NCCN Guidelines for Patients
: Esophageal Cancer
Part 7: Accepting a treatment plan
team. In addition, your treatment plan should include a
schedule of follow-up tests, treatment of long-term side
effects, and care of your general health.
Talking with your doctor about your prognosis can help
with treatment planning. If the cancer can’t be cured,
a care plan for the end of life can be made. However,
such talks often happen too late or not at all. Your doctor
may delay these talks for fear that you may lose hope,
become depressed, or have a shorter survival. Studies
suggest that these fears are wrong. Instead, there are
many benefits to advance care planning. It is useful for:
• Knowing what to expect,
• Making the most of your time,
• Lowering the stress of caregivers,
• Having your wishes followed,
• Having a better quality of life, and
• Getting good care.
Advance care planning starts with an honest talk between
you and your doctors. You don’t have to know the exact
details of your prognosis. Just having a general idea will
help with planning. With this information, you can decide
at what point you’d want to stop chemotherapy, if at all.
You can also decide what treatments you’d want for
symptom relief, such as surgery or drugs.
Another part of the planning involves hospice care.
Hospice care doesn’t include treatment to fight the
cancer but rather to reduce symptoms caused by
cancer. Hospice care may be started because you aren’t
interested in more cancer treatment, no other cancer
treatment is available, or because you may be too sick for
Hospice care allows you to have the best quality of life
possible. Care is given all day, every day of the week.
You can choose to have hospice care at home or at
a hospice center. One study found that patients and
caregivers had a better quality of life when hospice care
was started early.
An advance directive describes the treatment you’d want
if you weren’t able to make your wishes known. It also
can name a person whom you’d want to make decisions
for you. It is a legal paper that your doctors have to
follow. It can reveal your wishes about life-sustaining
machines, such as feeding tubes. It can also include
your treatment wishes if your heart or lungs were to stop
working. If you already have an advance directive, it may
need to be updated to be legally valid.
7.3 Your role in planning
The role patients want in treatment planning differs.
Some patients want to be involved as little as possible.
Others want to know everything and share decision
making with their doctors. These two roles are described
as passive and active. Tell your treatment team which
role you want or if you want a role in the middle.