Breast Cancer Treatment Decision-Making

PJ Hamel Health Guide
  • Making decisions – I wish the doctor would just tell me what to do!

    Remember the moment when you heard those words, “You have cancer?" Depending on the doc’s bedside manner, the message may have been delivered factually, straight-on and cold; or it may have nestled among words of hope, sticking out like an ugly weed in a bed of roses. But however it was delivered, it no doubt threw you for a loop, to put it mildly. If you’re like me, you didn’t hear anything else beyond that introductory sentence or two. All the information following–size of the tumor, treatment options, advances in cancer research, which doctors you’d be seeing and in what order–went into your brain and disappeared, totally obliterated by the enormity of the newly revealed fact: YOU HAVE CANCER.

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    So, already you’re behind the eight-ball. You leave the office, and 10 minutes later–or 30 minutes, or 24 hours–you’ve absorbed the fact that you have cancer; that all the positive thinking in the world (“Plenty of women every year have questionable mammograms… have negative biopsies…”) didn’t prevent you from drawing the short straw. Now what? Hmmmm, I think the doctor told me a bunch of stuff, but now I can’t remember what he said. Should I call him back? Won’t I seem stupid? What do I do next?

    Step one: Call (or get online), and figure out if the hospital where you’ll be treated has a special program for breast cancer patients or, if not that, for cancer patients in general. A good place to start is the office where you got your diagnosis–either your PCP’s office, or perhaps the department of diagnostic radiology, or mammography/breast imaging. Ask them if there are standard resources for breast cancer patients; you’re looking for someone to talk to, preferably a social worker or someone familiar with the treatment path you’ll be following. And what you’re REALLY looking for is a sympathetic ear, someone trained to help you absorb the fact that yes, you really do have cancer, then to support you as you begin treatment. The first step in this support is to show you where to begin.

    Right away, you’ll have decisions to make. Attention, ladies: cancer is not a broken leg. You don’t go to the emergency room, have the leg set, and walk out with a cast and some painkillers. Surprisingly, for something so much more dangerous, cancer is also much more flexible in its treatment options. Over and over throughout the process, I just wanted someone to tell me what to do. Instead, I got choices. Which meant I needed to make decisions. And how do you make a potentially life-or-death decision when your knowledge is so scanty? Your tumor is invasive, but small; do you opt for a lumpectomy and hope that does the job, or do you go for the mastectomy? If you have a mastectomy, do you have a simple mastectomy, or do you opt for plastic surgery, in addition? If plastic surgery, do you want an implant, or reconstruction? If reconstruction, a tram flap, or… And then there’s the chemo choice, and the radiation choice… Well, you see how it goes. Chances are your health-care providers will outline in detail the pros and cons surrounding each decision. For surgery, they’ll tell you success rates, recovery times; for chemo and radiation, lots of percentages: “If you take THIS drug and THIS drug, then follow with radiation, your chance for recurrence will be 6% less than if you take only THIS drug with no radiation…” Trust me; it’s all very confusing. No matter how hard you listen, how much online research you do, you’ll still have questions. You’ll still doubt, very much, your ability to make the “right” decision.


  • So, how do you finally make these decisions? Many hospitals have a department specifically serving patients who need to make health-care decisions, whether they concern cancer, types of heart surgery, or which way to go with a living will. Find out if your hospital offers this service, and if it does, take advantage of it! I chose lumpectomy over mastectomy as a result of watching a video that included interviews with women who’d had one or the other; it was great hearing other women speak about the pros and cons of their experience. Second, see if someone in the hospital–probably that same social worker–can hook you up with a few women who’ve faced the same decisions you’re facing. Like the video, it’s wonderful hearing about someone else’s experience; although doctors’ facts and figures about outcomes are valuable, hearing from someone who’s been down the path you’re about to take is invaluable. Like an outdoors guide, these women have been to the top of the mountain. And they can tell you not only about the spectacular view, but about the rockslides you might run into along the way!

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    Ask a question or share your experiences in the message boards.

Published On: July 20, 2006