When we or a loved one receives a serious diagnosis or a chronic condition goes into a crisis, our world changes. Suddenly we have to learn new information, perhaps have additional tests or procedures, often get a second opinion from a specialist, and sometimes choose between several treatment options. This assessment and exploration phase can take many months as we live with this new understanding about our health and well being. Ultimately most people choose an initial treatment plan in consultation with their specialists and perhaps primary provider with the hope of resuming normal life, even if somewhat modified by this new health condition.
Sometimes improvement is significant and life can be resumed. However, that is not always the case and if the side effects of treatment become intolerable or if there is just no significant improvement, alternative treatments or therapies are generally suggested. We’ve all heard of cancer patients who over time have surgery, radiation, and/or chemo-therapy to try and control the growth and spread of malignant cells. Most specialists are anxious to assist their patients in every way possible and will suggest new approaches when one no longer is working.
Patients can try to enroll in research trials for new drugs or therapies that may have a positive effect. This is often a good time to request a consult from a palliative care specialist or team who specialize in understanding the whole patient and provide information about various treatment options. They can help reduce side effects of various treatments and discuss treatment goals and advance care planning.
At some point many patients decide to stop additional treatments and move towards comfort care as provided by hospice, but not everyone. In keeping with their right to self-determination, some people cherish every breath of life and want to extend their time as much as possible. They decide to try another round of treatment or find another research trial that they qualify for. Some people choose to “go down fighting”, “to look death in the eye” or “die with their boots on”! There are no right or wrong answers and in some cases it is an option to continue treatments until the very end.