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Toward curing cancer: What you must know as a patient about shared decision making

Toward curing cancer: What you must know as a patient about shared decision making

A new cancer treatment using a patient’s own immune system is effective even for malignant melanoma, an aggressive skin cancer. The therapy may be available to patients in the next several years. Another experiemental cancer treatment achieved a cure of leukemia in a 13-year-old girl. Meanwhile, traditional treatments can also be effective, and some cancer patients are able to continue working and even coaching a high-level World Cup team, like Netherlands coach Louis van Gaal.

The word cancer is scary, with an implicit association of cancer with death, and regardless of age, untimely death. But there has been an ongoing revolution in cancer treatments since at least 1998, with the approval of trastuzumab, a targeted cancer treatment directed against a protein called human epidermal growth factor receptor 2, abbreviated Her2. While medicine still does not have the cure for chronic diseases like diabetes, even advanced cancer that has already spread to different parts of the body can be cured. In order to achieve such a cure, shared decision making between patients and physicians is necessary.

Cancer is an uncontrolled growth of cells that is often somewhat unique to each individual. Cancer centers are increasingly utilizing personalized medicine to determine targeted therapy based on advanced testing that includes genetic sequencing of a given patient’s cancer cells. Indeed, a recent New England Journal of Medicine article documents some of the ground-breaking molecular advances in cancer care in the last two decades. Unfortunately, personalized medicine and genetic sequencing of cancer is documented to be underutilized. Meanwhile, Medicare has approved next-generation sequencing tests that are part of personalized medicine, for certain advanced cancers, if a patient desires further cancer treatment.

Thus, an important requisite for personalized cancer care is, “shared decision making with patients about the likelihood that test results will identify effective treatments”. Shared decision making allows for at least two expert viewpoints – that of the physician and the patient. The physician is practiced and proficient in medical diagnoses and treatments, and the patient is much more of an authority (than the physician) on his/her/their own life, goals, and ability to tolerate any given medical plan in terms of time, cost, and expected side effects.

To be sure, the fact that cancer can sometimes be cured does not negate the stress, worry, and fear that can come with the diagnosis. Patients should not be expected to parse through the medical literature. Yet physicians and the healthcare system are overburdened. The explosion in medical knowledge prior to and during the COVID pandemic has put even more pressure on physicians to contend with an advancing pace of medical practice. Similarly, physicians and patients must not assume that physicians understand what a given patient is facing, on a personal, individualized level. The length of a life lived is not necessarily as important as the quality of a life lived. Even with optimal guidance from a caring and knowledgeable physician, each of us can only decide for ourselves regarding weighty and life-altering healthcare decisions.

As a physician and patient, I believe three steps support shared decision making. If you get a cancer diagnosis as a patient, make sure to evaluate your own priorities in light of the different treatment options available for your particular cancer. Make sure that next-generation sequencing and targeted therapies are discussed – while not available for every single cancer, there may be something new or on the horizon for your particular cancer. Ask your doctor, if you are not sure, where you can get more information on management and treatment options, particularly if there are multiple. More than ever before, certain cancers can be cured, and shared decision making between doctors and patients is necessary.


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