When the First Treatment Doesn't Work

When a person is diagnosed with cancer, the oncologist (a doctor who specializes in treating people with cancer) recommends a treatment plan that is most likely to have the greatest benefits and the fewest risks or side effects. That initial treatment—called first-line treatment or first-line therapy—is usually chosen because it has proven to be effective for similar patients who have the same type and stage of cancer.

However, every person responds differently to treatment. If your first-line treatment does not work, starts but then stops working, or has side effects that you are unable to tolerate, your oncologist may recommend second-line treatment (also called second-line therapy), which is a different treatment that may be another option for you. In some cases, you may be a candidate for third-line therapy or even additional rounds of treatment.

Considering a different treatment option

If you need second-line treatment, it doesn't necessarily mean that you did not get the right treatment the first time or that there aren't any more treatments to try for your cancer. Still, it is important to understand that, in general, the likelihood that second-line treatment, or additional rounds of treatment, will have good results is lower than with first-line treatment. The chances that a second-line treatment will be successful depend on the type of cancer being treated. People with certain types of cancer can respond very well to a second-line treatment, while people with other types of cancer may have only a small chance that the second-line treatment will help them recover.

Other factors that influence the potential success of a second-line treatment include the following:

• The type of cancer you have
• The stage of your cancer (where it is located, whether or where it has spread, and whether it is affecting the functions of other organs in the body)
• How well and how long you responded to your first-line treatment
• How long it has been since your first-line treatment ended (because, in many cases, second-line treatment is more successful if a year or more has passed between the two treatments)
• What side effects you experienced during first-line treatment
• Your age and overall health

In some cases, you and your oncologist may reach the difficult conclusion that undergoing a new treatment is not the best choice, particularly if the treatment may have unpleasant or dangerous side effects or if the chance for success is small. This decision allows you and your oncologist to focus more on controlling the symptoms of your cancer, known as palliative care. Learn more about palliative care.

Talking with your doctor

It is important to talk with your oncologist about the treatment plan throughout the process, asking questions and communicating your preferences. You will likely feel more confident being a part of the decision-making process and expressing your opinion if you clearly understand your situation. Read more about your specific type of cancer and treatment options.

Bringing a list of questions to the appointment can help guide your conversation and ensure that the oncologist addresses all of your concerns.

Here are some examples of the types of questions you may want to ask your oncologist:

• What is the current status of the cancer?
• Has the cancer grown and/or spread since my initial treatment?
• Are other treatment options available?
• Would you recommend undergoing a new treatment?
• Would you recommend participating in a clinical trial?
• Should I consider not undergoing any new type of treatment at this time?
• What is my prognosis (chance of recovery) if I choose not to undergo second-line treatment?

If you and your oncologist decide to pursue a second-line treatment, you may consider asking the following questions:

• How is this treatment different from the first-line treatment I had?
• What is the goal of this treatment?
• What are the potential risks and benefits of the treatment?
• What are the possible side effects of each treatment, both in the short term and the long term?
• What success rate does this second-line treatment have for my type of cancer?
• What is the expected timeline for my treatment plan?
• Do I need to be treated right away?
• What is the likelihood my cancer will recur (come back) after this treatment?
• Will I need to receive this treatment in the hospital, or can it be done in a doctor's office or clinic?
• How much experience do you and your health care team have using this treatment for my type of cancer?
• Where can I find more information on the treatment you are recommending?

Learn more about questions to ask the doctor.

Considering a clinical trial

At any point in your treatment, ask your oncologist whether a clinical trial is an option. A clinical trial is a research study that tests a new treatment to prove it is safe, effective, and possibly better than the standard treatment you may already have had. Because many clinical trials require that you have few or no previous treatments, it is best to ask about clinical trials early in the treatment process. In some cases, participating in a clinical trial may be a better option for your second-line treatment than a standard treatment. Your oncologist can help you review all clinical trial options that are open to you.

Coping With a New Treatment

Learning that your first-line treatment did not work can be as scary as finding out you have cancer. It is normal to feel a wide range of emotions, such as anger, fear, shock, grief, and anxiety. You may wonder if you and your oncologist should have chosen another option for your initial treatment. You may wonder whether you have the strength to go through a new treatment. These are all normal reactions, and it is important to seek the emotional support you need to get through this difficult time. Some strategies include the following:

• Share fears and anxieties with family, friends, clergy, or support groups, in-person or online.
• Connect with someone else who has undergone second-line treatment and understands the emotions you are experiencing.
• Express your feelings through journaling.
• Practice stress management and relaxation techniques.

However, if you experience strong anxiety; depression, such as sadness for long periods of time or loss of interest or pleasure in normal activities; or the inability to focus or make decisions, consider asking your oncologist for help finding a counselor. Even if you don't experience severe anxiety or depression, talking with a counselor can help you develop healthy ways to understand and respond to your emotional needs and concerns.

More Information

Making Decisions About Cancer Treatment

Emotional and Physical Matters

Last Updated: July 12, 2010