Treatment Choices

When a woman with breast cancer hears the news that she has breast cancer it can be very unsettling. It is normal for her to feel concerned, even bewildered at times, and to have many questions to ask.

It may be a good idea to have a support person when visiting members of your medical treatment team, particularly at the beginning when you will be discussing your treatment options and making critical decisions. It can help to have another person acting as "a second pair of ears", and also sometimes it helps clarify issues if you have someone else with whom to discuss them. There are interpreter services available for people from non-English speaking backgrounds.

When a woman is diagnosed with breast cancer, the Breast Cancer Nurse, or a member of the medical treatment team, should give her a copy of the publication "All about early breast cancer". This booklet has been developed by NBCC to give background information to help in the understanding of the different treatment options. It is recommended that this booklet is read early after diagnosis and that it is referred to throughout treatment. Find out how to access this booklet in our Resources / Booklets section.

• Where does my treatment start?
• How do I prepare for my visit to the surgeon?
• What are the treatment options?
• How is my treatment care pathway planned?
• Can I ask for a second opinion?
• What other support is there?
• What are clinical trials?
• Is there another website which gives further information?
• Are there relevant sections in the Multidisciplinary Care Guidelines for Women with Breast Disease?

Where does my treatment start?
The planning of your treatment care pathway usually starts with your surgeon. So this is your first decision. Who do I choose as my surgeon? It may help to discuss this decision with your General Practitioner. You should consider the following points:

• do they regularly treat women with breast cancer?
• do they work as part of a multidisciplinary team with doctors such as medical oncologists and radiation oncologists?
• how accessible will they be?
• how will I find their personal manner and approach?
• will I feel comfortable with them?
• will I find them easy to communicate with?

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• why is a particular treatment being recommended?
• what are the alternatives?
• are there any side effects to the treatment?
• if so, what are they?
• what are the long term implications for me?

It may help if you ask your support person, or the surgeon, to write down the main points that you need to remember.

If you haven't already met with your Breast Care Nurse (BCN) now is the time to ask your surgeon for a referral. The BCN will support both you and your family in making an informed treatment decision relating to your needs and family circumstances.

Your BCN will also:

• reinforce and discuss information provided by the surgeon
• provide you with further information as required
• offer both practical and emotional support, and
• provide referrals to other support services where indicated

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What are the treatment options?
Your treatment options may include:

• surgery
• adjuvant (or additional) therapies such as radiotherapy, chemotherapy and hormone therapy

These options can be used alone, or in combination, to treat breast cancer.

Treatment care planning may involve not only your Surgeon but also your Medical Oncologist and your Radiation Oncologist.

When considering the various treatment options your medical team will take into account:

• the tumour grade and stage of your breast cancer
• whether it is a hormone receptor positive cancer
• its location
• your age, general health and what you want

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How is my treatment care pathway planned?
When you meet with the surgeon they will outline possible treatment care pathways. They may advise that one type of treatment is better for you than another. Usually they indicate that surgery will be required. Make sure that you understand the reasons for this advice.

There are a number of possible components to your treatment. It may involve:

• Surgery
• Adjuvant (or additional) Treatments
• Treatment of Specific Complications
• Palliative Care

So that you can fully consider your decision, you need to gather information about:

• the types of surgery available (including breast reconstruction where appropriate)
• recommended adjuvant (or additional) therapy treatments (including radiotherapy, chemotherapy and hormone therapy)
• a full explanation about the aims of the planned treatment, the benefits and possible side effects
• appropriate written information

After surgery, which will involve further pathology tests, your surgeon will discuss the outcomes. You will again consider your future treatment options and a more refined treatment path will be agreed upon.

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Can I ask for a second opinion?
It is your right to ask for a second opinion from another specialist. Your outcome should not be affected by the time taken to seek a second opinion. You should have as much time as you need to make a decision about your treatment. A few extra days should make NO DIFFERENCE to your recovery.

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What other support is there?
There is a whole range of Support you can tap into beyond your medical treatment team and friends and family. This includes support groups, various written Resources such as booklets, web sites and phone help lines. There is even the opportunity to talk to other women who have been through a similar experience.

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What are clinical trials?
After your diagnosis has been made one of your medical treatment team may discuss with you the possibility of participating in a clinical trial. For further information refer to Clinical Trials.

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Is there another website which gives further information?
For further information refer to The Cancer Council's "How Do I Decide Which Treatment Is Best For Me?".

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Are there relevant sections in the Multidisciplinary Care Guidelines for Women with Breast Disease?
For a woman with breast cancer about to have an Open Biopsy refer to:

• Making Decisions About Treatment: A Guide for Women with Breast Cancer

For the Health Care Professional refer to:

• Care Pathway for Management of Breast Disease in Women
• The Role of the GP in the Provision of Care for Women with Breast Disease
• Psychosocial Guidelines for Women with Breast Disease. A Reference Book for Health Care Professionals

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