Quality Assessment Of Studies And Data Extraction
Study quality and eligibility were individually assessed by the two researchers . The extraction of data was done manually without extraction software. There was a critical review of the results by the researchers and coordinators . In case of different opinions regarding articles relevance, a consensus was reached by the authors. Data systematization was evaluated by the periodical , study location country, objectives , method , results, and mention of treatment refusal. Final assessment of the quality and level of evidence and the recommendation force of the articles, when absent in the original articles, were conducted by the authors, according to the criteria of the Strength of Recommendation Taxonomy scale by the American Family Physician .
Chemo Is A Carcinogen
The argument that chemotherapy drugs can cause secondary tumors or potentially increase your risk of the recurrence of cancer is another frequently toted reason some people refuse chemo. Again, there is a small kernel of truth in part of this fearfor normal, healthy people chemotherapy drugs can be harmful. Doctors and nurses who deal with these drugs daily must take extra precautions to protect themselves from the side effects of chemo drugs.
Every person diagnosed with colorectal cancer has the right to refuse chemotherapy, but hopefully, it’s done for the right reasons and the decision is based on sound research, thought and discussion.
Rejecting Cancer Treatment: What Are The Consequences
There have been several studies of people who have refused scientific treatments for cancer. The results have not been good.
These do not cure cancer
One of the points Ive tried to emphasize through my contributions to Science-Based Medicine is that every treatment decision requires an evaluation of risks and benefits. No treatment is without some sort of risk. And a decision to decline treatment has its own risks. One of the challenges that I confront regularly as a pharmacist is helping patients understand a medications expected long-term benefits against the risks and side effects of treatment. This dialogue is most challenging with symptomless conditions like high blood pressure, where patients face the prospect of immediate side effects against the potential for long-term benefit. Ones willingness to accept side effects is influenced, in part, by and understanding of, and belief in, the overall goals of therapy. Side effects from blood-pressure medications can be unpleasant. But weighed against the reduced risk of catastrophic events like strokes, drug therapy may be more acceptable. Willingness to accept these tradeoffs varies dramatically by disease, and are strongly influenced by patient-specific factors. In general, the more serious the illness, the greater the willingness to accept the risks of treatment.
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What Is Relapsed Multiple Myeloma
Multiple myeloma affects infection-fighting white blood cells called plasma cells in your bone marrow. Abnormal plasma cells multiply too quickly and crowd out healthy red blood cells and white blood cells.
Chemotherapy and other treatments kill multiple myeloma cells and put you into remission, which means your tests no longer show any signs of cancer. Relapsed or recurrent multiple myeloma is when the cancer comes back after you were in remission.
What Are The Benefits Of Chemotherapy
The main benefit of chemotherapy is its potential to destroy cancer cells. It remains one of the most potent tools we have to fight cancer. The potential benefit to each patient depends on treatment goals, which depend on the type of cancer, how advanced it is and what the patient hopes to get out of treatment.
For example, the goal might be to reduce the size of a tumor so that its easier to remove surgically. Or the goal might be to control disease progression as much as possible.
Some patients have cancer that has what we call curative potentialmeaning that if the cancer responds to chemotherapy, there may be no evidence of the disease after treatment. In these cases, the benefit is obvious. If theres a high likelihood that chemotherapy may get rid of your cancer, that benefit may outweigh possible side effects.
Some patients say they actually feel better and have more energy soon after starting chemotherapy because the symptoms of their cancer regress. When it happens, this improvement allows patients to enjoy some activities they hadnt felt up to doing.
Is chemotherapy worth it? In my years of experience as a medical oncologist, my answer is, Yes, usually. If its an option for you, its a decision youll have to make given your specific diagnosis and treatment goals.
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Patients Refusal Of Surgery Strongly Impairs Breast Cancer Survival
This was a Swiss study by Verkooijen et al, published in 2005 in the Annals of Surgery that looked at 5339 patients under the age of 80 with non-metastatic breast cancer. It didnt examine CAM, just the decision to refuse breast cancer surgery. It compared patients who refused breast cancer with those that those that accepted surgery. Only 1.3% of women refused surgery. Of that group, 37 had no treatment, 25 had hormone-therapy only, and 8 had other types of treatments. So only a small percentage refused all treatment. In this study, the five-year survival of women that refused surgery was 72% versus 87% of women who had surgery. Adjusting for prognostic factors, the authors estimated that women that refused surgery had a 2.1-fold increased risk of death from breast cancer compared to conventional treatment. The survival curves make this clear:
The bottom line in this paper was that a decision to forgo surgery for breast cancer is associated with dramatically worse outcomes and survival.
Advances In Cancer Care That Have Improved The Chemotherapy Experience
Cancer clinical trials, such as those we offer here at CTCA®, have resulted in an increasing number of treatment options and chemotherapy drugs. More options means your oncologist may have more choices if a treatment isnt working for you or if youre experiencing difficult treatment-related side effects. A quick look at the National Cancer Institutes list of drugs approved to treat breast cancer provides a good example of how treatment options have increased.
Researchers have also worked hard to reduce the toxicity of some drugs. Modifications include changing the dosage amounts, the intervals of administration and even how theyre administered. For example, researchers found that giving Velcade® to patients newly diagnosed with multiple myeloma may in most patients when its given by subcutaneous injection instead of by infusion.
Medications to prevent nausea and vomiting in those patients who experience it have also improved over the years. Some anti-nausea medications may be given at the same time as a patients chemotherapy infusion.
Chemotherapy drugs are sometimes used in combination with other innovative treatment options, such as targeted therapy or immunotherapy. In patients whose cancer exhibits certain genomic mutations, immunotherapy may keep their cancer in check on a long-term basisalmost as if it were a chronic illness like type 2 diabetes or heart disease.
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Refusing Medicine And Dying Early: When Complementary Medicine Actually Becomes An Alternative To Medicine
Olivia has breast cancer but refuses medical care, opting instead for natural herbs. This is alternative medicine.
Olivia has breast cancer and follows the recommendations of her oncologists, but also consumes natural herbs. This is complementary medicine.
While the refusal of medical treatment to pursue an alternative can be clearly understood as dangerous, we may ask, Whats the harm?, if medicine is not replaced but simply complemented.
A tiny window into the world of cancer patients who use alternative and complementary medicine has been opened by a team at Yale School of Medicine. It is a small, imperfect and possibly distorted opening, because their two studies had to accept a number of limitations, but it warns us that the phrase complementary medicine may often be a misnomer.
Heres what the team did. They looked at the National Cancer Database, which captures about 70% of new cancer cases in the U.S., and identified the almost 2 million patients who had been registered between 2004 and 2013 for the four most common cancers: breast, prostate, lung, and colorectum. They excluded people with stage IV cancer in order to study only curable cancers.
They wanted to know, compared to similar patients, do cancer patients who use either alternative medicine or complementary medicine fare worse? And who are these people?
Complementary and alternative medicine is bad for your survival
The smokescreen of complementary medicine
Talking With Your Loved Ones
Be open with your loved ones about your cancer and the news you’ve been given. Explore their thoughts, feelings, and suggestions. Talk to them about the options you have been given, along with the decisions you have made or are thinking of making. If you feel you need their input, ask. If not, be firm that you would like to make your own decision. You can read more about the importance of communication in Nearing the End of Life.
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When Someones Refusing Cancer Treatment: How To Accept Your Loved Ones Decision
When someone you love gets diagnosed with cancer, its normal to want to do everything to fight it. That said, not everyone wants conventional treatment. It can be devastating to have a parent, spouse or friend refusing cancer treatment. Although your first instinct may be to question their decision to refuse treatment, pause and listen first.
How Do I Make Treatment Decisions
Being diagnosed with advanced cancer or finding out your cancer has recurred or spread, can be overwhelming and you may feel a range of emotions. Everyones response will be different so you should give yourself time to take in what is happening and do what is comfortable for you.
It can be difficult to decide whether or not to have treatment for advanced cancer. Some people may choose treatment even if it offers only a small benefit for a short period of time. Some people may decide to treat symptoms such as pain or discomfort rather than having active treatment for the cancer. You may want to spend as much time as possible with family and friends without the disruption of treatment or you may choose chemotherapy if it meant having two good weeks each month.
Here are some things you may like to consider:
Know your options understanding the disease, available treatments and potential side effects can help you consider the options and make a decision you feel most comfortable with.
Record the details finding out you have advanced cancer can be a shock and you may not remember everything you are told. It can help to take notes or to have a family member or friend with you at appointments.
Ask questions if you want to check anything or feel confused, ask your specialist questions. You may want to prepare a list before your appointments.
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If Another Treatment Is Available
If you have cancer that keeps growing or comes back after one kind of treatment, its possible that another treatment might still help shrink the cancer, or at least keep it in check enough to help you live longer and feel better. Clinical trials also might offer chances to try newer treatments that could be helpful.
If you want to continue to get treatment for as long as you can, its important to think about the odds of further treatment having some benefit , compared to the possible risks and side effects. Your doctor can help estimate how likely it is the cancer will respond to treatment you might be considering. For instance, the doctor might say that more treatment might have about a 1 in 100 chance of working. Its important to have realistic expectations if you do choose this plan. The possible benefits, risks, side effects, costs, schedule of treatments and visits, and effect on quality of life should always be considered and discussed.
If You Refuse A Treatment In All Circumstances
You might wish to refuse a specific treatment in all circumstances, rather than in just one specific situation.
For example, you may want to refuse a specific medication in all circumstances if you:
- have an allergy
- do not want the medication for religious reasons.
If you want to make a statement about refusing a treatment in all circumstances, you should talk with a healthcare professional first. They will make sure that your ADRT is clear for any health professional who may need to use it in the future.
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Facing The Final Stages Of Life
When someone’s cancer is no longer responding to treatment, it can also be a scary time for those close to them. No matter how hard it might be, it’s still important to try to be there to give support. Try to follow the cues and stay in the background but be available when they need you.
Some people worry about what to say when a person with cancer talks or asks about dying. Listen to them and be open and honest. Dont try to answer questions that you dont know the answers to. Offer to help them reach out to their health care team. There are no magic words for a person who is dying, but often your presence and support goes a long way.
Treatment : Supportive Care
Supportive cancer care can be an effective complement to standard treatment, helping to minimize the physical and emotional stress of cancer treatment.
For example, psychotherapy and massage therapy can help ease patients anxiety as they cope with a diagnosis acupuncture can be beneficial for pain relief and nutrition counseling can keep a patient from losing too much weight during treatment and keeping their body as healthy as possible.
Other types of integrative medicine include the following:
Aromatherapy Hypnosis Mindfulness meditation
Anything you can do to keep a patient mentally and physically well while they handle the stress of having cancer is beneficial, Budds says. Its just one of the growing set of tools we have to help our patients deal with cancer. Weve come a long way in recent years.
What Are The Risks Of Chemotherapy
While chemotherapy may kill rapidly growing cancer cells, the downside is that it may also damage healthy cells in the process. This is often the cause of some common side effects of chemotherapy. For example, chemotherapy may temporarily decrease the production of red and white blood cells in the bone marrow, which may lead to anemia, fatigue and a suppressed immune system. Certain drugsnot all damage cells that help hair grow, which may lead to temporary hair loss. Damage to cells in the digestive system may cause vomiting, diarrhea or constipation.
Not everyone experiences the same side effects to the same degree. The side effects you may experience depend on the type of chemotherapy you receive, the combination of drugs youre treated with, whether you have any other chronic illnesses, the medications you may be taking for other conditions and how active or fit you are going into treatment. Your oncologist considers these issues when determining which treatment options may benefit you and whether you can tolerate treatment.
Common short-term side effects include:
Long-term side effects are less common, but they may include:
Before therapy, patients have to sign consent forms that list every potential side effectmany of which are very rare but still quite scary. Your doctor can tell you which ones you may be more likely to experience.
Questions For Your Doctor
Once you’re diagnosed, your doctor will put you on a new treatment plan. Make sure you understand why your doctor wants to go that route and what you can expect once your therapy starts.
Ask your doctor questions like:
- Why did you recommend this treatment?
- How might it help my cancer?
- What side effects can it cause?
- How can I manage any problems that I get from the treatment?
- When should I see you again?
- Where can I go for support?
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Talking With Someone Who Has Cancer
When talking with someone who has cancer, the most important thing is to listen. Try to hear and understand how they feel. Dont make light of, judge, or try to change the way the person feels or acts. Let them know that youre open to talking whenever they feel like it. Or, if they dont feel like talking right at that time, thats OK, too. You can offer to listen whenever theyre ready.
There may be times when the uncertainty and fear make the person with cancer seem angry, depressed, or withdrawn. This is normal and is a part of the process of grieving what was lost to the cancer . Over time, most people are able to adjust to the new reality in their lives and go forward. Some may need extra help from a support group or a mental health professional to learn to deal with the changes cancer has brought into their lives.
Some people with cancer might talk about death, worry about their future or their familys future, or talk about their other fears. You dont always have to respond but be ready to hear their pain or the unpleasant thoughts they might want to share. If you are asked your opinion about their illness, treatment, or other parts of their cancer journey, be open and honest, but dont try to answer questions that you dont know the answers to.
Try to make your response honest and heartfelt. Here are some ideas:
What Is A Dnacpr Decision
You may hear doctors or nurses talk about a Do Not Attempt Cardiopulmonary Resuscitation decision. This is a written record stating the decision not to give CPR if someoneâs heart or breathing stops. These may also be called DNARs .
You may have already made a decision about not wanting to be resuscitated in a specific situation and included this in your ADRT. If you have not made a decision about CPR but you want to, talk to your GP, cancer doctor or specialist nurse. You may also want to talk to your family, a close friend, or a spiritual or religious leader.
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