Cancer care planning is a way to help you understand your treatment options and discuss your needs and concerns with your doctor and what is important to you with your doctor. You can work with your doctor to create a treatment plan like the one included in this booklet. This plan will help you if your treatment needs to change, when you transition off of treatment, and when you visit other doctors.
Asking About Treatment Options
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What treatment options are available considering the type and extent of my cancer, my age, and my lifestyle?
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Are there any treatments, such as chemotherapy, that can be given in my own home?
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Are there new treatments that might be good for me to consider?
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Which treatment option(s) do you recommend? Why?
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What is the goal of the treatment?
Possible goals:
- Control growth of the tumor
- Cure or eradicate (destroy) the disease
- Increase comfort level through palliative care (reduce pain, stimulate appetite, increase energy level)
- Shrink the tumor so it can be treated by other means
- Prevent complications such as bleeding, pressure, or blockage of a vital organ
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How familiar is the doctor with treating this cancer?
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What types of doctors do you foresee being involved in treating me?
The National Cancer Institute recommends that diagnosis and treatment of cancer patients often may best be managed by a multidisciplinary team of doctors. This concept recognizes that effective cancer treatment often is a very complex task that requires not just a single doctor and a single medical specialty, but the team effort of doctors representing several types of medical skills. This team may consist of a medical oncologist, a surgeon, a radiation oncologist, sometimes referred to as a radiation therapist, and oncology nurses, social workers, pharmacists, dieticians, and rehabilitative specialists.
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What role will complementary and alternative medicines play in my care?
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It would be helpful for me to talk with someone who has been treated for this kind of cancer. Can you arrange that for me?
Questions About Each Treatment Option
Once you have learned what treatments are available to you, you can use the questions below to learn more about each treatment option.
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Please explain what the treatment is.
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What are the short-term and long-term risks?
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How long will I be in this treatment (how many weeks or months)?
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How often will I take the treatment (once a day, once a week, etc.)?
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What are the skills and training of the staff who will give the treatment?
For example, nurses giving chemotherapy should have had special training to safely give this type of treatment, and to recognize and treat potential problems. Many cancer nurses have OCN—oncology certified nurse—after their names. This means they are specifically trained and have passed a rigorous test in the field of cancer care.
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How and when will you be able to tell if this treatment is working as intended?
This is often a difficult question to answer. For example, in many cases where radiation therapy or chemotherapy is given, follow-up tests can be done in order to see if any cancer cells can be detected. It is a good sign if the tests are negative (there is no evidence of cancer cells), although there is no guarantee that the cancer will never return.
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How can I learn more about this type of treatment?
Possible Infections or Complications During Treatment
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Will the treatment make me prone to infections?
Some chemotherapy drugs suppress bone marrow functions and thus may make you more prone to serious infections.
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During chemotherapy or radiation treatments, what should I do if I have symptoms of possible infection?
Since these treatments can cause the white blood cell count to drop and thus increase the risk for infection, be aware of these symptoms:
- Sore throat
- Runny nose
- Sputum production
- Diarrhea
- Burning feeling when urinating
- Muscle aches
- A sore or cut that is red, will not heal, or drains pus
- Fever higher than 100° F
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What should I do about these symptoms?
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What side effects should I report to you during or after treatment?
For example, temperature higher than 100° F, nausea, and vomiting?
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What are other possible complications (problems) that could occur during the treatment?
For example, infection, bleeding, anemia?
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How will I recognize them, and what should I do?
Other Possible Treatment Side Effects
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How will this treatment affect any other medical problems I now have or medication I am now taking?
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How will the treatment affect my ability to work or perform other activities that are necessary or important to me?
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Will the treatment affect my emotions or sex life? If it will, will it be temporary or permanent?
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Will the treatment affect my ability to have children?
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Will the treatment cause any temporary or permanent personality change?
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If I take this treatment, what will my quality of life be like during and after treatment?
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Will the treatment leave a scar or a permanent skin discoloration?
Taking Care of Yourself During and After Treatment
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What will be done to monitor my nutrition and help me maintain good nutrition during treatment? Would vitamin supplements or other nutritional support be helpful?
Nutrition is a very important but often neglected subject. Cancer survivors, in particular, must maintain good nutrition in order to withstand cancer treatment and keep their immune systems as strong as possible. Often, a registered dietician or oncology nurse can be very helpful.
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Is there any need to restrict my diet or fluid intake (including alcohol)?
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What should I do if my appetite decreases or if I have problems swallowing during treatment?
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Under what conditions should I avoid being in contact with people who have contagious illnesses?
A low white blood cell count increases your risk of infection. You may be told to avoid people with colds, the flu, measles, or chickenpox, or to avoid large crowds of people.
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What other precautions should I take depending upon my blood count levels?
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After treatment ends, what medical care will I receive to determine whether the cancer recurs or spreads in the future? How often should I be checked for possible recurrence?
Getting a Second Opinion
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Should I get a second opinion?
Requesting a second opinion does not mean that the initial diagnosis is wrong or that the suggested treatment is not the best. Rather, you have the right to hear about all possible treatment options. Most doctors will not be offended if you chose to get another opinion, and some health insurance plans even require a second opinion. The doctor may not know all there is to know about treating every kind of cancer (there are over 100 types). This is not to discredit your doctor. But there may be other specialists who know of a treatment that may help you.
You may want to seek a second opinion and/or call the Cancer Information Service (CIS) to request a “Physician Data Query” (PDQ), which will give you information on the latest cancer treatment being used for your cancer. Study the PDQ printout you receive with your doctor. The CIS can also provide information on what are called “comprehensive cancer centers.” Comprehensive cancer centers are recognized by the National Cancer Institute (NCI) as leaders in research and treatment of cancer. The CIS also can give you information on what are called “clinical trials” of potential new cancer treatments. Many clinical trials are supervised by the National Cancer Institute, which urges patients to ask about this treatment option (see below). The CIS can be reached at 1-800-4-CANCER nationwide, during the work week. It is sponsored by the National Cancer Institute.
If you receive a second opinion that is different than your doctor’s opinion, you will have to decide about which opinion you believe is best in your situation. Understanding which opinion is backed by the latest research might help you decide.
