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One of the first questions to ask after receiving a cancer diagnosis is, “How much time do I have to make decisions about my treatment?” As treatment progresses – and often spans months – patients sometimes want to know, “Can I take a break from treatment?”
“Typically, we want to start treatment as quickly as possible, or at the very least have newly-diagnosed patients meet with a clinical team as quickly as possible,” says Robert Hegeman, MD, a medical oncologist with the UW Carbone Cancer Center. “But more importantly, we want to treat patients correctly.”
Dr. Hegeman says delaying or taking breaks from treatment may be a possibility, and he discusses some things to consider below. He stresses, however, that all patients and situations are different, and that each patient should discuss what is best for their treatment plan with their care team.
What to Think About if You're Considering Taking a Break From Cancer Treatment
Is the treatment intent curative or non-curative (palliative)?
There is a difference between treating cancer where the intent is cure with adjuvant therapy (treatments such as chemotherapy or radiation after the primary surgery), and non-curable cancer, where the intent is to help the patient’s symptoms and prolong their life.
With curative intent, I try to alter the schedule as little as possible, as these schedules are based on data from clinical studies, and I would hate to jeopardize in any way a person’s chance of cure. Whereas when chemotherapy is palliative, or non-curative in intent, then I am much more likely to be flexible in a way that fits into a patient’s goals for travel or seeing family.
The order and type of treatment may make a difference
At the very least, we aim to be as quick as possible in getting patients into our care at UW Carbone, even if their treatment does not begin immediately. But then one of the most common questions I hear from patients is, “How soon should I begin chemotherapy or radiation after surgery?” The answer is somewhat unclear and can vary by the cancer, but in general, treatment should begin as soon as it is safe and the patient has recovered well from surgery. Usually this is six to twelve weeks.
There is some evidence for breast and colorectal cancer that chemotherapy beginning more than 12 weeks after surgery may be a bit less effective, but there is not a clear time when chemotherapy becomes completely inadvisable. So you should talk it over with your doctor.
If someone has trouble recovering from their surgery, we can wait to start chemotherapy or radiation. Again, it goes back to treating patients in the best way possible rather than just as quickly as possible.
Cancer patients have more to factor into their lives than just cancer treatment
Of course patients have other things going on in their lives and important milestones to celebrate, like a planned vacation or a wedding to attend. We understand this and will always work with a patient to do our best to allow these to happen where possible, if the patient is feeling up for travel and get-togethers. So I again go back to the curative versus non-curative intent factor.
For non-curative, palliative treatments, I want patients to live their life – do as much as they can when and where they can, and I will almost always move treatment around to accommodate them. For curative intent, there is less flexibility, but you can still discuss options with your doctor.
How are the side effects?
For some patients, the side effects of chemotherapy or radiation are sometimes just too much. We do our best to anticipate these issues, but every patient is unique. If a patient is too fatigued to get out of bed or frequently vomiting, or any other truly debilitating side effects, it is incumbent on the cancer team to alter the schedule or dose of the treatment. We have to do this to ensure the treatment is safe and effective. And I always tell patients that there are things they can do themselves that can often improve side effects and even cancer outcomes – such as eating healthily, quitting smoking, maintaining a positive outlook, and exercising or moving moderately daily, when possible.
A break from anti-cancer treatment is not necessarily a break from treatment
Just because you and your oncologist agree you may need to delay or alter your chemotherapy or radiation schedule, it does not mean you need to take a break from all treatment. Symptom and pain management related to the cancer can still be treated, even if you are not actively receiving anti-cancer therapies.