To Treat or Not to Treat Disease at the End of Life

Barbara Karnes

Dear Barbara, my friends are getting terrible diagnoses. The women I am seeing are way too young to die. How do they make the decision to throw everything at their disease in the form of treatments that offer the low odds they will survive and poor quality of living during the treatment time or to “make the best” of the time they have left with no treatment?

The uncomfortable truth is disease and dying have no age barrier, it happens when it happens. You are so right that the decision to treat or try to live your best life is monumental, and age does play a factor in those decisions.

I have no answer in the decision making---too many circumstances come into play for a one size fits all answer---but here are some things I would consider:

*Age: I’ll get some slack on this statement but anyone over 75 in my mind requires quality of life thinking. What is the quality of the living I have left compared to being VERY sick with treatment options for an undetermined amount of time, if not always? Are many months of response to treatment (and maybe for the rest of my life) worth the extra breaths? For some, it will be. For others, maybe not.

*Extent of disease progression: How advanced is the disease in its progress toward ending life? What is the prognosis for the end result of treatment? Is it simply to reduce the tumor size and limit further disease progression? Is the purpose of treatment to eliminate or simply control? Is it to offer an active, fulfilling lifestyle when treatments are finished? Does treatment bring about a cure and a return to a normal, active life or is treatment slowing the disease progression but not eliminating it?

*What happens if I say no to treatment options? A scary question to ask, but important when making a quality of living decision. No one can put a number on how long someone has to live. There are too many personal factors determining the breaths we take BUT guesstimates can be made in years and months…

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