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(9) Cancer Symptoms & Treatment

Breast cancer - Symptoms and treatment

Signs and Symptoms of Cancer

CST9

I want to have the best quality of life possible. Should I refuse to take any treatment so I won’t have side effects?

 One of the most difficult aspects of being diagnosed with cancer is living with uncertainty about the future. Coupled with that is the fear of side effects from treatment. These feelings can lead to questioning whether it is worthwhile to get treatment. But your decisions about treatment should be based on knowledge, not on fear.

Speak with your doctor to get the information you need. The side effects and the likelihood of long-term control or cure are based on the type of cancer you have, on the stage of disease, and on the treatment you receive. Everyone responds differently to treatment; no one can predict precisely what will happen to you. However, your doctor can explain what he or she hopes to achieve and what you will most likely experience during and after treatment. Consider this information when making your decision.

When a cancer is curable, making the decision is relatively easy because the goal is easy to understand. Many treatments are easily tolerated, with minimal disruption in your usual routines, and many side effects from the treatment resolve without any long-term consequences.

Even for those who cannot be cured, obtaining treatment offers a number of benefits. Many types of cancer can be controlled with treatment for a long period of time, even for a number of years. Equally important, treatment can improve the quality of your life. It can lessen or prevent symptoms of the disease, and it can prevent or delay complications from the growth of the cancer. For specific questions to ask your doctor to ensure you get the information you need to make the decision about undergoing treatment for your cancer.

What is palliative care and how can I get referred to a palliative care program?

Palliative care addresses the medical, physical, emotional, social, and spiritual needs of patients to help them achieve the best possible quality of life. Historically, palliative care was associated with hospice care and was reserved for patients at the end of life who were no longer receiving active treatment for their disease. However, in recent years the focus of palliative care has expanded to include all patients who could benefit from this approach, even those receiving active treatment and with a good prognosis. Many hospitals have established palliative care programs for their patients.

Although oncologists have a great deal of experience in managing pain and other symptoms, for some patients the usual interventions are not effective. In these cases, a referral to a palliative care specialist may be helpful. Palliative care specialists are physicians who are specially trained in techniques to manage pain and other symptoms.

If you feel your pain or other symptoms are not adequately controlled, ask your doctor about seeing a palliative care specialist. An Internet site that can provide additional information about palliative care and help you find a nearby provider is Get Palliative Care (www.getpalliativecare.org/home).

What are advance directives? How can I be sure my wishes are known?

Advance directives are legal documents in which you indicate who you want to make medical decisions for you and/or what type of medical care you want to receive if you become unable to make decisions or speak for yourself in the future. Although the specific laws and terminology for advance directives vary from state to state, there are two basic types:

• A living will

• A health care proxy

A living will is a document in which you state specific instructions regarding your health care, outlining which medical interventions you want to have performed and which you want to have withheld, given a variety of circumstances.

For example, if you were to lose the ability to eat and drink, would you want to receive artificial nutrition through a feeding tube or by means of intravenous fluids? If your heart were to stop beating, would you want to have your chest compressed or have your heart shocked? If you were to stop breathing, would you want a tube placed down your throat and connected to a respirator, which would breathe for you?

When making these decisions, specify the circumstances in which you want your wishes followed. If the medical problem is treatable and reversible, you may want all medical measures taken to resuscitate and support you. If the medical problem results from progressive cancer that can no longer be controlled, you may not want any aggressive measures taken to resuscitate you or to prolong your life. Deciding not to accept aggressive care to prolong your life is not the same as withholding other medical care. You can still receive pain medication, antibiotics, food and fluid, and other supportive measures. However, the goal of treatment shifts from cure to comfort care.

Making these decisions is very difficult, and you need to think about what you want for yourself. A living will provides you the opportunity to state your decisions so that people can act on them.

One significant limitation to a living will is that you can’t foresee all possible health-related circumstances.

Decisions might have to be made that you have not specified in writing. These problems can be avoided by completing another legal document called a health care proxy, or durable power of attorney for health care. This document allows you to designate a health care agent, who is a person designated to make health care decisions for you if you are not able to. The designated person acts as your agent, deciding which medical interventions should be performed and which should be withheld. Although the terminology varies from state to state, all states recognize a health care proxy.

When selecting a health care agent, be sure to choose among people you trust, those who will make decisions based on what you want for yourself, not on what they want for you or on what they would want for themselves if they were in your position. You can choose your health care agent among family members or friends. Talk with candidates about what you want for yourself in a variety of circumstances. Talk about the issues just described with regard to resuscitation and life-prolonging measures like artificial nutrition and intravenous fluid. Be as specific as you can be. Then confirm with the person you choose that he or she will honor your wishes and be willing to speak for you. You can change your health care agent, as well as your decisions about what you want done, at any time.

Let your family and friends know whom you have selected as your agent so that, if the need arises, everyone can support the person in making the necessary decisions. If you have completed a living will, share this with the family as well. Inform all of your doctors and everyone else on your medical team of your wishes and provide them with copies of any advance directive documents you have signed.

Having a discussion about what you would want if you were unable to make decisions for yourself is difficult for most people. Sometimes the patient wants to bring up the subject but is afraid the family will be distressed by the conversation. Sometimes the family wants to bring it up but is afraid of alarming the patient. It is always better to talk about these things when you are feeling well and when no imminent crisis is looming.

With this type of preparation, you can calmly think about what you want and clearly talk about it with others.

You can initiate the discussion in several ways. You could say something like, “I want to be sure that, if I were to become sicker, you would know what I want done.” A family member could initiate the discussion by saying something like, “If you were to become sicker and couldn’t tell me what kind of care you wanted, I wouldn’t know what to do. Can we talk about this?” Some people find that their family does not agree with the decisions they have made, making a difficult discussion even harder. This makes it all the more important to have an advance directive to ensure your wishes will be honored.

You can obtain state-specific advance directive documents from your lawyer, your doctor, your local hospital, or Caring Connections (http://www.caringinfo.org/stateaddownload).

Your decisions about treatment should be based on knowledge, not on fear.

Palliative care - A philosophy of care that helps patients achieve the best possible quality of life.

Advance directives - Legal documents in which you indicate who you want to make medical decisions for you and/or what type of medical care you want to receive if you become unable to make decisions or speak for yourself in the future.

Living will - A document in which you can state specific instructions regarding your health care, outlining which medical interventions you want to have performed and which you want to have withheld, given a variety of circumstances.

Health care agent - A person designated to make health care decisions for you if you are not able to.

 

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