The breast cancer treatment plan you start with may not be the one you stick with through your entire journey.
And that’s OK, because every case is different, and your care needs may change. So, you may want to rethink your treatment plan.
“It helps to ask, ‘Is my treatment working as expected?’ and ‘What are the goals at this point — curing the cancer, lowering risk of it coming back, or controlling symptoms?” says Christos Papageorgiou, MD, a breast oncologist with Dartmouth Cancer Center in Lebanon, New Hampshire. “You can also ask if the plan should change based on how you’re tolerating side effects, or if there are newer options worth considering.”
Why People Change Breast Cancer Treatment Plans
You may consider changing your treatment plans for many reasons. Maybe you want a second opinion, you want to try a clinical trial, or a medication you’re on doesn’t seem to be working well.
“If the cancer is not shrinking, if scans or bloodwork suggest it’s not responding, or if the side effects are making daily life really hard, that’s a good time to talk about a new plan,” says Papageorgiou.
These are some reasons to talk to your care team about changing your plan.
Your current treatment isn’t working
If new test results leave you scratching your head, ask your doctor about the pros and cons of continuing or stopping a therapy. It’s very important for you to understand your options and what stopping a therapy may mean in terms of progression or recurrence, says Maryam Lustberg, MD, director of the Center for Breast Cancer at Smilow Cancer Hospital and Yale Cancer Center, and chief of breast medical oncology at Yale Cancer Center.
“Benefits and risks have to be discussed, and each patient will choose differently based on their health care goals and what toxicities and benefits they might be experiencing,” says Lustberg.
A new treatment is available
New treatments may become available that are ideal for your case, which is a reason to ask your doctor if you should switch gears, Lustberg says.
You’re struggling with side effects
In a 2024 BreastCancer.org survey of 1,400 people with breast cancer globally, 96.8% people had short-term side effects they had expected, but 18.7% said long-term side effects weren’t discussed. Track any side effects and bring them up with your doctor.
If side effects are a challenge, Lustberg says to ask your doctor about ways to manage your side effects. If those don’t work, ask about changing a dose of a medication, she added.
You want to explore a clinical trial
Ask your doctor if there are specific clinical trials that you might be eligible for, especially if you have hormone receptor-positive breast cancer, Lustberg suggests. “The time after several years of endocrine therapy is an area under intensive investigation, evaluating whether introduction of newer targeted therapies can additionally impact long-term outcomes and reduce recurrences,” Lustberg says.
You don’t love your doctor
You and your doctor should have a good working relationship. If you are questioning whether a new doctor or a new health system may be better, look into other doctors. “Some women feel very involved, while others feel their treatment was decided for them, not with them. The best care happens when women feel like partners in decision-making,” Papageorgiou explains.
You want a second opinion
It’s always OK to get a second opinion, but especially if the choices feel confusing, the cancer is aggressive, or you’re facing a big decision about surgery or chemotherapy, Papageorgiou says. “Sometimes, just hearing the same plan from two doctors can bring peace of mind,” he adds. “Usually, early on in diagnosis and at juncture when a change in treatment is being considered are common times to look for additional opinions,” Lustberg explains.
You want to know what’s next
Women with stage II or III breast cancer who have been on treatment for some time may want to ask their doctors what their care will look like in the years ahead at one, five, or even 10 years, says Natasha Kwendakwema, MD, an oncologist at Fred Hutch Cancer Center in Seattle, Washington.
“Breast cancer treatment and follow-up often continue for months and years after diagnosis, so understanding the expected timelines can help with planning and peace of mind,” Kwendakwema says.
You want additional care
Along with an oncologist, your primary care clinician can be an excellent source of referrals for other medical issues and help coordinate care with other doctors, Kwendakwema says.
You may need to see other specialists, such as a cardiologist or endocrinologist, depending on your needs, she adds. Palliative care may be another valuable add-on. This includes therapies to ease pain and symptoms and services to support your mental health.
Among respondents of the 2024 survey, 1 in 3 didn’t receive referrals for specialists such as mental health therapists or physical therapists.
Ask your doctor about what other professionals you need to see or let them know if you want to see a certain type of specialist, Lustberg says. A care navigator at your medical office can hopefully coordinate care so you aren’t overwhelmed with communication and details, Lustberg adds.
What Goes Into a Breast Cancer Treatment Plan
Depending on your case, you may need surgery, which is often followed by radiation therapy. Surgery can include removing a lump or removing the entire breast(s) or taking out some lymph nodes. Many people with breast cancer also go on some type of medication.
A wide variety of health care providers can work on treatment care, from oncologists and surgeons to dietitians and rehabilitative care specialists.
A few factors that go into your breast cancer treatment plan include:
- The type and stage of the cancer
- How fast the tumor is growing
- How likely the cancer is to recur
- Your age
- Your medical status
- Whether or not you’ve experienced, or are in the process of, menopause
- If you’ve had cancer before
- If the cancer cells have hormone receptors, as is the case with estrogen receptor (ER)-positive or progesterone receptor (PR)-positive breast cancer
- If the cancer cells contain large amounts of the HER2 protein (if you have HER2-positive breast cancer)
- Your finances
- Anything that could interrupt treatment, such as travel plans or work
- What you hope for in life after treatment (survivorship goals)
Your breast cancer treatment plan may include:
- Potential surgical treatments
- Expected doses of medications
- A timeline of how long you’ll undergo treatment
- Which doctors will offer care at different times
- How to handle side effects
- Expected long-term effects of the treatment
- Supportive therapies and medical equipment you may need
- Who will coordinate your care
- How health care providers will communicate
- Resources for emotional support or social concerns
- Disability and financial concerns
- Advance directives and/or care preferences
When to Consider Changing Your Treatment
Every person’s cancer is unique. Cancer can change with time, as can your overall health. This is why you may check in with your doctor or other health care provider regularly to confirm your treatment is working or re-examine your plan.
Each visit with your doctor is a good time to ask about anything new in treatments, Lustberg says.
When to Get a Second Opinion
Meeting with another doctor to receive a second opinion is OK at any time.
A second opinion doesn’t always mean that you’re looking for a new care team, though it can. The visit may give you insight into your diagnosis and treatment, expand your options for care, confirm that your care is beneficial, or help ensure you’re not overtreated. It can also help you determine if you’d work better with a different doctor.
In addition to competence, look for a doctor you get along with, says Larry Norton, MD, a breast medical oncologist at Memorial Sloan Kettering Cancer Center.
“A mistake I sometimes see patients make is to make a decision first, without sufficient information, then search for a doctor who either agrees with them or goes along with it,” Norton points out. When you think you have the right pick, trust it.
Check with your insurance company to see if there are any limits, though. Some health plans may only cover second opinions from doctors in their own network.
If you choose to go for a second opinion:
- Ensure medical records are sent to the doctor giving a second opinion.
- Come up with a list of questions.
- Consider bringing a friend or family member with you for support.
- Consider recording the discussion, asking the doctor first if you can do so.
Staying Informed and Empowered
Standing up for your needs and desires can give you a sense of stability while you’re going through a difficult time. If you need to talk to your doctor, be as honest and upfront as possible. If you’re not getting what you need, talk to your care team about your treatment plan and how to improve communication.
