When to stop treatment?


Question from Becky: When does one say, "Enough!" and stop all treatments?
Answers - Musa Mayer There comes a time for most women dealing with metastatic breast cancer when treatments are no longer effective and the toxicity is overwhelming. It's very difficult to make the transition from fighting the disease to beginning to think about what needs to be done and said with the people you love and how to prepare for the end of your life. That's a tremendous challenge. It's a difficult time and, obviously, members of your family will find it equally painful.

It's really important to get help and support as you enter this time from your doctor, possibly from hospice, and certainly from members of your family and friends. There is no hard and fast rule about when enough is enough. Some people prefer to receive treatment up to the last day of their lives, while others will stop and prefer to spend the last weeks and months with their families, with their pain and other symptoms relieved, but without having to deal with being in treatment anymore.

It's a very individual thing. The only constant is to keep the lines of communication open, even though this means shedding a lot of tears and facing very scary moments. These times can be very precious in the life of a family, and I've seen many women and their families approach the end of life with great courage. You may think that you could never be strong enough to do that, but people surprise themselves with their strength.
Eric Winer, M.D. In terms of communication, I think it's important to emphasize in this discussion about when enough is enough that it is a conversation that should be going on between a woman with breast cancer and her doctor and nurse and others who are involved in the team over the course of an extended period of time.

If I can use a simple analogy, when you're evaluating an employee in a job, the yearly evaluation should never be a surprise. In this same way, having a conversation about stopping treatment shouldn't come as a surprise to either a doctor or patient, but should be a very natural transition as part of the conversations that have been going on in the months before. Communication is the key!
Marisa Weiss, M.D. Sometimes, when you take a break from treatment and believe at that particular time that you'd like to stop, you might be surprised to find that you may feel relatively well off of treatment and can do well for an extended period of time. During the treatment break, it's also important to communicate with your doctor.

The decision to stop treatment is not irreversible. You can change your mind and initiate a form of treatment if it helps you feel better. There is a difference between treatment to extend your life that may involve more side effects, and treatment that can ease a particular symptom that is getting in the way of your quality of life. Again, as Dr. Winer and as Musa Mayer said, that communication is essential to the best care.

On Wednesday, September 17, 2003, our Ask-the-Expert Online Conference was called Metastatic Breast Cancer. Musa Mayer, Eric P. Winer, M.D., and Marisa Weiss, M.D. answered your questions about treatment and quality of life issues related to advanced (metastatic) breast cancer.

The materials presented in these conferences do not necessarily reflect the views of Breastcancer.org. A qualified healthcare professional should be consulted before using any therapeutic product or regimen discussed. All readers should verify all information and data before employing any therapies described here.

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