on a different type of cancer. Some clinical trials might test a new combination of treatments. Talk to your cancer care team to find out if a clinical trial is available for your type and stage of cancer.

There are other options to help someone with cancer, too, These include:

• Palliative care: Palliative care can help any person with a serious illness, such as cancer. Its goal is to improve the quality of life by managing symptoms, side effects, and other problems. It can be offered at any time from the point of diagnosis, during treatment, and until the end of life. 
• Hospice care: Hospice care provides compassionate care for people in the last phases of incurable disease, such as advanced cancer, so that they may live as fully and comfortably as possible.

It’s important to remember that advances in the ways to treat cancer are being made every day. New drugs and other ways to treat cancer are constantly being studied, and many are approved for use each year.

Talking about your options

At some point you will sit down with your doctor to talk about treatment options. When this discussion happens might depend on how quickly your cancer care team thinks you need to start treatment. It might also depend on how long test results take to come back. Learn more about this in When Treatment Should Start and Testing Biopsy and Cytology Specimens for Cancer.

While you wait for more details

Sometimes, you might only be able to have a general talk about treatment options at first. This can happen if the doctor doesn’t know the exact details about your cancer. Maybe there is not enough information available to the doctor, or test results have not come back yet. If you are faced with waiting for test results and don’t know what your exact treatment options are yet, here are some general questions you might want to ask your doctor:

• What type of cancer do I have? If you don’t know yet, when will you know?
• Do I have a certain subtype of a cancer or are tests being done to find this out?
• What tests are being done on my tumor that help you find out more information about it?
• What stage is my cancer? If you don’t know yet, when will you know?
• Are there any other tests I should have done?
• When will you know what treatments you can offer to me?

Learning about your options

When details about your cancer are known, your doctor will talk with you about the different treatment options. Sometimes other members of the cancer care team, such as nurses, pharmacists, and others, are involved in talking with you and teaching you about treatment. Here are some questions you might want to ask about the options being given to you:

• How do you know these treatment options should be offered to me?
• Are there guidelines you use to help figure out what treatments should be offered to me? Is there a website or place where I can find more information about the guidelines?
• Should I be concerned about my other health problems with any of these treatments?
• What are the benefits and risks of each treatment you’re offering?
• Is there one treatment you recommend? Why or why not?
• Is there a clinical trial available? If so, is it right for me? Where do I find more information?
• Should I get a second opinion?
• When does treatment need to start?

 Ask about other concerns that are personal to you, too. For example, if you have religious or spiritual beliefs or rituals, or if you have diet restrictions, be sure to talk about them. It's a good idea to ask if they might affect any of the treatments. If you have concerns about being able to get to treatment, you can find out where to get help. If you have trouble taking care of yourself at home, bring this up too.

Answers to all of these questions can help you better understand what can be expected from the different treatment options you're being offered.

There are questions you’ll probably have about each type of treatment you’re offered. You can find more questions that are specific to each type of treatment in Surgery, Radiation Therapy, Chemotherapy, Hormone Therapy, Targeted Therapy, Immunotherapy, Stem Cell Transplant, and Clinical Trials.

Doing your own research

Your cancer care team will teach you about your treatment options. But, there’s lots of information about cancer treatments available from other sources, too. There’s also a lot of misinformation out there. You might find out information on the internet, by talking with family and friends, by going to a support group, or even by watching TV. It’s very important to be careful about where you’re getting information. Pay attention to who is sponsoring the website or advertisement, or who is giving the information you find or hear.  

Remember these important points:

• Your doctor and cancer care team know your situation best. Write down your questions as you think of them. Bring any and all questions to your cancer care team. Write down the answers you’re given.
• Ask your cancer care team where you can find credible, honest, factual information about the treatment options you’re offered. If you’ve already started asking and searching on your own, bring information you’ve found and ask if it’s correct and if you should trust it.
• Consider asking a family member or friend to be with you when you talk to your doctor and cancer care team. This will help you remember what questions to ask, what answers are given, and they will be there to support you.
• Learning all you can about your cancer and the treatment options you’re given can help you make a decision that’s best for you and that you can feel good about. 

Making a treatment decision

Choosing the best treatment for your situation is a decision that needs to be made after all information has been shared with you, and after you’ve had time to ask questions and have them answered. This process is called informed consent and allows people to play an active role in making decisions that affect their health.

Some types of cancer have a very limited number of treatment options, so making a decision about which is best might not be difficult. It's also possible that treatment needs to be started quickly, so there might not be as much time to make a decision as you'd like. But, in many cases, it can be helpful to get a second opinion before making your decision. Don’t be afraid to ask if there’s time to get one, and remember you have the right to a second opinion. You can learn more in Seeking a Second Opinion.

Shared decision-making

Shared decision-making is a process where decisions about your care are made with you, rather than someone making the decisions for you. Shared decision-making involves doctors and other members of the patient’s health care team working with you and your family or caregivers to make decisions together. The process involves sharing information back and forth.

Shared decision-making can be hard in some cases when there are many doctors, specialists, or caregivers involved in helping a patient make decisions. It's not always easy to get everyone's input, and can take some work and reminding to keep information flowing well. But shared decision-making can help make sure you get the right tests and treatment, and that the right type of care is planned around them. It considers risks, benefits, and costs of treatment, along with any other concerns you might have.

If you're not sure you want to get treatment

Not everyone diagnosed with cancer decides to get treatment or to be treated right away.  That is always a choice, but make sure you understand why you are thinking about not getting treatment. It’s normal to feel anxious and overwhelmed by the amount of information you’ve been given. Make sure you get answers to all the questions you have to understand what is likely to happen if you do and if you do not get treatment for your cancer.

Some people have heard that cancer treatment is worse than the cancer itself. Getting through cancer treatment can be tough, but not getting treatment lets some types of cancer grow unchecked. Depending on the type, an untreated cancer can lead to new and worse symptoms and can be fatal. Also, getting treatment soon after diagnosis usually works better for most types of cancer than waiting until the cancer is worse when treatment probably won’t work as well.

If you or a loved one are thinking of refusing or delaying cancer treatment, talk with your doctor or nurse. If you’re not getting the answers you need, you might think about getting a second opinion. It might also help to talk to someone else who has been treated for your type of cancer.  Look for local or online support groups or join a cancer survivor community to connect with others.

When the decision has been made

Even when you have learned everything you can about your treatment options and you’ve made your decision, it's important to keep communicating with your cancer care team as questions come up. Here are some things to think about:

• Be sure to ask any specific questions about the treatment you’ll be getting before it starts. Even if you’ve asked the same questions before, you might feel better getting the answers again.  
• If you don’t understand something, ask your cancer care team to explain it better.
• If you forget something, ask about it again.
• Bring up questions at every treatment visit as you think of them.
• Plan for side effects. Each type of treatment has its own set of side effects that can be expected. It’s important to know about them, how to manage them, when to tell someone about them, and when to get help for them.
• It’s a good idea to ask your cancer care team how information will be shared with other members of your health care team, such as your surgeon, radiation oncologist, family doctor, and any specialists that might be involved in your care.
• Find out the best way to get in touch with your cancer care team. You should know the phone numbers to call during weekdays and on weekends. Ask about how to call for any emergency situations, too. There also might be an online patient portal you can get into to send messages and look up information about your care.