Given the number of chemotherapy regimens and other forms of treatment available (for ovarian cancer), physicians have found they often can keep the disease under control after a recurrence for many years at a time. If you have small amounts of disease that are stable—that is, not growing or spreading—you can live a normal life with the help of intermittent or even continuous treatment. For many women, this represents a very good option. They find the side effects of treatment are tolerable and, at the same time, they enjoy the benefits of an extended life. They also have hope that a newer, more effective treatment (for ovarian cancer) will come out of clinical trials. They may even decide to take part in a clinical trial themselves.
However, there also may come a point at which the disease fails to respond to treatment with any chemotherapy agent or any other drug, for that matter. In a small number of women, this happens early: The disease simply is not sensitive to treatment with chemotherapy. More often, however, this resistance develops over time, after many treatments are given. Still other women find that they reach a point at which the drawbacks of continuous treatment, such as fatigue and other intense side effects, outweigh its benefits. Wearied by the rigors of life-sustaining treatment, they begin to question whether they wish to continue.
There is no magic formula for determining when the time is right to stop treatment. Rarely is this decision absolutely clear. Although one woman may prefer to move from treatment to treatment in the hope of prolonging life, another might feel this is simply no way to live. This is a deeply personal decision that must be made in close cooperation with your healthcare team and loved ones.
If you do reach a point at which you decide to stop treatment, you should not feel you have failed or given up too soon. It takes great courage to stop treatment and prepare for the end of life. There is no rhyme or reason to explain why your disease is progressing. It's tempting to think thoughts such as "if only I had fought harder" or "if only I had thought more positively"—but you will not find any answers there. There is no clear explanation as to why some women go into long-term remission and others do not, and there is no scientific evidence that positive thinking will prolong your life.
Try not to worry that your decision will disappoint family members and loved ones. A t first, you may have their support or you may not. Given time to adjust, they eventually should come around to support you. And even though things may seem completely out of your control, there are ways you can take control at this very difficult time. You can help determine what kind of experience you and your closest loved ones will have as your life comes to an end.
Questions to Ask Your Doctor
How would you say I am doing right now? How would you describe my prognosis, or the likely outcome of my disease?
If my current treatment proves unsuccessful, what would you recommend next?
Do you recommend that I stay on treatment indefinitely if it continues to work for me?
At what point might you recommend I stop active treatment for the disease?
In your opinion, when would the drawbacks of continuous treatment begin to outweigh its advantages? How have you dealt with this issue for other patients who are under your care?
Excerpt from Ovarian cancer: your guide to taking control. (Kristine Conner) O'Reilly, 2003 with permission from the publisher.
Keep in mind that stopping active treatment for cancer is not the same as stopping treatment altogether. As we will explain in the next section, there are still things that can and should be done to ensure your quality of life. You and your healthcare team may decide that surgery, chemotherapy, or radiation therapy are warranted if the cancer begins to cause unpleasant side effects, such as pain, pressure, ascites, or intestinal problems. Pain medications also should be used to make sure you are comfortable.
Ronald Alvarez, MD, a gynecologic oncologist at The University of Alabama at Birmingham, explains:
"I always make the point that I don't treat cancer—I treat people with cancer. So if and when the time comes that there are no treatments likely to be effective for the cancer, there are still lots of 'treatments'; to alleviate cancer-related symptoms."
Making these decisions requires flexibility and good communication with your healtcare team. There is no set path that works well for every woman. In large part, decisions about interventions will depend on what your goals are. It's important to gibve some serious thought to what you want to accomplish during this time. Perhaps you simply want to enjoy time with family and friends. Ior maybe you want to take a trip, finish a project you have been working on, or make videos or scrapbooks for your children, grandchildren, or siblings. Tell your doctor what you want to accomplish so she can best help.
