I. What are advance directives? 

Patients with cancer face difficult decisions when it comes to their healthcare. From diagnosis to treatment and beyond, there are many overwhelming decisions to make. 

Advance directives are a powerful way to take control of healthcare choices. These documents allow you to outline preferences for medical care and specify end-of-life wishes. These documents can also be a way to appoint loved ones who you would like to help with these decisions, such as a healthcare proxy (someone to make decisions on your behalf, if you cannot). As cancer treatments can involve aggressive treatments and/or complex medical management, having advance directives ensures that your desires regarding treatment options and end-of-life care are clearly communicated. 

II. What are the different types of advance directives? 

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Living Will: These are legal documents that address what treatments you would (or would not) want to be used to keep you alive. These can include decisions about chemotherapy, radiation, or surgery. A living will can also be a way to outline your preferences about pain management and end-of-life care and can address things like:

• Cardiopulmonary resuscitation (CPR): An emergency procedure using chest compression, often used with methods to give oxygen to the lungs, in the event your heart stops beating.
• Mechanical ventilation: An emergency method using a breathing machine in the event you are no longer able to breathe on your own. 
• Dialysis: A method of removing toxins from your blood if your kidneys no longer work. 
• Antibiotics: Typically used in treatment of infection. 
• Feeding tube: A way to supply the body with nutrients and fluids through a vein or a tube placed outside of your body into your stomach. 

Health Care Proxy (HCP) (or Agent): This is a person you can designate to ensure your wishes are followed, even if you yourself cannot voice them. Your proxy should know your wishes about the above interventions. 

Do Not Resuscitate (DNR) Order: Some patients with serious illnesses choose to have a DNR order in place, meaning they would not wish for CPR. They instead opt for a natural death if their heart stops beating. 

Physician Orders for Life-Sustaining Treatment (POLST): Many states now have these (often brightly colored) forms that document wishes about the above interventions (CPR, mechanical ventilation, hospitalization, dialysis, etc.) as discussed between patients and their medical provider. It is always signed by a medical professional and is something to have on hand in hopes that it can be used by hospitals and first responders.

III. Why is it important for patients with cancer to have advance directives? 

Maintaining control and quality of life: Patients with cancer face difficult treatment options. By expressing preferences about treatments and end-of-life care, you can ensure your wishes are respected throughout. Treatments can directly affect quality of life; being proactive in specifying treatment preferences is one way to maintain control of your cancer therapy navigation. 

Providing peace of mind: For both patients and their loved ones, there is comfort with knowing your healthcare preferences are fully documented. This can alleviate anxiety and uncertainty for family members as well. By creating advance directives, you can focus more on what matters the most to you outside of your cancer diagnosis. 

IV. How can you create advanced directives? 

• Consult with your healthcare team: Discuss your cancer diagnosis and treatment options with your oncologist and their team. Ask questions about what cancer treatments are possible, what the goals of such treatments are, and how to deal with side effects. If possible, discuss what end-of-life care might look like. 
• Complete documentation: Fill out the necessary forms; these may vary by state. If applicable, create a living will, HCP, DNR, and POLST. 
• Communicate your wishes: Share your wishes with your healthcare proxy, trusted loved ones, and healthcare providers. This can ensure that everyone involved in your care understands your preferences. These documents can often be filed within electronic medical records and displayed in highly visible areas of your home. 

Additional resources/references: 

American Cancer Society. (2021). “Advanced Directives.” 

American Society of Clinical Oncology. (2021). “Advance Directives.” 

National Cancer Institute. (2021). “Advance Directives and End-of-Life Decisions.”

National Institute on Aging. (2020). “Advance Care Planning: Healthcare Directives.”

Mayo Clinic. (2004). “Living Wills and Advance Directives for Medical Decisions.”