Question from Anonymous Caring.com community member
In our last conversation with my father's doctor, she suggested we consider stopping chemotherapy, because it is no longer effective and is causing so many side effects. However, my father says he wants to continue chemo because he wants to "keep on fighting." How do we decide when it's time to stop, and how do I talk to my father about this?
Expert Answer by Redwing Keyssar
Redwing Keyssar coordinates the Palliative Care Program for Jewish Family and Children's Services of San Francisco.
This is a very hard conversation to have, when the doctor acknowledges that cancer treatment is no longer achieving results. You and your father have to weigh the negative aspects of treatment, such as uncomfortable and painful side effects, against your father's need to keep seeking a cure. It's one of the moments in care giving when the role reversal is very intense -- you're going to have to be the parent in this situation, and help your father decide what's the best thing to do, just as he did with you when you were young.
The fact that your father's oncologist raised the subject is a sign that she's a good doctor. Because oncologists are in the business of curing cancer, many times they feel such a sense of failure when a patient is getting sicker that they just keep treating even when it no longer makes sense.
You could start by suggesting to your father that the two of you talk to the oncologist again and ask a few specific questions, such as, "Is continuing treatment going to make a significant difference in the progress of the cancer?" You can also ask, "If we discontinue treatment, can we expect the nausea, pain, and other discomforts to diminish?" If the doctor answers that treatment at this point won't make a big difference, but discontinuing it will improve your father's quality of life, that may help clarify the decision for both of you.
You may find that your father is more ready to talk about these big issues than you think. So often for family members it's actually their fear of bringing up difficult issues that's getting in the way, not the cancer patient's refusal to talk about them. We as a culture are death-phobic, and family members are very fearful that stopping treatment will be perceived as "giving up" on the patient, when it can be just the opposite.
Sometimes this moment can be the catalyst for a really important conversation; you could ask your father, "If you only had six months or a year to live, what would be most important to you? What can we do to make it as wonderful as possible?" I always remind people that there's a difference between hope and what we call "expectations for outcome." Just because the treatment is no longer expected to bring about a cure doesn't mean it's time to give up hope. And as time goes on, hope can be about being out of pain and suffering.
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I just went thru this with my husband. I did not try to talk him out of it, he was terminal, but the treatments gave him some hope to cling to. In the end that was better for us and him.
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My father was becoming more and more weak with each chemo treatment. While driving home one day I asked him what was more important to him? His quanity of life or his Quality of life? He thought it thru then asked me to rephrase the question, I said, Dad, I can tell that this gets more difficult on you with each treatment, his chemo wasn't effective enough and the doctor had told him this. I explained the differences, that quanity would mean more chemo, more weakness etc whereas quality would allow him to sleep in if he wanted, allow the nausea to go away, for his hair to grow back, and allow him to enjoy what time he had left. I assured him that whatever he decided that I would stand by him. I just wanted to make sure that he understood that he did have a choice. After thinking it thru he decided that he wanted to eat his favorite foods, feel strong enough to hold his grandchildren, work in his garden and sit on his porch. He passed away 5 weeks later. Our family had some great times in those last weeks!!
