Medical advances have made many cancers treatable, but it is not uncommon for doctors to meet patients that refuse standard cancer treatments. One in five patients might decline conventional cancer treatments at first, according to Dr Ravindran Kanesvaran, who is a clinical senior lecturer at NUS Medicine and a medical oncologist of the National Cancer Centre Singapore (NCCS).
Cancer patients may opt out of standard treatment methods for various reasons. Some may choose to rely on the power of their faith, or possess negative perspectives towards such treatments, thinking they will end off worse. Family members and caregivers may also be barriers to treatment, while others may reject the option due to depression.
Notably, patients who refuse treatment are not just those in the terminal stages of their disease, but also some in the early stages of cancer. Doctors usually strive to provide the right information to cancer patients, but treatment decisions are highly personal and the patients’ wishes should be respected, said Dr Kanesvaran.
Some patients may also prefer to use complementary and alternative medicine (CAM) or a combination of CAM and conventional medication, possibly due to influence by hearsay about the harmful side effects of standard cancer treatments. But those who declined standard treatments had worse survival rates at the five-year mark (43 per cent) than those who received the treatments (82 per cent), according to a study published in the World Journal of Surgical Oncology in 2012.
Another misconception is that patients will feel worse after undergoing treatment, said Dr Kanesvaran.
“Usually, the issues patients deal with while on treatment are the toxicities of the drug, but that differs from tumour type to tumour type. With the newer range of drugs and less toxic side effects, things have improved. Patients also have to be aware that sometimes, with treatment, their cancer shrinks, the adverse effects from the disease improves and this contributes to them feeling better,” he added.
Depression may also cloud the treatment decisions made, especially among older patients who face a higher risk of depression due to reasons like lack of social and financial support and multiple medical conditions. Currently, cancer patients are not routinely screened for depression.
“If there is a good drug that can prolong your life substantially but you decline treatment because you are depressed, then we should be treating the depression. That may help patients change their decision (to decline treatment), and potentially improve their survival and prolong a good quality of life,” said Dr Kanesvaran.
Nonetheless, it is not illogical for patients to refuse treatment that may prolong life but will not cure them. When a patient of sound mind refuses treatment because the disease is terminal, palliative care is an option to help them control the symptoms such as pain, nausea, vomiting or shortness of breath. And for patients who are no longer able to make treatment decisions themselves, doctors may act in their best interests.