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Colorectal Cancer: Managing Your Medical Care: Diagnosis to Treatment: Stage IV

How To Make A Colorectal Cancer Treatment Decision

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Having no regrets is important for emotional well-being. For survivors, this seems to depend far more on having gone through a reasonable decision making process than on whether or not the outcome was the one desired.

While you likely want to start the treatment as soon as possible, generally a decision about what treatment to have does not have to be made immediately.  This is an emotional time. It may be helpful to give yourself time to let emotions settle and to make the decision when you are more calm and clear headed. (For information about emotions and how to lessen their effect, click here.)

Take the time to study the pros and cons of each treatment under consideration.

  • The treatment recommended will be based on the type of colorectal cancer you have and the stage. (For information about colon cancer staging, click here. For information about rectal cancer staging, click here.)
  • If there is only one standard treatment for your situation, there may not be a lot to think about other than understanding the advantages and disadvantages - including possible side effects. Before starting treatment, at least learn how to deal with side effects that are most likely to occur so that you are not surprised and are prepared to deal for them.
  • There may be more than one option available in a given situation.
    • Although there are standards of care and guidelines, specifics may vary by doctor.
    • There may be disagreement between doctors about whether, and if so, how fast, a cancer will progress
    • Even top experts may disagree on the most effective treatment for a particular situation. Medicine is a combination of science and art.
  • Be aware that treatment options depend on the following:
    • The stage of the cancer
    • The location of the cancer.  Is it in the colon or rectum?
    • Your general health
  • There are nationally established guidelines in cancer treatment available and  used by all major cancer centers and NCI certified comprehensive cancer centers  offsite linkthat are published by the National Comprehensive Cancer Network and are available online at  offsite link
  • Discuss with your doctors the availability of curtting edge treatments through a clinical trial for your cancer. Clinical trials are studies performed with to test new drugs or combinations of drugs, new approaches to surgery or radiotherapy or procedures to improve the diagnosis of disease and the quality of life of the patient. Clinical Trials may offer you the opportunity to receive a treatment that is not yet available for the general public. (For a clinical trials matching service, click here offsite link). 
  • If there is a choice about which treatment to take, an often-used-analogy is to suggest that you at least take as much time considering which treatment to take as you do when deciding what automobile or other major purchase to make.

When considering the pros and cons of each treatment, keep in mind the following:

  • Each situation and person is unique. 
  • Your personal goals and priorities  – such as preserving quality of life for you and your loved ones.
  • No treatment for colorectal cancer is totally free of the possibility of side effects including diarrhea, and possibly incontinence  problems and an ostomy may be needed temporarily or even permanently.
  • No treatment for colorectal cancer has a side effect which leads to death.
  • When a drug is recommended, keep in mind that all drugs have risks as well as the benefits. Learn what they are. (For information about drugs, including how to purchase, store and dispose of them, click here.)
  • Ask any and all questions of concern to you about available treatment plans
  • Make a treatment decision based on your own lifestyle and beliefs.
  • You may want to consider treatments such as acupuncture, yoga, massage and the like as complementary or integrative to treatment, not "instead of” or as an “alternative to”. While many of these treatments can be helpful, there is no scientific proof that any of them cure colorectal cancer. (To learn about complementary or integrative treatments, click here
  • Ideally, your family and healthcare team should be involved before making a final decision.

A Few Things To Consider As You Make Medical Decisions

  • People who are the most active participants in their health care tend to do better. The ultimate active patient is the decision maker. However, the key is to do what works for you. It is your body and your decision. There are no right or wrong answers when it comes to who makes medical decisions. 
  • Select a person that can act as a patient advocate.  This person can  go with you to doctor appointments.  This person can help ask questions you may have forgotten to ask. He or she can also help recap when you get home what was discussed.  
  • Many cancer centers have patient navigators or oncology nurse navigators that are available to you to help guide and assist you as you navigate the healthcare system.  The Oncology Nurse Navigator is provided free of charge by hospitals and treatment centers..  For more information about Oncology Nurse Navigators go to offsite link.
  • Professional patient advocates are another option that is available if needed.  These advocates generally charge a fee for their services.  To learn about the value of a patient advocate and how to choose a patient advocate click here. For information about professional advocates, click here
  • If you want someone else to make medical decisions for you, expect that the doctor will require you to sign a document allowing him or her to disclose your medical information to that person. This is because of the confidentiality requirements in the federal law known as HIPAA.
  • You can continue to have control over medical decisions even if you become unable to communicate through legal documents known together as "Advance Healthcare Directives" or simply "Advance Directives." A Living Will is the advance directive we hear about most often but a Health Care Power of Attorney is the most all inclusive document to have. For more information, click here. (T32). Also consider Planning Ahead  
  • Ideally, your family and healthcare team should be involved before making a final decision.

NOTE: If body image is a consideration in making a decision, there are many tips to help with body image and sex/intimacy. Click here. 

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