Stopping cancer treatment: Deciding when the time is right
Stopping cancer treatment: Deciding when the time is right
Stopping your cancer treatment — what to consider when making this decision.
You've come a long way. You made it through your initial cancer diagnosis and the shock and fear that came with it. You've been through cancer treatment and the related side effects.
But for all you've overcome, if your cancer treatment isn't working as you and your doctor had hoped, you may face another tough step in your journey with cancer. You may eventually need to consider ending your cancer treatment.
As you and your doctor decide whether or not to stop your cancer treatment, take time to gather information and assess your goals. What you find might help you understand that stopping your cancer treatment isn't necessarily giving up. Rather, it's a way to gain more control over how you'll spend the rest of your life.
Changing your cancer treatment goals
When you were first diagnosed with cancer, you and your doctor probably discussed what sort of results you could hope for from your cancer treatment. You probably hoped that your cancer would be cured. But if your first line of cancer treatment didn't work as well as you had expected, you might have realized that your goal of a cure was no longer possible and that you needed to refocus your goal.
In life, whether dealing with cancer or anything else, goals aren't fixed and static. Goals must remain flexible and change with the circumstances. This is true when dealing with cancer. Though your first goal, reasonably, is one of cure, sometimes treatment doesn't go as you had hoped. Cure may no longer be a realistic option. Readjusting your goals can help you focus on those things you can still reasonably control.
Throughout your cancer treatment, three phases or goals of care exist. When you move from one phase to the next is up to you and your doctor.
Your treatment goals are never static, and you and your doctor should continually discuss your goals — slowly and gradually adjusting them based on your individual circumstances. The process is very gradual and evolves throughout the course of your illness.
Making the decision to end treatment
Making the transition to comfort and symptomatic (palliative) care can be a difficult choice. Talking about your decision with your doctor and your family might help you sort out your feelings. Some points you might want to discuss include:
In your decision to end your treatment, take into consideration your religious beliefs and other personal values. Discussions with your religious adviser can help you focus your goals.
Discussing the end of your treatment with your doctor
In a perfect world, the decision of whether or not to end your treatment will be thoroughly discussed between you, your doctor and your loved ones. Your doctor would be sure of the potential benefits of your treatment. And you would be open with your doctor about your fears and hopes for your future.
In truth, your doctor might find your prognosis difficult to estimate, and you might be afraid to admit feelings of depression or anxiety. For this reason, it's important that you and your doctor have adequate time to ask each other questions and not be afraid to ask or answer difficult questions about your future.
Many times you and your doctor will agree with each other on whether to continue treatment. But in some cases, you might disagree.
When your doctor wants to end your treatment, but you don't
Know that your doctor has your best interests in mind, and listen to your doctor's reasoning. Ask questions. Be honest about how the thought of ending your treatment makes you feel. Just because your doctor suggests no longer treating your cancer, your doctor will always continue to treat you, to assure comfort and relieve symptoms to the best of his or her ability. Ask to see X-rays and other tests that show the progression of your cancer. This might help you better understand your doctor's opinion.
You might be reluctant to stop your treatment because you're afraid to lose control over your health. You might also equate ending treatment with giving up. But you can maintain both control and hope without the cancer treatment:
If, after discussing your treatment with your doctor and your family, you decide you don't want to stop your treatment, your doctor may be willing to continue treatment. However, if your doctor knows the treatment will only hurt you, he or she can refuse to treat you. If that happens, you can request a review of your case with the hospital or clinic management. Or you can get a second opinion from another doctor.
When you want to end your treatment, but your doctor doesn't agree
After these factors are controlled, you might be in a better frame of mind to make a decision about continuing your cancer treatment. Don't accept pain, anxiety and depression as part of your cancer — they can all be controlled to some extent most of the time.
If you simply don't want to continue treatment, that's OK. It's not a sign of weakness. When to stop treatment is a highly personal decision. You can always change your mind and restart your treatment if your doctor agrees.
In the end, it's your decision to make, but input from your doctor, other health care workers and your friends and family can be an important part of the decision-making process.
Telling your family and friends
If you decide to end your cancer treatment, be honest and open with your family and friends when telling them. Talking about your feelings can be therapeutic. It can also help your friends and family come to terms with your decision to end treatment. They'll better understand what they can do to help you and how you want them to behave toward you. You might prefer to keep your feelings to yourself, and that's OK too.
It's possible that your friends and family might not understand your decision because of fears about your future or theirs. Talking about your decision to end your treatment and your change in goals might help them overcome these fears.
If you have difficulty talking with your friends and family or if they have difficulty accepting your decision, talk to someone trained in counseling, such as a nurse, social worker, psychologist or a member of the clergy. That person might have ideas for you to make talking with your friends and family easier.
Your friends and family may just need time to adjust to your decision. Let them know you want them close and still need their support.
Talk with your family about your wishes for the future — called advance directives. Discuss whether you'd want to be kept alive if machines were breathing for you. Appoint someone to make health care decisions for you if you were to become incapacitated.
What to expect after your treatment ends
If you decide to end your treatment, it doesn't mean you'll stop being cared for by doctors and nurses. You and your doctor will discuss your options. You might have a loved one or friend who wants to help take care of you. Or you might decide to use a home nursing service.
No matter what you choose, you'll still have regular checkups to make sure your pain is kept at bay and that you're comfortable. Your doctor might have you seen by another doctor who specializes in palliative care — a doctor whose main focus is to make you comfortable, not cure you.
Stopping your treatment doesn't mean you'll die immediately. After you end treatment, you could still be active and care for yourself for many months. It's also possible your health could deteriorate rapidly. How long you'll live after ending your treatment will vary depending on the type and stage of your cancer, as well as other health problems you may have.
Whether you want to stay at home is up to you and will depend on the level of care you need. You might feel more comfortable in a hospital or nursing home with doctors and nurses nearby at all times. Or you might prefer the comfort of your home with a nurse to check in on you every day. You might choose a hospice program, which is designed for people who generally aren't expected to live more than six months.
More time for what matters
When ending treatment makes you pain-free and more able to participate in various daily activities, you might find you have more time for friends and family. Being able to be cared for at home might mean you could keep up with hobbies or activities that make you happy.
Last Updated: 02/20/2006
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