NCCN Guidelines for Patients
Melanoma, Version 1.2014
Making treatment decisions
Have a treatment plan
Financial stress is common. You may be unemployed
or miss work during treatment. Or, you may have too
little or no health insurance. Talk to your treatment
team about work, insurance, or money problems.
They will include information in the treatment plan to
help you manage your finances and medical costs.
Cancer survivorship begins on the day you learn of
having melanoma. For many survivors, the end of
active treatment signals a time of celebration but also
of great anxiety. This is a very normal response. You
may need support to address issues that arise from
not having regular visits with your cancer care team.
In addition, your treatment plan should include a
schedule of follow-up cancer tests, treatment of long-
term side effects, and care of your general health.
Advance care planning
Talking with your doctor about your prognosis can
help with treatment planning. If the cancer can’t be
controlled or 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, immunotherapy, or
other treatments, if at all. You can also decide what
treatments you’d want for symptom relief, such as
radiation therapy, surgery, or medicine.
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 cancer treatment. 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
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