How One Oncologist Helps Patients Weigh the Pros and Cons of Cancer Treatments

Every cancer treatment comes with its own risks and advantages. A Keck Medicine of USC medical oncologist explains how nuanced thinking and open communication can help doctors find the best match for each patient.

As a medical oncologist, I am extremely cautious about what I prescribe to my patients. The most important part of my job is to do no harm. The goal of treatment is to aim for a cure, prolong life and improve quality of life. I never want to burden a patient with a treatment that makes them feel worse or puts their life at risk.

I’ll consider this as a major determining factor when tailoring their treatment plan.

Others may say, “I’m really afraid of chemotherapy. Are there any alternatives?”

That’s when we focus on treatments alternative to chemotherapy, such as immunotherapy, targeted therapy and radiation, depending on the type and stage of the cancer.

It’s so important to communicate that chemotherapy today is not what it was 20 years ago. Treatments have come a long way, and our drugs are more refined. We’ve learned how to carefully manage dosing, pause when needed, and control side effects more effectively. While there may still be challenges, we are here to support them every step of the way.

Age vs. general health

Let’s say we’re considering a four-drug treatment regimen for an aggressive cancer. Not everyone will be a good candidate for this therapy. It may be too toxic for a frail patient who’s 82 years old. However, a healthy 82-year-old with the same diagnosis may have a better outcome. On the other hand, a 55-year-old with multiple comorbidities may struggle more than a healthy 82-year-old.

That’s why we never make decisions based on age alone — we look at the whole person. Every treatment plan is tailored to the individual, considering their overall health, medical history and ability to tolerate therapy.

Lifestyle

I take a comprehensive approach to each patient’s care. When developing a treatment plan, I consider every aspect of their life, including diet, physical activity and sleep.

I also consider their support system and how far they have to travel for treatment.

When aggressive treatment is the best choice

Approaching a fast-growing cancer with an aggressive treatment may sound scary, but sometimes short-term difficulty provides long-term benefits to quality of life and prognosis.

A classic example is high-grade lymphoma, where patients often undergo an intensive, multidrug regimen. While the treatment is aggressive, it’s also highly effective, sometimes seeing 70%-90% of the cancer eliminated within the first few cycles. The remaining cycles are focused on consolidating that response and reducing the risk of recurrence.

As soon as the cancer burden decreases, patients often start feeling noticeably better. They may regain weight, experience improved energy and have less pain.

When choices are limited

There are times when treatment options are limited, especially in aggressive or fast-growing cancers. In these cases, the best chance for controlling the disease may involve therapies that are difficult to tolerate.

This is why close monitoring during the first few cycles of treatment is so important. If a patient’s quality of life begins to decline, I make adjustments right away, such as reducing the dosage or allowing more time between treatments. We also provide comprehensive support that includes pain management, palliative care, nutritional guidance, physical therapy and nursing services.

No matter which treatment we start with, I find it’s best to keep a hands-on approach. We generally recommend close monitoring of patients for the first three months of treatment to see how well they are tolerating it and what kind of response we are seeing.

I personally like to see my patients weekly when they first begin treatment. Once things stabilize, I gradually taper visits to every two weeks, then every four weeks. This allows me to monitor how they’re responding and adjust as needed.

Throughout the treatment process, I prioritize listening. I want my patients to be actively involved in the decision-making process because, ultimately, it’s their decision. My role is to provide guidance, but every step we take must be one we agree on together.

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