The sly nurse was testing my mettle. She could have given me a heads up. As I open the door, Greg unloads on me and, as the covering Doc, I race to catch up. He is furious about the side effects to hormone therapy to reduce testosterone (miracle grow) for prostate cancer. The guidelines are practically set in stone and his management designed not just to treat, but avoid developing metastatic disease or even dying sooner from the cancer. But standards should never replace listening to the patient. The treating physicians offered the best practice and Greg wanted “everything done”. When anti- androgen therapy is delivered, however, it is frequently in a shot that lasts months. Greg is midway through the 6 month injection effects and is furious. He now has “buyers remorse” and we can’t take it back. (That is true for surgery, radiation and chemo effects). There is new medication for hot flashes, anti depressants and some mitigating actions, but mostly Greg is done with all of this “healthcare” that is making him sick.

Later, Alexander comes with a long list of his own side effects to treatments. He wants to quit chemo. At 82, I am not going to coax or cajole him into continuing. That would be insulting. He knows what he is willing to sacrifice at this point in life and he needs to determine his own path. For Jenna, even though the testing showed improved survival with chemo, she chose only radiation and hormones for breast cancer and is satisfied she made the right decision.

With newer treatments, monoclonal antibodies, immuno-therapies, various new combinations, in cancer treatment we physicians often apply the “more is more” principle. With 1 in 2 seniors expected to be diagnosed with cancer, we all need to adjust our thinking.

So here is my message to these patients and you. Choose what is right for yourself….always. Don’t let us bully you into treatments that are more aggressive than you want. As I told Leon, who is weighing therapy vs observation for a new cancer, your physicians have an obligation to provide recommendations for the most up to date, state of the art treatments to enhance and expand your life. When you come into the center we assume you are seeking care. Always ask about side effects and even write them down since it is hard to recall after a visit. If you have therapy and are completely miserable don’t tough it out. Tell your Doc. They frequently reduce doses of chemo, change hormones and even modify radiation.

Your mission is only if you choose to accept. I am aging right along with the patients for whom I care. I understand their perspectives. Patty said, OMG Doc, do everything that will help! I am alone with 3 small children… help me survive for them, I can take it. But as seniors are aging, what is right for a young mother is not for an 80 year old. How do you want to live your remaining time? (may be months or years). You need to decide and then accept your choice. Having advised thousands of patients over the years, I provide my best recommendation while respecting their own value system. I tell them the national guidelines (you can find NCCN guidelines for cancer by type on line), the most common side effects, and occasional awful side effects! If you choose to do something “less”, I will still be here to help you manage if the disease advances, spreads or becomes burdensome or painful. You can abandon therapy but I will not abandon you. You will not be punished for your decisions. Those of us in cancer care respect that all decisions are your choice and you have many reasons for making them. Doctors and cancer centers will still welcome you, even if it’s to hear options and make another choice.

With aging, we must be realistic. I told 92 year old Harvey, that we can treat if you like (and he does want this) but it will not extend your life at this point. Whether its medication, surgery, chemo, radiation, be part of the decision. Your choice will be the right course at that moment, and it can always be modified as you continue your path. Today I give you permission, as I have in the past, be your own advocate. Modify expectations. Listen to your own voice. We are here to help you to live your best life. Be assured you are smart enough to know what is right for you. God Bless.