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Chapter 5

Deciding on Goals and Treatment

We now have all the diagnostic information we need, and an emotional support team is in place. We now need to decide how to move forward with treatment.

Doctors should spell out the goal of cancer treatment for each patient. By goal I mean that the treatment should have one of two intentions:

1 Curative intent: This means we’re trying to cure the cancer.

2 Palliative intent: This means we’re managing pain and the effects of the cancer on life. The goal of treatment is not to cure the cancer but to maintain the patient’s life for as long as we can with as much quality as possible.

Stating the goal of treatment helps patients understand where treatment is going and what they can expect. As with all things in life, there is often a gray zone between curative and palliative intent, but it’s helpful to have a starting point. Of particular importance is the gray zone of oligometastatic patients (see the glossary and chapter 9) and the evolving treatments for this particular group. We will review this in detail later on. In regard to reviewing the goals of care, you can find a doctor’s appointment cheat sheet to help identify goals of care at stephenrosenbergmd.com.

This chapter is the most significant in the book, as we’ll also go over three common mistakes in this chapter.

Looking at Day-to-Day Performance

To decide on the goals of care, many factors are taken into account. This includes the type of cancer, the stage of the cancer, and the performance status of the patient. In past chapters, we have talked about cancer types (liquid versus solid) and cancer stages. We’ll focus this discussion on performance status.

Have you ever walked into a room and said, “That person doesn’t look well”? What are you measuring when you say that?

A person may look ashen or thin, indicating they aren’t eating or have poor nutrition. They may be too weak to get out of bed, meaning their muscles aren’t working well.

Performance status aims to quantify how a person is functioning globally, in all aspects of their lives. Is a person able to get out of bed and dress themselves? Are they able to make their own food and feed themselves?

Overall, determining performance status means trying to figure out how much of a person’s daily activities they can do on their own. Cancer doctors obsess over performance status.