Decision Making and treatment of cancer is a complicated one and involves in addition to service provider , also the family or the care giver. The treatment team involves the medical Oncologist , Surgical Oncology Team and the Radiotherapist . Usually the treatment is planned by the treating Oncologist. The different option for cancer treatment are decided in a particular patient depending on socio- economic status , Functional status of the patient and social responsibilities .
Decision Making is involved at several steps:
- Curative or Palliative Treatment
- Treatment in hospital
- Treatment or Care at home
- Follow up
- Recurrence or prolonged Treatment
- End of treatment
- End of Life Care
- Diagnosis :
- Revealing complete diagnosis to patient and family is most difficult and is always done with care and there is always a question how much patient should know ? . Gradually patient has all the right to know everything as it involves planning of left goals and social responsibilities.
- Curative or Palliative Treatment ?
- Depends on stage at which patient presents and hence decision is more a scientific decision but also involves the carer as whole support is provided by them.
- Treatment in Hospital:
- All the events that take place during hospital stay are regularly informed and decision are taken with multiple family meetings.
- Care at home:
- Home care whether in a post treatment sitting or Palliative sitting is provided by the family and small things should not bother them , patient relatives should always be in contact with oncologist for identifying suitable intervention required or not.
- Follow up:
- Proper follow up protocol to be followed and any untoward incident and disease progress needs to be addressed by joint decision making.
- Recurrence and Prolonged Treatment :
- Regular follow up leads to early detection of recurrence and sometimes repeated intervention from part of treatment. Prolonged treatment usually makes the person emotionally drawned along with the family hence decision making is always difficult. But repeated counseling and reassurance leads to be good decision in favour of patient.
- End of Treatment :
- Biggest dilemma is when to stop treatment as at nay stage of disease some form of treatment is available but its always the carer prerogative to decide till when to continue.
- End of Life Care:
- When the patient is almost is exhausted with supportive treatment also then end of life care is a tough decision but family has the utmost right when to stop.
There is support of the government for some government employees , PSUs and through some insurance companies. Suppose the patient has an advanced cancer , has an important pending social function ,he may opt for aggressive treatment to get some more valuable time. However , if a patient has minor social responsibilities , he may not go for advanced aggressive treatment considering financial implication . So , the family and the professional team have to decide individualized treatment for a particular patient . Newer treatment options likes HIPEC , Targeted Therapy and Immunotherapy may not be affordable for the common man. There are about 50% dropouts when a strict treatment protocol is followed. Surgical methods likes Robotic Surgery and Radiation Techniques like SBRT and cyber knife involve high cost are of limited use.
Multimodality cancer treatment has several option of treating a particular disease. Hence decision making can be as per patient comfort and requirement. For breast Cancer , Breast Conservative Surgery VS Modified Radical Mastectomy , Chemoradiation protocol VS Total Laryngectomy in Ca Larynx. Chemoradiation followed by Surgery for Ca Rectum to enable sphincter preservation. All these decisions need the patient and family to decide as per socioeconomic requirement and treatment advised by the oncologist.
Being an Oncologist or Oncosurgeon , we always decide as per our own conscience , that as if the patient is our own family member then what to do ? that almost all the time gives the best answer. But still we always advise all our patients not to hurry in decision making and second opinions are most welcome.
Different options , modalities , treatment outcomes are always explained to the family . Apart from scientific protocol , socioeconomic status , future responsibilities all play a vital role in decision making. Hence a trimodal approach , Patient care and professional usually forms the decision making team.
As you decide which car to purchase which house is suitable for you to decide , patient and care giver has all the right to ask for different options in the treatment. In modern Cancer Management role of patient , care giver and the Oncologist in decision Making process makes best use of available options and resources.
“Max Hospital offers the best of cancer treatment services with its dedicated team of Oncologist , Onco surgeon and Radiotherapy Specialists. As we always involve the care giver and the patient in the process of Decision making”.