Question asked by: 
KD, London
Date asked: 
Nov 2014

I have advanced disease and am considering the possibilities for treatment. I can either have chemotherapy (probably carboplatin on its own) to try and control it. Or not have chemotherapy and get seriously ill as the cancer spreads and attacks other organs. How can I make the right decision? Is it better to let nature take its course and opt for palliative care?

How can I make the right decision for my treatment?
Each time you have chemotherapy the experience and results can be different.
Response by Dr Alison Farmer, Oncology Nurse

This is a very difficult time for you and your family. It’s important to speak with as many people as possible, including family, friends and your treating team - listen to their thoughts and suggestions. This can lighten the load and help put things in perspective.

Each time you have chemotherapy the experience and results can be different.

Don’t think about it as committing to a number of treatments; just think of it as one at a time. You can stop treatment at any point if you feel the side effects outweigh the benefits.

The palliative care team can support you whenever you have symptom issues and often work alongside the chemotherapy team, helping to minimise symptoms and improve quality of life. If treatment gets the disease under control, your symptoms will improve and they can step back.

Talk to your CNS as often as necessary to help in this decision making process. You might also benefit from talking to other women who are in similar situations. Is there a support group you can attend? If not, ask your treating team if any other patients would be happy to share their experience with you.

There is no easy answer.
Response by Professor Iain McNeish, Professor of Gynaecological Oncology

This is a very difficult question and one with no easy answer. Women with recurrent ovarian cancer can respond very well to chemotherapy again (sometimes over and over). It can reduce symptoms from recurrent cancer and improve quality of life, even allowing for the side effects of treatment.

Trials have suggested that combination chemotherapy (such as carboplatin plus another drug) is more likely to make the cancer smaller and stop it recurring, than carboplatin alone. Combinations also allow women to live longer, however they undoubtedly have more side effects.

I usually offer women combination treatment, but respect their right to either ask for single agent carboplatin or refuse chemotherapy. In my experience most women opt for treatment.