The Second Step Determine Your Cancer Treatment

The Second Step Determine Your Treatment

Cancer calls for a rational plan of treatment. After understanding your diagnosis, you will have several treatment options to consider. Much of the conventional treatment recommendations will depend on a combination of the results of your pathology report and the treatment customs in your geographic area.

• You have the central role to play in this decision. Your treatment plan needs to balance the physician’s recommendations with your beliefs and wishes about what is best for you. This section will help you make a step-by-step evaluation to arrive at the treatment plan that is right for you. Let’s move on to this next series of decisions.

Read And Learn More: Cancer Essential Things To Do A Road Map For All Cancer Patients Treatment Diagnosis

Understand Your Conventional Treatment Options

In addition to the information you generate from your own research, you should expect your oncologist to carefully explain which type of conventional treatment(s) is recommended for your type and stage of cancer. The options will typically fall into one or a combination of three primary treatment modalities:

• Surgery: removal of the tumor
• Radiation: exposure to X-rays or radium
• Chemotherapy: the use of cytotoxic chemicals

Surgery is the most frequently employed cancer treatment. It is best used when the cancer is small and has not moved to other parts of the body.

• Radiation therapy is employed in approximately one-half of all cancer cases.
• It is often used in combination with other treatment options, for example, either before or after surgery.
• Chemotherapy is most often used when the cancer has spread or when the diagnosis is a systemic-type cancer.
• It is often used in combination with radiation therapy and surgery to control tumor growth.

Three other types of conventional medical treatment modalities are being used more frequently:

• Hormonal: employs or manipulates bodily hormones
• Immunotherapy: enhancing the body’s own immune function
• Investigative: experimental programs

Hormonal treatment is used in cancers that depend on hormones for their growth.

• Hormones are either removed, or added, or their production is blocked through drugs or surgery that removes the hormone-producing gland.
• Immunotherapy includes cytokines, like the family of interleukins and interferons, and is an attempt to boost or restore the body’s natural defense system.
• Many people believe immunotherapies will soon comprise a fourth widely accepted treatment modality.
• At this writing, their scientific efficacy is yet to be established. Investigative protocols are experimental. They are typically the last choice.

As you evaluate your conventional treatment options, please carefully consider some of my personal observations from over two decades of helping patients make informed choices:

1. While surgery is the most common form of conventional treatment, dozens of types of cancer diagnoses do not indicate surgery.

• Many patients panic when they are told their cancer is “inoperable.” If you have been told that your cancer in inoperable, do not despair.
• Recognize that inoperable does not equate with incurable!
• If your oncologist suggests surgery, and you concur, the decision as to who actually performs the procedure is yours.
• Your choice of surgeon is important. You’re more likely to get a well-qualified surgeon if you choose one who is a fellow of the American College of Surgeons and who is also board-certified in his or her field. Only about half of practicing surgeons are board certified field, so be sure to ask.

Special note to premenopausal breast cancer patients:

You typically have some flexibility on the timing of your surgery.

• Scientific evidence is mounting that fewer breast cancer recurrences are reported among women who choose to have their surgery during the luteal phase of the menstrual cycle, i.e., fourteen to thirty days following the onset of menstruation.
• Except for one Canadian study that suggested day 8 to be the optimal time, research shows surgery performed in the latter half of the menstrual cycle results in the fewest recurrences. Ask your surgeon for the most up-to-date research information prior to scheduling.
• You may have to assert yourself here; most surgeries are scheduled at the convenience of the surgeon and/or the hospital.

2. Thoroughly understand chemotherapy. Before you say yes to chemotherapy, ask to see proof, such as scientific papers and reports, on the effectiveness of the treatment being offered.

Examine the hard evidence that the suggested chemotherapy protocol actually cures, extends life, or improves the quality of life. Those are the three “outcomes” against which you must measure all treatments—conventional, experimental, complementary, and alternative.

• If your clinician uses the terms “response” or “tumor response” or “reduce the tumor burden” or “achieve a remission,” these represent different standards.
• These terms mean shrinkage or stopping the progression of the cancer. None of these terms are synonymous with “cure.”
• A cure actually requires that your body fight the cancer on a cellular level and that your immune system maintain a disease-free state.
• To maximize your opportunity for such a response, I encourage you to follow as many of the health-enhancing, life-enriching principles in this book as possible.
• Study the chemotherapy treatment option in depth. Do your own research. Ask about both short-term and long-term side effects.
• Request the names and phone numbers of long-term survivors who were treated with similar regimens. Ask for their experience and analysis.
• Know exactly what you can expect and not expect—chemotherapy to accomplish. Once you possess that information, you are in a position to make a truly informed decision. (See previous section, Caution: Overtreatment, for a more detailed discussion of chemotherapy options.)

3. Radiation therapy is most often administered by means of an external beam machine.

Internal radiation is becoming more common, where radioactive material is surgically implanted into or on the area to be treated.

• This procedure requires precision. You will maximize your opportunity for receiving excellent care if you choose a physician who is certified by the American Board of Radiology. Ask.
• Proton beam therapy is an advanced type of radiation treatment that uses a beam of protons to deliver radiation directly to the tumor, destroying the malignant cells while sparing healthy tissues.
• Protons enter the body with a low radiation dose, stop at the tumor, match its shape and volume, and deposit the bulk of their cancer-fighting energy right at the tumor.
• This new technology is excellent, especially for lung cancer, prostate cancer, lymphomas, esophageal cancer, as well as brain and skull base cancers.
• Although not curative, proton therapy is also used in liver and pancreatic cancer to relieve pain. It can also be used for the treatment of soft tissue sarcomas, a relatively rare cancer.
• I am particularly encouraged by the rapid advances in proton beam radiation. Because the technology is expensive, it is currently found only at major cancer centers. Go to the National Association for Proton Therapy’s Website, www.proton-therapy.org, to find the hospital nearest you.

All cancers are treatable. Even in cases where the cancer is advanced, experimental investigative programs are available.

If your cancer is not responding to conventional treatment, ask about hormonal treatment and biological response modifiers. Especially consider the many complementary and alternative programs described in this book.

• You are entitled to understand the full range of treatments available. From that understanding, you will have the knowledge and power to make the most intelligent treatment decisions.
• Conventional treatment has its important place. In interviews with and surveys of more than 16,000 cancer survivors, over 96 percent stated they initiated a course of conventional therapy.
• It is a myth that cancer survivors turn exclusively to alternative, nontraditional cancer treatments in large numbers. In the late 1980s, a Food and Drug Administration study estimated that 40 percent of cancer patients used unconventional treatments.
• That may be true; in fact, I believe the number may now be much higher, perhaps 75 percent. But survivors do not give up the traditional treatments. They integrate complementary and alternative practices into a comprehensive recovery program. That is what the guidance in this book is all about.

A final thought on conventional treatment options:

Please clearly understand this point: the vast majority of survivors select a conventional program using surgery, chemotherapy, or radiation, often in combination, as the foundation of their treatment.

• Survivors then supplement this conventional approach with many of the ideas presented in this book.
• I recommend you implement a conventional medical treatment program based on your own research and your own strong belief.
• However, I also believe your treatment is not complete until you initiate a comprehensive and integrated cancer recovery program.
• Given our current levels of understanding, this integration represents your very best opportunity for surviving cancer.

An Essential Thing to Do

Ask your oncologist to explain the specific treatment options available to you in the areas of surgery, radiation, and chemotherapy.

• Ask also about hormonal, immunotherapy, and investigative programs. Ask for his or her recommendation.
• Then check these recommendations against the “What to Expect in Treatment” section of the Cancer Recovery Foundation Website, www.cancer recovery.org.
• Record this information in your Wellness and Recovery Journal. Do not give your approval for treatment just yet. First, more work remains to be completed.

Gauge Your Confidence in Your Medical Team

Few patients have any objective way to judge whether their surgeons, oncologists, or other medical professionals have technical competence.

• We can consider our medical team’s education and professional certifications and the experiences of other patients.
• But few of us can evaluate, with technical accuracy, whether a particular doctor will be able to address our specific case with success.
• We can, however, make subjective assessments, the kind of judgments that can be enormously important in our recovery journey. We can intuitively gauge our confidence level.
• Ann Simmons, a highly successful insurance executive, was diagnosed with ovarian cancer. By the time it was discovered, the metastasis was significant and the prognosis poor.
• Ann interviewed seven different oncologists. She went to them with her pathology report and diagnosis in hand and simply asked, “Assuming this diagnosis is correct, what would you have me do?”

The answers she received were actually fairly predictable and consistent. That was reassuring.

• But what was more comforting was one oncologist’s interpersonal skills. He listened. He asked questions to determine Ann’s confidence in a procedure. Based on Ann’s answers, and her confidence level, he offered his recommendations. Ann chose this doctor.
• Ann’s analysis was based not so much on any objective measures of technical competence but on her intuition, her belief in a person and a recommended program. She followed that intuition.
• I believe you can trust your intuition provided you doublecheck it. To be sure, an excellent bedside manner can seldom make up for a lack of training, knowledge, and technical expertise.
• However, survivors have repeatedly told me there is a direct correlation between the confidence one has in one’s healthcare team and the probability of recovery.
• Communication skills shape that confidence level. You are seeking a balance here.

An Essential Thing to Do

Evaluate your confidence level following an encounter with members of your medical team. This is particularly important when you are being asked to make treatment decisions.

• If you harbor more doubt than assurance toward your healthcare providers and their recommendations, it is time to change either your confidence level or your team.
• [Be sure you are approaching this work at a comfortable pace. I suggest you take a break now and reflect on this important step. Continue your work after you have rested.]

Conviction Versus Wishful Thinking

Following an ovarian cancer diagnosis, Elaine Bothwell, a busy mother and community volunteer, was told by her oncologist that an aggressive course of chemotherapy, one that would require hospitalization, was recommended.

• Elaine deeply feared chemotherapy. Still vivid in her memory was her mother-in-law’s agonizing death from cancer. The side effects of treatment were much worse than the illness.
• Elaine vowed at that time if she were ever diagnosed with cancer she would never have chemotherapy. Now she faced precisely the situation she feared most.
• Elaine went in search of nontraditional treatments. Among others, she consulted a naturopath who suggested metabolic therapy, a combination of detoxification, herbs, and hyperthermia (the use of heat) to help destroy cancer cells. While this program sounded minimally toxic and noninvasive, Elaine now feared she was getting too far away from conventional medical care.
• Then Elaine went to another medical oncologist. After she explained her fears and her search, this doctor recommended the use of hormones. Elaine was assured that hormonal therapy was typically less toxic than chemotherapy and in most cases generated far fewer side effects.
• However, the hormone treatment was not as highly recommended as the original and more effective chemotherapy program.
• Torn between these three different approaches, Elaine realized that the treatment she was most convinced would work was a combination of two. Through sheer persistence she was able to find a cancer treatment center that combined fractionated-dose chemotherapy with hyperthermia. On her own, she adopted a nutritional supplementation program that included the herbs. She decided to hold the hormone treatment in reserve.
• Elaine’s choice of treatment is clearly not the answer for everyone. But following one’s conviction is an important element of nearly every successful treatment program.
• Today, twenty-four years after her initial diagnosis, Elaine’s cancer remains in remission, and she leads a full and happy life.
• “I wanted conviction from my doctor,” said Bill Follett, a colon cancer survivor.

“I looked him right in the eyes and asked, ‘Is this treatment just the conventional thinking, Doctor? Or can you show me the hard data to back up your recommendation?’ When he reviewed the published research, it seemed surgery followed by chemotherapy was my best bet.”

An Essential Thing to Do

Before you commit to a treatment program, take the time to ask yourself some critical questions: “Do I hold the belief that this is the right thing to be doing?” “Am I just taking the path of least resistance?” If you don’t believe in it, resist! Find a treatment program that you can follow with conviction.

Reflect on THE Treatment Decision

If you’ve carefully read each step up to this point, you’ll realize that you’ve simply been gathering information about treatment options.

• You have not yet made any treatment decisions. Now it is time to systematically review your treatment options one last time prior to crossing this Rubicon.

First, compare. Are you receiving consistent information from:

• The doctor who made the initial diagnosis?
• The oncologists whom you consulted for your second opinion?
• The recommendations you found through your independent research?

You should expect to see a reasonable consistency in the recommendations you receive from these sources.

• Most treatment variances should relate to differences in levels of toxicity and degrees of invasiveness. If there is a fundamental agreement, your decision-making process will probably be straightforward.
• If the recommendations are inconsistent, then your information gathering is not complete. When you receive mixed signals, it is a certain sign to obtain another qualified and independent opinion. This is time and money wisely spent.
• Several providers in the oncology community have criticized me for this suggestion. Their objections have included: “The differences in treatment that you’ll find are actually very minor. “Most patients cannot afford the cost.” “You’re just losing valuable time in receiving treatment.” I disagree.
• In all but the very rare case, the few days spent in gaining third or fourth opinions are well worth the wait. We can all find the funds if necessary. As a patient you are after the very best treatment. You should expect a consistency of recommendations, if not a consensus.
• Terry Bartholomew is a forty-seven-year-old man from Indiana who was diagnosed with lymphoma. He obtained eight different opinions before agreeing to a program of treatment. Terry’s determination to find the best has proven wise, and today he is alive and well.
• Terry’s experience points to an objection patients often raise: “But my insurance won’t cover a third or fourth opinion.” My response is, “Find a way.” I was only too glad to pay for the services of qualified medical experts who would help determine the best course of treatment for me. Develop a similar attitude.
• Don’t let insurance coverage limits determine this issue. Borrow the money or even seek out a free clinic. There is nothing more important in your life at this moment.
• Once you attain clarity and conviction in terms of the medical treatment, another evaluation needs a second reflective look. Are you comfortable with the people who will give you treatment and the place where the treatment will be administered?
• June Callas, a single mother in her fifties, had ovarian cancer. The treatment program in which she had the most confidence was recommended by doctors at a cancer center that was located more than an hour s commute over busy California freeways. She was expected to visit the center weekly while undergoing treatment.
• The commute was a problem. June didn’t want to drive in rush-hour traffic; a friend or family member would have to act as chauffeur. She also didn’t feel completely sale in the part of the city where the treatment center was located.

June expressed her concerns about the drive and her physical safety to the supervising oncologist. The doctor’s response was compassionate and understanding.

• He was able to make arrangements at a hospital only ten minutes from June’s apartment. She could receive her weekly treatments there and visit the cancer center just once a month.
• To this day, June believes the change in location was an important part of her successful recovery.
• Does the recommended treatment program truly have your conviction? Are you convinced that the recommendations are the finest? Conviction implies a sense of certainty.
• While there are no guarantees, your treatment program and the people who administer it should elicit a strong degree of certainty that this is the right path to be taking at this time.
• Cancer Recovery Foundation has helped thousands of cancer patients walk through this treatment option analysis.
• Invariably a question arises: “What about all the alternative approaches? I haven’t checked them out.”

We have consistently recommended this strategy: First, explore the conventional treatment options.

• Surgery, radiation, and chemotherapy are the basis for the overwhelming majority of survivor success stories.
• If the conventional treatment methods hold no real promise, then analyze both the investigative options as well as the complementary and alternative therapies.
• With all the options, integrate improved diet and nutritional supplementation, gentle exercise plus the psychosocial and psychospiritual techniques. Mobilize body, mind, and spirit. I believe that a physician who withholds this integrated treatment approach is no longer offering an informed medical opinion.
• Allow yourself time to reflect on these important decisions. Don’t be pressured by anyone to make a decision.
• When the treatment recommendations are consistent, the people who administer the treatment have your confidence; you understand the reflect on the treatment decision importance of integrating body, mind, and spirit, and you can say with conviction that this is what you should be doing now. Then, and only then, are you ready to go to the next step.

An Essential Thing to Do

Consult your notations in your Wellness and Recovery Journal. Thoughtfully, carefully, and systematically, reflect on your treatment decision. Take another break. Reflect… again.

Decide

• There is power in decision.
• The cancer journey is made up of both little decisions and big decisions. Your treatment program is a big one. In many ways, it will determine the direction of your entire life. Now is the time to decide.
• The decision is the spark that ignites action. Until a decision is reached, nothing happens.
• Making decisions like this takes courage. But there is power in facing the fact that you have cancer, then carefully doing your homework, and finally choosing a course of action. Without exercising your courage, the problem will remain forever unaddressed.
• Decide! Do not straddle the fence or make a partial decision. This is the time to take a firm stand on one side or another. Make a full commitment.
• Yes, you will monitor your decision. You will keep your options open, of course. But now is the moment to say, “This is how we will climb the mountain! Now let’s get started!”

The decision frees us from many of the uncertainties caused by fear, doubt, and anxiety. Yes, there is risk. But there is a greater risk in making no decision, hoping that all will magically be well.

• Decide. You’ve done the work. This is not a blind chance. This decision is the culmination of careful and sustained inquiry. Now is the time for action.
• Decision awakens the spirit. Do you feel a new awakening? Do you sense that part of you is springing to life? Nourish that spirit.
• Cherish it. It is the life force inside you working for you, helping you get well again.
• Decide. The decision comes first, and the results follow. Today is the day. Now is the hour. This is the moment! Decide!

An Essential Thing to Do

Now, make the treatment decision. Appreciate the power of your commitment. Be optimistic. Decide! Inform your team of your choice.

Give Only Informed Consent

All treatment decisions should be made—must be made—with the informed consent of the patient or the patient’s guardian.

• This means you need to know in detail, in terms you can clearly understand, all the risks entailed in any procedure involving surgery, anesthesia, radiation therapy, chemotherapy, or a similar medical procedure.
• You’ll be asked to sign a consent form. Do not sign a blank consent form. Make certain that the exact procedure is described and that you fully understand it. You have the right to set limits on these documents. You can cross out statements to which you do not consent.
• For example, I drew a line through the section of my consent form that asked my permission to videotape the operation for the removal of my lung.
• You have the right to refuse treatment. An adult who is mentally competent can refuse treatment even if it may result in death. Nancy was a young woman who was pregnant.
• Even though she was advised to go ahead with treatment for lung cancer, she felt so strongly about the potential harm to her unborn child that she elected to postpone treatment until after her delivery. She exercised her right to refuse consent.
• You need to understand clearly and completely all to which you are consenting. Gary Nadine, a retired pilot who made his home in Oregon, recognized that something was wrong with his health when he began to feel weak all the time. In six months he lost more than twenty pounds without dieting.

“I just wasn’t hungry,” he said. “And I felt like I had a low-grade fever all the time.” Then Gary became aware of swelling in his abdomen.

Finally, he went to his doctor, who ordered a variety of tests. There was a complete physical examination, the most thorough he had ever experienced.

Then chest X-rays, CAT scans, a blood workup, urine tests, and more. After consulting with other specialists, the doctor finally told Gary he had Hodgkin’s disease.

• Gary signed a consent form that said “laparotomy,” thinking that he was permitting a biopsy.
• “The way it was presented,” said Gary, “this seemed like just another test to determine, with more certainty, the extent of the disease. The doctor told me they needed to know where the cancer had spread.
• I thought it was no big deal and that I’d be out of the hospital the next day.”
• It was a big deal and Gary was not fully informed. A laparotomy is a surgical procedure that allows doctors to explore the entire abdominal area. It is a major surgery that should only be done by a team of experienced surgeons.
• Because of complications and infections, Gary’s hospital stay lasted two and a half weeks. It left him with significant scars and lasting discomfort.

While Gary technically, even legally, gave consent to the procedure, in his mind he gave his okay for something much different. “I should have asked,” lamented Gary. “But it seemed like no big deal.”

• Your doctor is obligated to inform you fully of any procedure to which you are being asked to give consent. This means explaining to you the procedure’s purpose and risks, other alternatives, and the risk involved in not having the procedure.
• Don’t be intimidated by the medical lingo. Make certain you get this information in a language you understand.
• More importantly, make certain you ask detailed questions prior to giving any consent. Don’t tolerate a physician’s attitude that your concerns are unwelcome.
• If he or she is condescending or overly impatient, find another doctor. And be certain to include on your list of questions, “Why is this procedure absolutely necessary?”

An Essential Thing to Do

Ask your physician—not an associate, not an assistant, and not a nurse—to describe clearly the risks involved in your tests and treatment. Compare the risks to the expected benefits.