During a consultation with an oncologist, one of the most important issues to address is what we call "goals of treatment." Although this may seem like an obvious topic, I see many times where the patient and their physician are not on the same page which leads to frustration for both.
I believe that setting goals with the patient is extraordinarily important- or in the words of Yogi Berra: “If you don't know where you are going, you'll end up someplace else.”
Most times for our cancer patients, we think of goals of therapy in terms of being "curative in intent" or "palliative in intent."
"Curative intent" therapy is where we are trying to cure the patient of the cancer and hopefully return the patient to completely normal function and health afterward; this is our typical goal for most patients with early stage cancers (such as stage I- III breast or colon cancers) or even in cancers that may be more advanced stage but are highly curable regardless of stage (such as certain lymphomas, testicular carcinoma, and others). With "curative intent" given that the goals to permanently eliminate the cancer, we sometimes will ask our patients to tolerate significant side effects since our reward will be cure of the cancer.
There are times when it is unfortunately impossible to cure the patient of the cancer or that cure may not be the goal of the patient. In those cases, we are treating patients with "palliative intent". In other words, and our goal first and foremost is to alleviate symptoms and improve quality of life and in the process hopefully extend the amount of time a patient can live with their cancer. In this case, as I tell my patients : "quality of life is king." The intention of this therapy is to improve quality of life, alleviate symptoms, decrease pain, or avoid symptoms the patient is already feeling well. When pursuing "palliative intent" to treatment, we have to remember that the goal is quality of life more than anything. From my perspective, whatever tool we use to achieve our goal is not as relevant as the improvement in quality of life itself.
With palliative intent therapy, I always remind my patients that the point of chemotherapy is to feel better. It is not necessarily a victory if we make a tumor shrink by 25% on an x-ray but the patient feels miserable every single day. Similarly, there may be some therapies that do not cause a cancer to shrink at all but keep it contained for an extended period of time and the patient can feel quite well.
As always, these are issues that need to be discussed between the patient and their physician. Make sure that you and your doctor both understand and agree on what the goals of therapy are in your case; in that way, you can best work as a team.