Small cell lung cancer patients can make care goals, but how can they ask about them? Expert Beth Sandy from Abramson Cancer Center shares her perspective about care goals, proactive questions, and advice for doctor-patient communication.
As a person living with cancer myself, one of the things I know that is often focused on by my healthcare team is the standard of care, and then it’s more of a reactive approach to dealing with symptoms. Talking about goals of care seems more proactive. So for a patient going in and wanting to talk about goals of care, maybe it’s not brought up by their care team, would it be appropriate for that patient to say, “Hey, I’d like to talk about some goals for my care too?” And not just have it be a reactive approach, but more of a proactive approach. Would that be a weird thing to ask the care team or is that appropriate for a patient to ask that question? Can we have a conversation about the goals for my care?
No, I would love if a patient said that to me, because these are conversations that we want to have with patients. We want to have an open communication so that everybody’s on the same page of understanding of what’s going on with their cancer, but patients are often reluctant, and I get it. To be honest, a lot of doctors are reluctant. Sometimes they feel awkward in the conversation. So it goes both ways, but if the patient is open and wants to have that line of communication, I think that’s great. When I say goals of care, I mean what are your goals out of the treatment I’m giving you?
And it’s something because you bring up a good point. In small cell lung cancer, goals of care are very important, because there are a lot of things we can do to you. Some patients do not want their whole brain radiated. There’s a risk there of loss of cognitive function, and especially in the extensive stage setting, we can offer it. There is actually a slight advantage in survival to doing preventative for whole brain radiation.
However, the trade-off is that you can have neurologic decline and physical decline from that. So it’s like do I want to take the risk of having that side effect to prevent the brain metastases? So these are goals of care discussions like, is this right for me? Is this something I want to do and risk feeling this way? And some of that may depend on your performance status which is something that we used to say like, do I have a lot of other conditions? I have bad COPD, and I’m in a wheelchair already, and if I get this whole brain radiation, will I never walk again? Something like that. Those are all things that are important to discuss with your treatment team.
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