Cancer Treatment Decisions May Lead to Costly Risks, But You Can't Dwell on the 'What-If's'

When you are diagnosed with cancer, there is often a period of shock that follows, the “this-can’t-be-happening” time when you are trying to process all your feelings about it: the fear, the confusion, the guilt, the sadness.

Usually there is a flurry of appointments and tests, and you are introduced to the team that will be beside you as you move through the experience. You are given a bunch of information about treatment options, if there are any, and you sign papers and insurance forms with sometimes shaking hands because somehow, that makes it real.

Through all of this, you are asked to make some of the biggest decisions of your life, because the goal is often to still have a life after treatment is finished. I’m not sure that it’s possible to understand that if you are one of the lucky ones and your treatment works, you may end up back in the same chair making the same types of decisions years down the road.

When we met with the radiation oncologist to discuss the preferred treatment plan for my daughter, he talked about his desire to go at her cancer with everything in his wheelhouse, including an extra “boost week” for a total of six weeks of five days a week in the machine. He told her that in some cases but that was “20 or 30 years down the road, so she didn’t need to be worried about that.”

My daughter was diagnosed with breast cancer at the age of 27. Twenty years from now, she will still be classified as young if she presents with a second cancer. But when she was making the decision about living now, about coming out of this with 20 or 30 years of future to make memories in, she agreed to go ahead.

In a recent telemedicine appointment with the medical oncologist, when they were discussing the possibility of coming off tamoxifen to try for a pregnancy, my daughter asked if she would be offered extra surveillance and if they would potentially do an MRI before she went ahead to make sure she’s still in the clear. He responded that they do not want to add anything beyond regular follow-ups to the radiation exposure she has already experienced. Again, extra radiation may contribute to another cancer diagnosis, we were told. I just stared at the phone for a few minutes trying to digest that.

I had to make some decisions when my daughter was 18 months old about a new asthma medication that was being brought onto the North American scene after several years of use and research having been done in Scandinavia. She was one of those children who has asthma, and in the 1960s likely wouldn’t have made it out of childhood or would have spent much of that part of her life in a hospital bed, as she had done during the first year of her life.

After weighing all the possibilities, we decided to go ahead with putting her on the medication. It changed her life. She went from a little girl who couldn’t run or play to dancing six days a week on a competition team. When she was diagnosed with cancer, I started wondering if my decision then could have contributed to her cancer diagnosis years later. But when I talked to her about that, she emphatically said she was grateful because her life had been so amazing because she could breathe.

We will never know if the extra week of radiation was the difference in whether my daughter has spent the last two and a half years with no evidence of disease, or if it will contribute to her living the next two decades cancer free. It was only one piece of her treatment puzzle but if she had said no, would she have given up the rest of her life in exchange for missing five days of treatment?

The challenge with making these sorts of decisions is that you can’t measure consequences that don’t happen. All you can do is hope that things will turn out for the best. I like to think that if my child ends up in a treatment chair once again at 47, she will look at those 20 years the way she looks back at her life before breast cancer and that she will have filled those years with adventure and accomplishments.

Because she has time.Her decisions gave her time.And I will measure every second of that with joy.

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