Your treatment plan for metastatic colorectal cancer may need a change from time to time – and that's OK. Some therapies stop working or cause tough side effects. Or your personal goals might shift. If this happens, you'll probably want to ask your doctor about other options. A simple talk with your care team can help you find a treatment that best fits your needs.
What Treatments Are Available for Metastatic Colorectal Cancer?
Metastatic colorectal cancer means the cancer is advanced and has spread to other areas of your body. In general, there are two ways to target this type of disease:
- Control the cancer
- Treat the symptoms
"Cancer control with treatments involves both picking therapies that have the best chance of working for a given patient, and equally important is supportive care and measures to help patients tolerate the therapies and maintain acceptable quality of life," says Ardaman Shergill, MD, a medical oncologist who specializes in gastrointestinal cancers at the University of Chicago Medicine.
Doctors may use these treatments for metastatic colorectal cancer:
- Surgery. It can be done to remove the original cancer or the cancer that's spread.
- Chemotherapy. Medicines that kill cancer cells. There are many types of chemo for advanced colorectal cancer.
- Targeted therapy. They block specific proteins that cause cancer to grow.
- Immunotherapy. This treatment uses your body's own immune system to fight cancer.
- Radiation therapy. Energy beams destroy cancer cells.
- Ablation. This procedure uses heat, cold, radio waves, or microwaves to kill cancer cells.
- Liver transplant. A diseased liver is replaced with a donor liver.
- Palliative care. This approach is used to make patients more comfortable.
Why You Might Start a Conversation About Changing Treatments
You may want to talk to your care team about a treatment change if:
- The treatment no longer works or doesn't work as well.
- The side effects are too strong and affect your daily life.
- A newer, more effective therapy becomes available.
- Another treatment would be a better fit for your personal goals.
Metastatic colorectal cancer isn't a one-size-fits all disease. There isn't a single drug, procedure, or plan that works for everyone. Also, each patient has different priorities that may change throughout their cancer journey. Some people want more aggressive treatments, while others place a higher value on quality of life.
"I always want to maximize the benefit that we can get from a given treatment for each patient," says Shergill. "We do that by very thoughtfully titrating supportive care medications, and modifying regimens to maintain efficacy while controlling side effects the best we can."
Why Your Doctor Might Start a Conversation About Changing Treatments
Your doctor might come to you about changing treatments if they think:
- The treatment is too harsh or toxic.
- It isn't effective.
- There's a better option.
They may recommend a new treatment altogether or suggest a simple dose change.
"Sometimes, we intensify the therapy upfront, and once we have good response from the agents that we started with, modifications may be made to change to maintenance regimens," says Shergill. "In colorectal cancers, these strategies have been shown to improve outcomes for patients, while controlling or minimizing toxicity."
Also, Shergill says doctors might consider your tumor's genetic makeup when they suggest a treatment change. "This is how we personalize therapies. We want to know the biomarkers for each patient's cancer upfront so that we can pick therapies that have the highest chance of working for that patient," she explains.
Concerns You May Have About Changing Your Treatment Plan
A change to your treatment can be stressful, especially if you have advanced cancer. There are a lot of unknowns.
You may wonder if the new treatment will work. If it doesn't, will you have other options? Also, will you have side effects? And, what will your quality of life be like?
"Cost of the drug and medical facility visits and testing needed for it may be of concern as well," adds Shergill.
Questions to Ask Your Doctor
When you decide whether to switch treatments, you may want to ask your doctor these questions:
- What is the name of the new treatment and how does it work?
- How long does it take to work?
- What are the possible side effects of the new therapy? How do they compare to those of my current treatment?
- What is the best I can hope for if I try this new therapy?
- Is the treatment designed to control the cancer or ease my symptoms?
- What are my other options?
- How often will I need to come in for treatments or tests?
- What will my quality of life be like?
- How much does it cost? Will my insurance cover it?
- Do the benefits outweigh the risks?
- What supportive care services are available to me?
- What will happen if I do nothing?
- How can I get a second opinion?
"I also think this is an excellent time to ask about opportunities to participate in research and/or clinical trials," says Shergill. "In my opinion, patients should know and ask for trials even if that means going to another clinic or center where such options may be possible."
Some resources that provide information about clinical trials for colorectal cancer are:
- ClinicalTrials.gov
- Colorectal Cancer Alliance
- Fight Colorectal Cancer
Questions You Might Be Asked When Considering a Treatment Change
Cancer treatment decisions are very personal. Your cancer team and family members will likely want to know your goals and what's important to you.
Questions Your Doctor May Ask
As you decide on a treatment option, your doctor and health care team may ask you these questions:
- How does your cancer affect your daily life?
- What side effects do you notice on your current treatment?
- What are your treatment goals?
- Would you like a more aggressive treatment or a gentler approach?
- Do you have support at home?
- How much do you want your family to know about your outlook?
- Are you able to travel for treatments?
- Do you have any financial concerns?
- Would you be interested in a clinical trial?
- When it comes to treatments, what's most important to you?
If your doctor doesn't ask you questions like these, it's still important to let them know how you feel. You can simply schedule an appointment and say, "I want to talk about my treatment goals."
Questions Your Family and Friends May Ask
Talking to family and friends about changes to your treatment plan can be hard. You might not want to upset them. Or you may worry about how they will react.
Sometimes, it's helpful to share your story. It gives you a chance to express your feelings with people you love. You can also ask for support.
If you plan to start a new therapy, your family members and friends may ask you questions, like:
- Why are you changing treatments?
- What happens if this new treatment doesn't work?
- How long do you have to live?
- What will the side effects of the new therapy be like?
- How often will you need to go to the hospital or clinic?
- Will you need help getting to your appointments?
- How do you feel about this change?
Every relationship is unique, but it's usually helpful to be honest and upfront with your loved ones.
Takeaways
If you have metastatic colorectal cancer, you may need to change your treatment plan at some point. An honest talk with your care team is a good way to find the best options for your specific goals. Tell your doctor whether you'd like strong medicines to fight the cancer or supportive therapies to improve your quality of life. There's no right or wrong approach. What matters most are your personal preferences.
Treatment Switching FAQs
When is it time to change treatments for metastatic colorectal cancer?
It may be time for a change if your treatment stops working, the side effects are too harsh, or there's a better option to treat your cancer.
How should I talk to my doctor about treatment changes?
You should be open and upfront about your goals. Tell your doctor what's important to you. Some people want treatments to fight their cancer. Others just want therapies to help them feel better.
When should I consider a second opinion?
You might want to get a second opinion to make sure your treatment change is the best option. Another doctor may suggest a different medicine that could fit your needs better. Or another medical center may offer different clinical trial opportunities.
Show Sources
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SOURCES:
National Cancer Institute: "Choices for Cancer Care When Treatment May Not Be an Option," "Talking to Family and Friends about Your Advanced Cancer."
American Cancer Society: "Living with Advanced and Metastatic Cancer: Support and Symptom Management," "Questions to Ask When You've Been Diagnosed with Cancer," "Telling Others You Have Cancer."
Mayo Clinic: "Stage 4 (metastatic) colon cancer."
Hirshberg Foundation for Pancreatic Cancer Research: "Treatment Decisions: Questions to Ask Your Doctors."
Cleveland Clinic: "Your Guide for Talking with a Health Care Team."
Houston Methodist: "When Should You Get a Second Opinion for Cancer?"
