Care at the end of life for advanced cancer patients
When to stop cancer treatmentDownload PDF
When you have cancer and you have tried many treatments without success, it’s hard to know when to stop treatment. Sometimes, even with the best care, cancer continues to spread. It is hard to accept, the best thing for you at that point may be to stop the cancer treatment. Instead, you could focus on getting 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 it time to think about stopping cancer treatment?
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.
Still, 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. Your doctor should give you clear answers to any questions you ask.
You need to understand how advanced your cancer is. Ask your doctor about the stage of your cancer and how much it has spread. Ask about your prognosis, or how long you have to live. No one know exactly, 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. Fighting the cancer may no longer be the best thing 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.
At any time during your treatment you can get help to relieve your symptoms and improve your quality of life. It’s called palliative care. If you decide that you don’t want more cancer treatment, then it’s time to focus on a kind of palliative care called hospice care.
Hospice care improves your quality of life.
Care near the end of life is called hospice care. Hospice 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. Services include:
- Doctor and nursing care
- Pain management
- Medical equipment and medicine to ease symptoms
- Grief counseling for family and friends
- Social worker services
- Respite care, which gives your caregivers a break
When is the right time for hospice care?
You may reach a point when there are no more effective cancer treatments for you. This is when you should seek hospice care, according to the American Society of Clinical Oncology (ASCO). You may have reached that point if:
- Your doctor does not think you will live for more than six months.
- There are no other treatments with more benefits than risks.
- You want to focus on quality of life for the time you have left.
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, please visit ConsumerHealthChoices.org/about-us/.
Consumer Reports' Advice
Questions to ask your doctor
Let your doctor know how much you want to know about your cancer and when you are ready for discussion about end-of-life care.
Ask your doctor:
- How long do I have to live if I have more treatment? What will happen if I do not have more treatment?
- What is the goal of more treatment? Will treatment stop or slow my cancer, or will it help with the symptoms?
- What is the best way to manage my symptoms and side effects?
- Are there things I can do to make my quality of life better?
- Should I meet with someone who knows about hospice care?
If you would like to know more about hospice care:
- Ask your doctor for a referral to hospice. Or go to www.cancer.net/coping/end-life-care/hospice-care.
- You can talk to hospice without having to sign up. And, even if you decide to be on hospice care, you can always change your mind.