Making Treatment Decisions

Receiving the news that you’ve been diagnosed with cancer is a difficult and stressful event that leads to numerous questions and concerns. It may take a number of days before you can begin to think clearly about this information. The inclination may be to follow whatever the person delivering the news tells you. This may or may not be the best option for you. You have time to think through your diagnosis and what type of treatment fits you. People who have been through the diagnosis of breast cancer tell us the best way to get through it is to seek out support and don’t rush into a treatment you may not be comfortable with. There are many resources at Siteman that can help you explore your options.

Getting the Information to Make a Decision

  1. Write down your questions and bring them with you when you visit your doctor.
  2. If there is something you do not understand, don’t be afraid to ask questions. You need to understand what is happening in order to make the best possible choice for yourself.
  3. Bring a friend or family member when you visit your doctor. Because you will have a lot on your mind, a friend can help you remember what was said. Your friend also can take notes and remind you of questions to ask.
  4. Find other women who have had breast cancer and talk to them about what was important to them about their treatment.
  5. You may be at Siteman for a second opinion because the physicians here lead in their fields. Many people get a second opinion. One doctor may recommend less or more treatment than you think you need. Get as many opinions as you need to feel comfortable about your decision. You don’t have to decide today.
  6. Learn what you can about your cancer, but don’t over-study it. Just research the parts you need to know now to make a decision. It will help you ask the right questions.
  7. Ask the doctor to put chances of recurrence with various treatment options in a way that makes sense to you, such as percentages. If surgery plus radiation and tamoxifen has an 85 percent cure rate, and chemotherapy would only add an additional 2-3 percent, is it worth the trauma and side effects of chemotherapy? The only person who can answer that is you. Research has shown that people do better with any medical treatment if they feel it is the right choice for them.

Finding Support for Putting Treatment Into the Context of Your Life and Family

Palliative Care: Palliative care provides a specialized approach to medical care for people with serious illnesses, focusing on relief from symptoms of the illness and the treatment, and incorporating the patient and family as a unit. The goal is to improve quality of life for both the patient and family members. Palliative care is provided by a specially-trained team of doctors, nurse practitioners, a social worker and a chaplain who work together with a patient’s surgical, radiation or medical oncologist to provide an extra layer of support. It is appropriate at any age and at any stage in a serious illness and is provided along with curative treatment.

One of the biggest misconceptions is that palliative care is about not treating the disease and dying. Its real goal is to help you manage your symptoms and treatment effects so you can also have a life during treatment, not put your whole family on hold. The palliative physician, as a consultant to the doctors managing medical care, makes recommendations on extended pain management and any other support the patient or family needs. Palliative care takes the proposed treatment plan and looks at how it integrates into the family’s life, taking into account family status, socioeconomic issues, and spiritual needs in the plan of care.

Decisions to Make About Your Treatment

Genetic counseling and testing

A strong family history of cancer can help you make treatment and screening decisions under certain conditions. The Hereditary Cancer Clinic at Siteman helps identify and support patients with familial predispositions to cancers like breast cancer. In individuals and families with a BRCA mutation, clinicians often see early onset cancer or both breasts with cancer because of the pervasiveness of the mutation. Red flags for possible hereditary cancers include a family history of certain types of cancer, early-age onset of a particular cancer, multiple family members with the same cancer, or multiple types of cancer within the same person. Identifying greater risk helps in decision-making, which could include preventive mastectomy, more aggressive treatment, and more vigilant screening.

Participation in Clinical Studies

At any given time, Siteman Cancer Center has more than 350 clinical studies in progress. Breast cancer patients who come to Siteman have access to novel or more advanced treatments than you could get in a community hospital. If your doctor feels a clinical study is appropriate, he or she may suggest it. You can review the clinical studies for breast cancer currently in progress.

Breast Reconstruction after Surgery

If you think you might want reconstruction after surgery, either after a mastectomy or a lumpectomy, talk to your surgeon about it. For many patients, reconstruction can be done during the same procedure as the breast cancer surgery, with your surgeon and the reconstructive surgeon working as a team. Explore the reconstructive surgery options.