Working with your doctor when you have metastatic breast cancer: Interview with a Mayo medical institution expert.
A cancer expert answers common questions about making treatment decisions and preparing for the future when you have metastatic breast cancer.
Hearing your doctor tell you that you've got metastatic breast cancer can be shocking. Once you've had a chance to gather your thoughts, make time to have a conversation with your doctor and your loved ones about next steps.
Here, Mayo medical institution oncologist Timothy J. Moynihan, M.D., shares his advice on what issues to discuss with your health care provider and loved ones.
Many different treatment options for metastatic breast cancer exist. What factors should guide my treatment choices?
Discussing treatment goals is a critical conversation to have with your health care provider and loved ones. Some questions to get the conversation started include:
How aggressive do you want to be? Depending on how you are feeling right now, age or other factors, you may or may not be able to tolerate more-aggressive treatment.
Aside from the cancer, how is your health otherwise? Do you have other medical conditions to consider?
Is having children in the future a concern for you? Talk to your doctor about your fertility options and how that may affect your treatment plans. Ask for a referral to a fertility specialist if you have questions.
What quality-of-life issues are most important to you during this time? Are you willing to put up with side effects of treatment such as fatigue and nausea that may negatively affect your day-to-day life but could prolong your life and time with loved ones?
How important is pain and symptom control to you? Discuss with your doctor how your pain will be managed or if there are complementary medicine methods that may help you cope.
Do you have health insurance? If the cost of treatment is a concern for you, let your doctor know. There may be lower cost options, such as generic drugs, or financial assistance available.
I hear about new cancer treatments in the news all the time. Are there any experimental treatments I should consider?
Ask your doctor if you're a candidate for a clinical trial. Eligibility depends on many factors, including where you live, previous breast cancer treatments and individual characteristics of your condition. A searchable listing of clinical trials is available at clinicaltrials.gov.
What if the treatment isn't working? How will I know?
Talk to your doctor about how to measure the success of your treatment plan and when to discuss stopping or changing treatments.
If treatments to slow the growth of the cancer aren't working, it may be time to discuss switching your treatment focus to reducing pain and other symptoms through palliative care, hospice care or home care.
How can I make sure my treatment wishes are respected?
Talk about your wishes with your loved ones as well as your health care team in advance.
An advance directive, such as a living will or durable power of attorney for health care, can let you decide ahead of time about how you will be treated. Laws regarding these documents vary by state. Talk to your doctor, social worker or lawyer for more details.
I don't want my loved ones to suffer. How can I prepare them?
Planning for the future may seem daunting, but it can also bring you peace of mind. Having a plan in place can ease the emotional, financial and legal burden your family will face after you're gone.
Talk to your lawyer or social worker about creating two different wills. One is for financial purposes; the other is for medical decision-making. Assigning someone to help make your decisions for you, if you are ever unable to speak for yourself, can make sure that you are treated the way you wish to be treated.
It's also a good time to get your affairs in order by gathering your financial records, insurance policies and other important documents. Put them in a safe place, such as in a safety deposit box, in a fireproof box or with your lawyer. Be sure your loved ones know where to find them and can access them in case of an emergency.
You may also want to help your family make funeral arrangements or plan a celebration of your life with your own personal input.
Feb. 05, 2020
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- Moynihan TJ (expert opinion). Mayo medical institution, Rochester, Minn. March 2, 2017.
- Talking about your advanced cancer. National Cancer Institute. https://www.cancer.gov/about-cancer/advanced-cancer/talking. Jan. 6, 2020.
- Planning the transition to end-of-life care in advanced cancer (PDQ) — patient version. https://www.cancer.gov/about-cancer/advanced-cancer/planning/end-of-life-pdq. Accessed Jan. 6, 2020.