When Treatment Fails: Facing Death

Patient Expert

When you were diagnosed with breast cancer, what was your first thought?

"I'm going to die." Right? First vision that popped into your head: a deathbed, a funeral, motherless children.

In years gone by, cancer often did progress to death. Doctors didn't understand it; there were no good treatments, save surgery. So especially for those of us who are a bit older, a cancer diagnosis can still feel like a death sentence.

Statistically speaking, as of 2005 (the last year such statistics were gathered by the National Institutes of Health), about 1 in 5 women with breast cancer will die from that cancer, or its complications.

1 in 5. Just twenty percent. If you have breast cancer, your odds of surviving it are quite good.

Still, some of us fall into that 20% who won't survive. Who do everything right - surgery, chemo, radiation, hormone therapy - and still have it all come out wrong. Who find ourselves at the end of the line; no more treatments to try.

What then?

Facing the inevitability of death is almost certainly a longer-lasting, harder blow than the initial cancer diagnosis. Back then, you may have faced sleepless nights as you imagined the worst. But you very quickly went into treatment; your oncologist assured you that you were doing everything possible to kill those cancer cells, and that you had every hope of living a long and healthy life, post-treatment.

Now, the oncologist looks at you somberly, sympathy in her eyes. She didn't cure you. She has nothing left to try. Her pain is real, and no doubt significant - though surely not as great as yours.

How do you deal with death?

Some women are almost happy to let go. Exhausted from treatment, both physically and emotionally, they see death as a blessed relief from unrelenting pain.

Others refuse to accept death's inevitability. Miracles happen. There's always another treatment out there, despite the oncologist's best advice. These women go to their death fighting with every ounce of remaining strength to hold onto life.

In between these extremes are women who maintain hope up to their last few weeks or days. "I'm not really going to die. Something will happen." Then, when "something" doesn't, they face death - eyes wide open.

When you stop fighting cancer, and admit that it's gained the upper hand, how do you feel? Is there a "right" way to feel?

It depends on your personality. For some - those who refuse to accept death, right up to the moment it comes - ending treatment probably feels like defeat. You fought hard, and lost. You're angry. You feel like a loser.

Or you feel that you don't "deserve" to die, not after trying so hard. Life is unfair; it's not supposed to end like this.

And that's OK. Validate your feelings; they reflect the person you are, the person you've been your whole life.

At the same time, try to let those feelings go. Living out your last days with bitterness in your heart is a tough way to go. How much easier if you can see death as simply the end of life. No one won, no one lost. We all die; fair or not, your time has come.


For some - the peacemakers, those who've always avoided conflict and valued cooperation - death is something to work with. It's scary, for sure; none of us likes change, and fear of the unknown is natural. But death isn't the end; it's a passage to something else.

If you're religious, you might see yourself in Heaven, or your religion's equivalent. If spiritual, you might envision your soul returning to the universal river of life. But you harbor no anger; death is simply a very short transition in the continuum of eternal life.

How do you think you'll feel about death, when your time comes? Will you "go gentle into that good night"" or not?

Me, I hope to "go gentle." I believe life continues after the time I spend here on Earth.

How about you? To join the discussion, please add your comments below.

For more on the subject of death and dying, please check out the following posts:

When It's Time to Let Go - words of wisdom from one of America's foremost palliative care experts, Dr. Ira Byock.

How an Oncologist Deals With the Death of a Cancer Patient - by Dr. Kevin Knopf, our contributing oncologist.

Calling Hospice - by expert patient Phyllis Johnson.

When Friends Die - my take on helping a friend or family member through the days leading up to death.