The Decision – Which treatment is best?

You, or one of your loved ones, have been diagnosed with cancer. How do you best move forward…

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Short summary on treatment decisions

From anxiety to control:

• A cancer diagnosis often leads to anxiety and a sense of loss of control, as the healthcare system can quickly take charge. Taking an active stand is a way to regain some of that control.

Your choice, your strength:

• It is crucial to find the treatment you believe in most—whether it is conventional, complementary, or purely alternative. An informed choice that you support wholeheartedly provides inner peace and strength.

Find your own path:

• Use your own compass by considering all factors: your type of cancer, the different treatment options, and your personal values. The goal is to find the path that is right for you.

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Which treatment is best

The Fear

We are all afraid of being struck by cancer, because we all know someone who, despite following the prescribed treatment, did not make it through the process or suffered a relapse (recurrence) shortly after.

A cancer diagnosis, not least for the reason above, often triggers an intense feeling of anxiety. This anxiety is natural and can be related to many different aspects of the disease and treatment. Many patients experience a deep uncertainty about the future. Fear of not being able to be cured. Fear of pain. Fear of losing control over one’s body and life. Fear of death. Fear of how loved ones will cope. And if you have no close relatives, fear of how you will manage this alone. [4, 15]

See also Psychological and emotional management

Loss of control

When you receive a cancer diagnosis, you also experience the ultimate loss of control. In principle, you receive a death sentence and are aware that time can be a decisive factor. This leads to vulnerability in your situation and, consequently, in your decision-making process.

Thus, the established system finds it easy—with the best of intentions—to completely take over the management of the treatment and, by extension, your life or the life of your loved one. To provide the best possible help, our healthcare system has designed pathways to ensure what it deems the best cancer treatment as quickly as possible. From this point, it can feel as though all decisions are being made over your head. And, in a sense, they are.

For this reason, it is common for patients to be far into the course of treatment before they have the capacity or the opportunity to reflect on what is actually taking place.

Considerations

Often, you will have already undergone surgery and be well into chemotherapy by the time you begin to think:

• Is this even the right path for me?
• Can I live with the side effects that are appearing?
• Am I prepared for the consequences of any potential late effects? What do I value most in my life—quantity or quality?

Se også Ansvar og kontroltab

Your role in the decision-making process

Although the doctors provide the professional recommendation, you are the most important person in your own journey. Taking an active role can provide a sense of control and helps ensure that the final treatment plan aligns with your values and wishes for your daily life.

Shared Decision-Making

One often speaks of “shared decision-making.” It is a process where you and your doctor work as partners to make the best decision.

• The doctor contributes: Medical knowledge of your illness, the different treatment options, statistics on effectiveness, and knowledge of risks and side effects.

• You contribute: Knowledge about yourself. What is most important to you in your life. Which side effects you particularly fear and why. What your family situation and work life look like. Your preferences and your gut feeling are also a completely legitimate and important part of the decision. [1]

Your informed consent – a statutory right

The foundation of your involvement is the right to informed consent, which is established in the Danish Health Act (Chapter 5, Section 15). This principle means that no treatment may be initiated or continued without your consent, which must be given on a comprehensive and understandable basis. [30]

For your consent to be valid, you have the right to receive information about:

• Your health status and treatment options, including an understandable presentation of the illness and the purpose of the proposed treatment (Section 16, subsections 1 and 3).
• Risk of complications and side effects that may arise in connection with the treatment (Section 16, subsection 1).
• Other medically sound treatment options, so that you are aware of relevant alternatives (Section 16, subsection 4).
• The consequences if no treatment is initiated, so you understand what opting out entails (Section 16, subsection 4).

This right ensures that you have the necessary foundation to be an active and equal partner in the decisions made about your health.

Second opinion

The term ‘second opinion’ is often used for situations where a doctor chooses to ask another medical colleague for an assessment of a patient’s course of illness.

It is important to be aware that, as a patient, you do not have an actual right to demand that another doctor evaluates your diagnosis or treatment.

If you experience that your case is particularly complicated—for example, if the diagnosis is difficult to establish, or if there appear to be no more treatment options—you can have a conversation with your treating physician. Together, you can discuss the possibility of being referred for a new assessment at another hospital or a different department.

What you should do

It is not an expression of distrust toward your current doctor, but a way to achieve peace of mind and certainty in a difficult situation. A second opinion can confirm the original plan or provide new perspectives on your treatment options.

If you want a new assessment, the standard procedure is to speak with your attending physician or contact the patient advisor in your region. They can help you, if possible, to be referred to a relevant specialist at another department or a different hospital within the public health system.

If this is not an option, you can, at your own expense, contact a hospital in Denmark or abroad for a second opinion.

Experimental treatment

For patients with a life-threatening illness where no further established treatment options exist, there is a special pathway. In these cases, your attending physician can contact “The Panel for Experimental Treatment” under the Danish Health Authority on your behalf to investigate whether relevant experimental treatments, such as Phase 1 trials, are available. [10]

Factors of significance for choosing treatment

Understanding treatment goals

It is crucial to have an open conversation with your doctor about the purpose of the proposed treatment. The goal significantly impacts the course of treatment, expectations, and the choices you make together. Broadly, a distinction is made between two purposes:

• Curative treatment: The word means healing. The goal here is to remove all cancer from the body and make you healthy. Curative treatment is typically an option when cancer is detected at an early stage and has not spread.
• Palliative treatment: The word means relieving. If the cancer is advanced and a cure is not possible, the goal is instead to slow the progression of the disease, alleviate symptoms such as pain and nausea, and maintain or improve your quality of life for as long as possible. Palliative treatment is not the same as no treatment, and in many cases, it can extend over a long period (many years).

Type and stage of the cancer

• What type of cancer is it, which specific form of cancer is involved, and how advanced is it (size and boundaries of the tumor)?
• Is the cancer localized, or has it spread to other parts of the body (are there metastases)?
• What is the prognosis for survival with traditional cancer treatment compared to no treatment or alternative or complementary cancer treatment?
• Do you have actual pain or a certain degree of physical discomfort?

Statistics and quality of life

The personal trade-off

A central question in any treatment choice is whether the statistical gain in survival is worth the cost in terms of side effects. Many would rightly opt out of a harsh treatment if the difference was only a few percent.

What the statistics show

Scientific studies show that when comparing full conventional treatment with exclusively alternative treatment for curable cancers, the difference in survival is not small. A central retrospective observational study (non-randomized) from Yale University, for example, found a 5-year survival rate of 86.6% for the conventional group compared to only 57.9% for the alternative group. This statistic refers to source [25].

A study like this from Yale can seem frightening, but it is crucial to use it correctly. Its primary conclusion is not that complementary measures are dangerous, but that there is a significantly increased risk in completely opting out of documented, conventional treatment, especially for cancer types that are otherwise curable. Specifically, the study says nothing about the effect of an integrated approach, where one combines the best of both worlds—for example, by supplementing surgery with targeted supplements, lifestyle changes, or repurposed drugs.

In modern cancer treatment, this dilemma is recognized. Tools like ‘Predict’ (for breast cancer) are used precisely to provide you with an individual estimate of the statistical gain from a given follow-up treatment. This knowledge is your strongest card. It provides you with a solid foundation for a conversation with your doctor, where you can together weigh whether a potential gain of, for example, 2% or 20% in survival is worth the cost in terms of the risk of side effects and, not least, late effects. The goal is to make the choice you feel most comfortable with—based on clear information, not fear. [26]

(One can then rightly discuss how much significance this study has. But now you are aware of it (and its absolute weaknesses), should anyone refer to it).

Treatment Options

• Which traditional treatment options are available, e.g., surgery, radiation therapy, and chemotherapy?
• Which alternative or complementary treatment options exist, e.g., repurposed drugs, dietary supplements, herbal medicine, dietary changes, healing, and acupuncture?
• Additional measures that can supplement the chosen cancer treatment.
• What are the pros and cons of each individual treatment option, including side effects, effectiveness, and the impact on quality of life [6]. See more under Traditional cancer treatment and Alternative cancer treatment.
• Prognosis (Predict for Breast Cancer).
• Furthermore, you may consider supplementing your conventional treatment with more complementary treatments if you have been diagnosed with cancer.
• Feeling that you have an influence on the outcome of the treatment provides strength and reduces the sense of losing control over your life.

Personal values and preferences

• What are your personal values and beliefs about health and well-being?
• What level of risk and uncertainty are you willing to accept (uncertainty is, however, cancer’s constant companion—regardless)?
• What role do your faith, culture, spouse/partner, family, and other loved ones play in the decision-making process?
• Do you prioritize the quality of your remaining life over quantity?

Psychological and emotional management

• How are you coping with the cancer diagnosis and the emotional burden of cancer?
• Do you have a strong support network of a spouse/partner, family, and friends?
• Do you have access to psychological and emotional support to help you through the treatment?

See also Emotions

Financial considerations

• What are the costs of the various treatment options, and how do you cover them?
• Do you have health insurance that covers certain forms of integrative, complementary, or alternative cancer treatment—for example, abroad, or significant expenses for dietary supplements?
• Can you manage the potential loss of income or increased expenses due to the chosen treatment?

There is no “right” or “wrong” answer when it comes to choosing cancer treatment. The best decision is the one based on a thorough assessment of all relevant factors, balanced with your individual needs and wishes.

Se også Holistic clinics in Europe

My intent

The intention of this topic is not to discourage you from accepting conventional treatment—on the contrary. You should receive (and ensure you receive) the treatment you feel most comfortable with. However, you should also be aware of the many measures that can support you in your journey toward becoming cancer-free or being able to live a good life with the diagnosis you have received.

Conviction is strength

Believe in your treatment

You must find the treatment that provides you with inner peace. And then, you must commit to it unconditionally. Whether you have chosen conventional treatment such as chemotherapy, radiation therapy, and/or surgery, or whether you have opted out of this (or parts of it) in favor of alternative methods, your conviction and your commitment are crucial.

Informed choice

Having made an informed choice—and standing behind it wholeheartedly—can be of great importance for your experience and your well-being. If you receive medication, it is important to take it as prescribed and without inner doubt. If, after careful consideration, you follow a specific alternative strategy, it is equally important that you do so with conviction and with trust in its effect.

Inner resistance, skepticism, or a feeling that you “should” do something you do not believe in will often create stress and weaken your motivation. Being at peace with your treatment choices—no matter what they are—is an essential part of your journey. Being at peace with your treatment choices is an essential part of your journey and releases energy and hope.

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It must feel right – your own compass

Your cancer journey is unique, and there is no checklist for the “right” strategy for treatment, diet, or lifestyle. The most important thing is to find the path that provides you with meaning, motivation, and inner peace.

• Listen to your body and intuition: Sense what feels right for you. It is okay to adjust your choices along the way, and it is important to be able to forgive yourself if you deviate from the path.
• Informed choices: Base your choices on information you find relevant and credible, but always remember to adapt it to your own situation and what feels right.
• Dialogue with professionals: Always discuss your treatment choices with your healthcare provider.

For my own part

During one of my first consultations, the nurse said to me: “A cancer diagnosis brings the ultimate loss of control.”

At that time, I had already decided that I did not want traditional cancer treatment beyond surgery (breast-conserving surgery). So I thought: “That certainly doesn’t apply to me. I have taken control myself.” This realization gave me a sense of strength.

It is a difficult position to be in when you want to make a qualified choice yourself regarding your cancer treatment. Personally, I placed a high value on the quality of my remaining time. At the same time, I felt convinced that I would end up with every conceivable side effect and late effect if I accepted chemotherapy and radiation therapy. [7, 9]

On the other hand, I gladly accepted the public system’s offer of surgery, which I believe can ensure that one gains time. Furthermore, I was frightened by all the tragic stories in various groups where some cancer patients become truly ill from conventional cancer treatment.

Problems and support

But as I see it, where you are in life also matters. I don’t have small children who are dependent on me. I have no one I have to answer to if I choose “wrong.” Fortunately, my husband supports me in the decision that feels right for me.

Do everything possible to get your loved ones to support you in the choices you make. [3]

To be continued…

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What you read on I Have Cancer is not a recommendation. Seek qualified guidance.