Care at the end of life for advanced cancer patients

When to choose supportive care

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When you have cancer and you have tried many treatments without success, it’s hard to know when to stop trying. Sometimes, even with the best care, cancer continues to spread. Although it is hard to accept, the best thing for you at that point may be to stop treatment for the cancer and get care to keep you comfortable and out of pain.

This fact sheet explains how to know when it is time to stop treatment and focus on end-of-life care. You can use this information to talk with your doctor about your options and choose the best care for you.

Cancer responds best to treatment the first time.

When you treat a tumor for the first time, there is hope that the treatment will destroy the cancer cells and keep them from returning. But if your tumor keeps growing, even with treatment, there is a lower chance that more treatment will help.

This is especially true for solid-tumor cancers, like breast, colon, and lung cancer, and sarcoma. Doctors know a lot about how these cancers grow or shrink over time and how they respond to treatment. They have found that treatment after treatment offers little or no benefit.

When is more treatment probably not going to be helpful?

If you have had three different treatments and your cancer has grown or spread, more treatment usually will not help you feel better or increase your chance of living longer. Instead, more treatment could cause serious side effects that shorten your life and reduce the quality of the time you have left.

However, almost half of people with advanced cancer keep getting chemotherapy—even when it has almost no chance of helping them. They end up suffering when they should not have to.

How do you know when to stop treatment?

It can be hard for both the patient and the doctor to talk about stopping treatment for the cancer and focus on end-of-life care. You may need to start the discussion. Doctors do not always know how much the patient wants to know. But if you ask questions, the doctor should give you clear answers.

You need to understand how advanced your cancer is. Ask your doctor about the stage of your cancer and how much it has spread. You also need to know your prognosis, or how long you have to live.  No one can say exactly how long this is, but your doctor should be able to tell you a range of months or years.

And you need to know if more treatment for cancer will help you live longer. Ask your doctor to explain the risks and benefits of any treatment. Otherwise, you may think you have to keep fighting your cancer, even when it’s not best for you.

Sometimes, if there are no more known treatments and you want to continue trying, you may be able to join a clinical trial. Clinical trials offer new, experimental treatments. Ask your doctor if you are eligible for a clinical trial. Or check www.clinicaltrials.gov.

If you decide that you do not want more treatment, then it’s time to talk about supportive care.

Supportive care improves your quality of life.

Care near the end of life is called supportive, or hospice, care. It is care for your physical, mental, and spiritual needs at the end of life. It does not treat your cancer, but it helps keep you free of pain and other symptoms. And it helps you and your family get the most out of the time you have left together.

Hospice care can be in your home, in a hospice facility, or at a hospital. It includes many services, such as:

  • Doctor and nursing care
  • Pain management
  • Physical and speech therapy
  • Counseling for family and friends about grief
  • Social worker services
  • Respite care, which gives your caregivers a break

When is the right time for hospice care?

If you have reached a point where nothing more can help, the American Society of Clinical Oncology (ASCO) recommends that you turn to hospice care. You may have reached that point if:

  • Your doctor does not think you will live for more than six months.
  • There are no other proven treatments.
  • You can no longer care for yourself and spend most of your time in bed or a chair.

This report is for you to use when talking with your health-care provider. It is not a substitute for medical advice and treatment. Use of this report is at your own risk.

© 2012 Consumer Reports. Developed in cooperation with the American Society of Clinical Oncology. To learn more about the sources used in this report and terms and conditions of use, visit ConsumerHealthChoices.org/about-us/.

9/2012