The majority of men with advanced prostate cancer can live for a long time because of the treatments available. However, if your prostate cancer becomes more advanced and if treatments have become less effective, it is natural to want to know how long you may have to live. In many cases, it is difficult for your doctor to say exactly.
Treatment choices at end of life can vary depending on your situation and what is important to you. For many people, worrying about what will happen to their surviving family members is difficult. Planning ahead to settle legal, financial, and business affairs also allows you and your family to concentrate on the emotional aspects of your illness and its effect on your family. Some people may choose to stop all treatment; others may base their decision on what will offer them the best quality of life. Your decisions are personal, although you may like to discuss them with someone you trust (e.g. your partner, a family member or friend). Health professionals working in a palliative care team can also help.
These professionals can help you with:
- symptom management (e.g. pain and other uncomfortable symptoms)
- making difficult medical decisions
- coordinating care with other health professionals working with you
- emotional support.
It is important at this time to make sure that your treatment wishes are known – what type of treatment you are and are not willing to receive. An advanced health care directive (sometimes called a living will) is a legally binding document that is recognised in every state or territory in Australia (state and territory government laws may vary). It’s a document that outlines your wishes for future medical care (e.g. organ donation, do not resuscitate options). Starting the conversation early strengthens your relationship with the health professionals who are working with you, and enables them to provide you with the necessary information.
It is important to know that you don’t have to make treatment decisions immediately. Give yourself some time to consider your options. Some things to think about may be:
- Am I tired and exhausted because of side effects, my advancing disease or the emotions that I am experiencing?
- What is the expected outcome of my treatment?
- What should I tell my family about my current condition to prepare them?
- How will my preferences affect my treatment options?
‘Patient preference is an important factor in treatment decisions, as the values people place on quality versus quantity of life, their acceptance of risk and fear of complications will influence the acceptability of the various treatment options.’
(National Health & Medical Research Council, 2003, p.xii).
When the end of life comes, each of us hopes to die with dignity. Some people may like to consider leaving a life legacy – for example, a letter written to loved ones, a video, a painting. Other people may find dignity in daily interactions with their family, friends and carers. Some people like to set themselves tasks in the time they have left, for example re-reading a favourite book or just spending quality time with loved ones or pets.
Tell members of your healthcare team what they need to know about you as a person to give you the best care possible. This information will help your healthcare team to ensure you are treated with dignity.
Many people affected by advanced cancer of any kind say that spirituality is, or becomes, an important part of their lives. What matters is finding comfort, completion and peace, and sustaining hope and finding meaning in the illness. You and your family may seek spiritual support and help in finding these resources from health professionals working with you.