Decision-Making With Cancer During A Pandemic

For some us living with cancer, decision-making increases anxiety and doubt. If we are lucky, there are options for treatment sequence, clinical trials, and room for the personal preferences of both the patient and the doctor. Unfortunately, having choices also can mean questioning if the right decision has been made. If foregoing that one option means that all future choices are actually worse than they would have been if just one thing had been done differently.

I see this a lot in people who want to know the exact reason they got cancer. Sometimes it is possible to make a good guess for what increased the likelihood of such a diagnosis, but more often it is known and unknown forces working together and our attempts to soothe ourselves by assigning blame isn't especially helpful.

Now thrown into the mix is a virus that can be harmful and deadly to anyone but appears to put people living with cancer at particular risk.

Decision-making has become much more difficult.

I have friends who receive treatment via IV at cancer centers every week, those (like me) who go for treatment every 3 weeks, some who are awaiting crucial surgery to slow the spread, and others whose compromised immune systems are a result of treatments years in the past. Among them are people with older parents they care for, children who rely on them for their own well-being, people with jobs that include healthcare. With relatively little certainty about the best choices for patients in active treatment, I have friends who've decided to forgo treatment for metastatic cancer despite the risks. I also have friends who are continuing with their treatments despite the increased risk of serious effects should they develop COVID-19.

I remind myself daily that everyone makes the best possible choice for themselves and their loved ones.

This week, I've had to make a number of difficult decisions, including continuing treatment without a break even though it puts me inside a hospital at a moment when it is less safe to be there. I've also decided that it is temporarily okay that my two oldest children remain in another city, 1000 miles away, as long as they are together and isolating themselves. They are both young adults and I would rather have them here with me. They were in high school when I was diagnosed with Stage IV cancer, and many of their memories and much of their concern for me centers around the disease I live with. I have to respect that their peace of mind may come from helping to keep me safe.

These kinds of decisions have no good options to choose from, only the ones that seem best-at-the-moment.

There are so many unknown and unknowable variables, lots of anxiety, and confusion. I remind myself that a single decision - good or bad - rarely has the kind of effect that it's easy to imagine when you are scared, and that how decisions are framed, as positive choices or as losses, can help me think more clearly about what is the best and most practical path.

If you are faced with untenable healthcare choices, speak honestly with your doctor and the people you love, and seek out reliable sources of information so that not only are you safe but also as secure as possible with whatever decision you make.