Is Opting Out of Breast Cancer Treatment an Option?

What to Consider About Refusing Treatment for Breast Cancer

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Is choosing to opt out of breast cancer treatment an option? What if I choose 'no treatment' or 'natural treatments' instead of conventional breast cancer treatments? You might think that if you were diagnosed with breast cancer, then the first course of action would be to determine your treatment options and get started right away. But for some patients, the treatment of choice may be no treatment at all.

Why Would Someone Refuse Treatment?

The reasons for opting out of cancer treatment are as diverse as the treatment options themselves. For some women, it's purely a personal decision; for others, cultural or religious considerations may play a part. Here are a few of the reasons why a patient might not be eager to begin treatment:

  • The need for more time before commencing treatment. In deciding against an immediate start of therapy, a woman may not be ruling out treatment altogether. She may be leery of jumping into a treatment plan while she's still coming to terms with the diagnosis. Or she may want to delay treatment for a wedding, big trip, or some other specific event.
  • Skepticism about health care. Patients who have witnessed bad outcomes — or are generally distrustful of the healthcare system — may not be willing to put their faith in a treatment plan or medical team.
  • Fear of the side effects of treatment. The side effects of breast cancer treatment can be difficult and may have a profound impact on a woman's quality of life. Depending on what stage of life she is in (and the stage of her cancer), she may decide that the likely benefits don't outweigh the hair loss, nausea, missed work and other effects.
  • Matters of faith. Many religions discourage certain medical interventions that may be necessary for cancer treatment. Even in cases in which the patient's religion doesn't explicitly forbid treatment, she may feel comforted by entrusting her fate to a higher power.
  • A desire to maintain quality of life in the time remaining. If a woman's prognosis isn't good, she may prefer to spend her days doing what she loves rather than fighting a battle she's unlikely to win. Likewise, for advanced cancer cases, some women choose hospice care, with its emphasis on emotional support, maintaining quality of life, and pain control rather than aggressive interventions or participation in clinical trials to test new therapies.

    How Can This Be Allowed?

    How can this be? In this era when we have excellent treatments for breast cancer do patients have the right to refuse medical treatment? While it may be hard for those around to understand a woman's decision to refuse cancer treatment, this option is well within her rights. Her physicians may urge her to reconsider, especially if her chances for recovery are good. But in the end, they must defer to her wishes.

    As part of the decision process to undergo or decline significant medical treatment, patients must either give or withhold their informed consent. Most people have encountered one aspect of informed consent, which is the signing of a medical consent form.

    But informed consent is much more than just signing a document. It involves discussing the risks and potential benefits of the recommended treatment, as well as the risks and benefits of receiving no treatment at all. The physician addresses the patient's questions about treatment.

    The decision does not need to be made immediately. Patients may want to discuss their options with loved ones or think about them privately before making a decision. Patients may have follow-up questions or they may want to consult another clinician for a second opinion before making a final decision.

    Whether a patient decides to accept or decline treatment, she may be asked to sign an informed consent document confirming her decision.

    Integrative Cancer Treatment

    Some patients may look into complementary and alternative medical (CAM) treatments for their cancer diagnosis. As examples, these may include reflexologyherbal supplements, and homeopathic remedies.

    It's important to understand that these options are not the same as conventional treatments like chemotherapy, surgery, or radiation. Although they are sometimes titled "alternative," the label is misleading—these treatments are not alternatives to the potentially curative conventional treatments, which are treatments with agents that have proven efficacy.

    They lack the evidence and scientific basis that conventional treatments have, and thus are not recommended to be used in place of conventional treatments.

    However, many patients can use CAM treatments alongside conventional treatments. This is called integrative medicine: a combination of conventional treatments and complementary ones. The complementary ones can help patients cope with the side effects of conventional cancer treatments. In fact, many of the large cancer centers now offer integrative treatments for people living with cancer, as they can be a source of strength and comfort for someone living with cancer.

    Before incorporating a complementary treatment into your plan, you should talk to your doctor and make sure it is safe to do so. Question the benefits you can expect, the risks involved, potential side effects, and if insurance will cover sessions, for example.

    If You're Thinking of Opting Out of Treatment

    If you've considered foregoing conventional treatments for breast cancer, consider first the 4 goals of medical treatment. What are your goals? Are they preventive? Do you hope for a cure? Is your focus the management of your disease, or instead palliative — staying comfortable with the time you have left.  Check out these tips on making an objective medical decision including weighing the pros and cons of your choices. Getting a second opinion — or even a 3rd or 4th — may help you not only make the best decision for you but one that leaves you feeling confident in your choices.

    If You Know Someone Who Is Declining Treatment, What Should You Do?

    If someone you care about has chosen not to continue their cancer treatment, be as supportive as you can. She may have already been met with resistance from her healthcare provider and those closest to her. If her mind is made up, she won't welcome yet another debate.

    If she's still struggling with her decision, offer to listen and help her sort through the options. Ask if she'd like you to join her for support at her next doctor's appointment to help her get the answers she needs or stand her ground.

    Sources:

    National Cancer Institute. Complementary and Alternative Medicine. http://www.cancer.gov/about-cancer/treatment/cam.

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