When you learn you have cancer, you may want to rush to treatment so you can be disease-free as soon as possible. You might also be influenced by stories of other people’s cancer journeys—for example, you hear that one treatment was effective while another produced terrible side effects.
Before you pick any path, it’s important to talk to your doctor about what radiation therapy, chemotherapy and other cancer treatments will mean for you in your situation. Every cancer is different, so there is nuance in what will be best for you.
“Always start by asking what your options are,” says Trevor G. Hackman, MD, a UNC Health head and neck cancer specialist. “In this day and age, with most cancers, you have multiple options. Take a moment to breathe. There is time to make this decision.”
Dr. Hackman explains some of the common options for treatment and what your doctor considers when making a recommendation.
What’s the difference between radiation and chemotherapy?
Besides surgery, the most common treatments for cancer are radiation and chemotherapy.
Radiation is a localized treatment, as it affects a small part of the body—the place where the cancer developed and the lymph node areas immediately surrounding it. Gamma X-ray beams are delivered to that target via a machine called a linear accelerator. Radiation works on cells that reproduce quickly, and therefore damages the faster growing cancer cells more than healthy tissue. However, there is still some damage to the healthy tissue, and side effects can include fatigue, skin changes and other issues near the radiation site; if you get radiation to the head and neck, for example, you may develop mouth or throat ulcers, chronic dry mouth, tooth loss or changes in your ability to taste food.
Chemotherapy is a treatment with a medication that can affect cells all over your body, not just in one specific area. There are many types of chemotherapy medications, and the drug you receive for your treatment may not be the one your friend received for theirs. These drugs, typically delivered via infusion, travel through the body with the goal of damaging fast-growing cancer cells, but they can also affect healthy cells. Damage to healthy cells causes side effects such as fatigue, bleeding issues, gastrointestinal issues and hair loss. Chemotherapy can also cause nerve issues and affect the heart, kidney and reproductive system.
In the past decade, immunotherapy and hormone therapy have become increasingly available as cancer treatments. Cancer can hide in plain sight from your immune system, but for certain cancers, these therapies can essentially make the cancerous cells more visible to your immune system and give your immune system tools to recognize and destroy them. Ask your doctor if you are a candidate for one of these treatments.
What factors go into deciding on a treatment?
To determine the best way to treat your cancer, your doctor will consider the type of cancer and its stage, which is a measurement of how much the cancer is growing and spreading within your body. Your doctor will also take into account your overall health, how the side effects may affect you and what you want your outcome to be.
“There are pros and cons to every treatment, and every treatment will have some detriment to quality of life,” Dr. Hackman says. “We have to look at what will be effective for survival and what will give the best opportunity for quality of life. The patient communicating their values and goals is essential, as they must help us to define what ‘quality’ means for them. Cancer care is a balance of preserving life and autonomy, in which the patient plays a vital role.”
Dr. Hackman says surgery and radiation are the first-line options for treatment, especially in lower stage (stage 1 and 2) cancers, which are still localized to a region.
“Chemotherapy is typically used either to amplify the effect of radiation for higher stage cancers (stage 3 and 4) or when the cancer is no longer contained and has spread beyond the regional lymph nodes,” Dr. Hackman says. “It can also be used prior to or after surgery in some instances as well to make the treatment more effective.”
You may have some combination of treatments; radiation or chemo is often used before surgery to shrink a tumor or after surgery to target remaining cancerous cells. You may have radiation and chemo at the same time.
For some cancers, such as slow-growing ones, the recommended course might be to wait on treatment and instead go with active surveillance.
Some treatments may not be advised if you have preexisting health conditions that would worsen because of side effects, or you may decide with your doctor that certain side effects are not worth the risk.
“Quality of life and what’s important to the patient is a big part of the decision-making,” Dr. Hackman says. “For example, a chef losing their sense of smell and taste as a result of radiation could be devastating.”
Side effects will continue beyond your last treatment, so no matter which option you pursue, expect a recovery period. You might also have to wait several months before knowing if a treatment was successful or if you will need additional treatment.
Chemotherapy and radiation can also be used for palliative care to relieve symptoms such as pain and control the growth of cancer, even when a cure is no longer the goal.
What questions should you ask about your treatment options?
As you investigate treatments, ask about the pros and cons of each option and be sure it aligns with your needs. “You should understand the goals of your treatment and the expectations for side effects,” Dr. Hackman says.
You may need several conversations with your doctor to understand everything.
“The cancer discussion with the patient and family is typically filled with so much information that patients can be overwhelmed,” Dr. Hackman says. “It is essential to have frequent followup discussions before and throughout treatment so that all parties—physicians, patients and family—have a similar set of expectations of what is to come.”
Beyond the immediate treatment schedule, have your doctor build a framework of the year ahead, which can decrease anxiety, Dr. Hackman says. “Ask what to expect a few weeks into treatment or a few months after treatment.”
Get your doctor’s recommendation for places to receive the best treatment. “Ask about the volume of any cancer treatment at a facility,” Dr. Hackman says. “There’s a better outcome at centers with greater experience.”
Ask what you and your loved ones should expect as treatment progresses.
“For caregivers, there is an initial focus of getting the person through treatment—making sure they’re getting the hydration or nutrition they need,” Dr. Hackman says. “Treatment is just the beginning. There will be a new normal and issues related to recovery and survivorship, and everyone will have to adjust to what’s different. Survivorship is challenging and having a strong mindset is essential to long-term success.”
Dr. Hackman says to ask your doctor about supportive services for you and your loved ones during treatment; you may be able to access mental and emotional support or nutrition and exercise coaching.
If you’re unsatisfied or unsure about the answers to your questions, don’t be afraid to ask for a referral to another doctor. “There is always time for a second opinion,” Dr. Hackman says. “Advocate for yourself.”
If you have questions about your cancer diagnosis or treatment plan, talk to your doctor. Don’t have a doctor? Find one near you.The post Radiation vs. Chemo: How to Decide What’s Best first appeared on UNC Health Talk.
