Goal Setting Throughout Cancer Treatment and Beyond

By Stewart FleishmanM.D.

Let’s dig a little deeper with regard to goal setting. Goal setting at the start of cancer treatment focuses on living one’s life with cancer. After treatment, when people say that the cancer has “changed them” in some way, they often mean that they look at themselves differently and how they spend their time and energy, as well as how they choose to enjoy what may have otherwise slipped by. Applying those themes at the beginning of treatment is still somewhat the exception. Most of us are frightened and caught unaware when we first find out that we have cancer and are lost in the busy-ness of getting tests, arranging for appointments, and the fear that treatment will not work and we will die. As more and more testing and treatment are done in office visits, not on a hospital admission, that period of time can be many days or weeks. Despite the initial shock and with guidance from veteran patients, it is during that time when the most meaningful self-examination can take place.

The general areas of reflection include, but may not be limited to the following broad areas:

*How much of an investment of immediate quality of life am I willing to make to achieve successful control of the cancer?

*What general approach should my treatment team take for me?

*What have I experienced in my life thus far that can prepare me for the rigors of treatment?

*How active do I want to be in decision-making with my providers?

*How involved do I want my family or close friends in my care?

Quality of Life Investment:Ask yourself: Am I willing to do anything and everything necessary to control my cancer? To extend my life? Am I interested in protecting my quality of life now if I am expected to survive my cancer for _____ months based on reasonable medical certainty (fill-in: 3,6,12,24)? Or am I willing to make an immediate sacrifice in my quality of life to control the cancer and extend my life about equally?

Providers’ General Approach: Should my providers lean more towards optimism, pessimism or realism for decisions that have less medical certainty?

Life Experience until Now:What have I been through before that can help me now? How did I manage (Did I learn as much as I could? Make decisions purely on intuition? Am I a gambler?)

Role in Decision-Making:Do I want to be involved in decision-making when it is possible or defer to the treatment team’s professional judgment? Do I prefer that experienced professionals make most decisions for me? Is it easier for me to make decisions with a lot of detailed information or broad general concepts?