Right2Hope

At Right2Hope, we are dedicated to helping patients explore all available treatment options, including experimental therapies that might offer new hope. However, hope should always be balanced with thoughtful decision-making. When facing a serious illness, especially advanced cancer, patients and their healthcare providers must carefully consider whether the potential benefits of aggressive treatments outweigh the risks, side effects, and impact on daily life. The goal of treatment should not only be to prolong life but to ensure that the extra time gained is meaningful and worth the effort. While some patients may choose to fight with every tool available, others may prioritize quality of life over additional months of suffering. Both choices are valid—but they should be informed decisions, based on realistic expectations rather than fear or false hope.

The Burden of Treatment: More Than Just Side Effects

Many patients assume that if a treatment offers a chance to extend survival, it is worth pursuing. However, every treatment comes with a cost—not just financial, but physical, emotional, and psychological. Modern cancer therapies, including chemotherapy, targeted drugs, and immunotherapy, have led to remarkable advances, yet they often bring severe side effects that can significantly impact day-to-day living. For example, patients with advanced pancreatic cancer often face a difficult choice. The standard treatment, FOLFIRINOX (a combination of chemotherapy drugs), has been shown to improve survival by several months compared to older regimens. However, it comes with a high risk of severe side effects, including:

Debilitating fatigue
Nausea and vomiting
Severe diarrhea
Neuropathy (nerve damage that causes pain and numbness in hands and feet)
Increased risk of infections due to low blood counts

For some patients, these side effects may be manageable and worth enduring for the possibility of more time with loved ones. But for others—particularly those already in frail health—the burden of treatment may outweigh the potential benefit. In these cases, focusing on symptom management, comfort, and spending time with family might be a better choice. Another example is small cell lung cancer (SCLC), which is highly aggressive and often diagnosed in advanced stages. Chemotherapy and immunotherapy can extend survival, but the benefits may be limited to only a few months, and the treatment itself can cause profound fatigue, breathing difficulties, and immune system suppression. Patients need to consider: Is the extra time gained worth the potential suffering?

Hope vs. Realistic Expectations

It is natural to want to believe in miracle treatments—especially when hearing stories of rare patients who defied the odds. However, these exceptional responses are the exception, not the rule. For example, immunotherapy has transformed the treatment of cancers like melanoma and lung cancer, with some patients achieving long-term remission. Yet, for many others, these treatments do not work at all or only provide a brief benefit before the cancer progresses. Immunotherapy also carries risks of severe autoimmune reactions, which can cause lung inflammation (pneumonitis), colitis, liver damage, or even life-threatening complications.

The Numbers Matter

Patients often hear about the potential benefits of a treatment but not enough about the probability of success versus harm. In clinical trials, treatments are evaluated based on the Number Needed to Treat (NNT)—the number of patients who need to receive a therapy for one person to benefit—versus the Number Needed to Harm (NNH)—the number of patients who will suffer a significant side effect. For example, in advanced pancreatic cancer, the chemotherapy drug gemcitabine has an NNT of approximately 10–15 patients for one person to experience meaningful survival benefits. However, the NNH is much lower—meaning that many patients will experience severe side effects, but only a small fraction will actually benefit.

This is why an honest conversation with healthcare providers is crucial. Patients should ask:

What are the realistic chances that this treatment will work for me?
What side effects will I likely experience, and how severe will they be?
Are there alternative approaches that could offer a better balance between benefit and quality of life?

What Matters Most to You?

When considering a new treatment, it is important to clarify personal priorities. Not all patients want to pursue aggressive treatments—and that is okay. The key is to make an informed decision based on personal values, not pressure from doctors, family, or societal expectations. Here are some important considerations:

If you choose aggressive treatment:

Are you prepared to endure possible hospitalizations, infections, and prolonged recovery times?
Will you still be able to do things that bring you joy, such as spending time with family, traveling, or engaging in hobbies?
Do you understand the realistic life extension this treatment may provide? (Is it months, or potentially years?)

If you prioritize quality of life:

Would you prefer to focus on symptom control, comfort, and time at home rather than in a hospital?
Are there palliative care options that can help you maintain the best possible quality of life?
Would you rather spend time with loved ones without the physical burden of ongoing aggressive treatments?

The Role of Shared Decision-Making

Patients should never feel like they must fight at all costs or have failed if they choose not to pursue aggressive treatment. Treatment decisions should be made through open discussions between patients, families, and healthcare providers, considering not just survival but the lived experience of each patient. A good oncologist will provide a balanced discussion of the benefits and risks of all available options. A great oncologist will also ask:

What matters most to you?
What are you hoping to achieve with this treatment?
What are you most afraid of—progression of the disease, side effects, loss of independence?

By shifting the conversation from "What can we do?" to "What is best for you?", providers can help patients make decisions that align with their personal goals and values.

Palliative Care: A Misunderstood Option

Palliative care is often misunderstood as "giving up", but in reality, it is about improving quality of life at any stage of illness. Studies show that patients who receive early palliative care not only feel better but sometimes even live longer than those who pursue aggressive treatments until the very end.

Palliative care teams help with:

Pain management
Controlling nausea, fatigue, and shortness of breath
Providing emotional and psychological support
Helping families navigate difficult decisions

In advanced cancers like pancreatic cancer, early palliative care can help patients spend their remaining time in comfort, with dignity, and surrounded by loved ones—rather than in and out of hospitals.

The Bottom Line: There Is No Right or Wrong Choice

At Right2Hope, we believe that every patient deserves access to the best possible information to make the right decision for their situation. Whether you choose to pursue experimental treatments, traditional therapies, or focus on palliative care, the choice should be yours—guided by honest discussions, realistic expectations, and personal values. We are here to help you navigate the complexities of treatment decisions, find potential options, and connect with resources that prioritize both hope and quality of life. Would you like assistance in exploring treatment options? Right2Hope is here for you.

Making the Right Choice: Balancing Hope, Treatment, and Quality of Life