Your doctor will recommend the best treatment for you after taking into account all the factors discussed in the previous section. Feel free to ask how the treatment works and how it may affect you. You can also ask why the doctor has chosen a particular treatment.

You can discuss the effect that your treatment may have with your partner, family, doctor, nurses, or other therapists or counsellors if you wish. Many women find that being involved in the treatment decision helps them to have a sense of control over the cancer and their emotions.

Some women find that their secondary breast cancer may be controlled for a time by one treatment, and they then need to change to a different treatment when the cancer starts to grow again. Sometimes several different treatments may be given, one after the other.

Most doctors understand that you may want some time to think about their recommendations and any other treatment options. It can be hard to take in all the information about a treatment, especially if you have just learned that your cancer has spread.

Not all women want to be involved in decisions about their treatment. You may feel you have enough on your mind in coming to terms with the spread of your cancer and that you don’t want to make decisions about your treatment. In this case, you shouldn't feel under any pressure to get fully involved in treatment decisions. Doctors are aware that individual women have different ways of coping with their cancer and will respect your wishes.

Many people are frightened at the idea of having cancer treatments, because of the side effects that can occur. Although many of the treatments can cause side effects, these can usually be controlled with medicines. Some people ask what would happen if they did not have any treatment.

With secondary breast cancer, the aim of treatment is to control the cancer for as long as possible, leading to an improvement in symptoms and a good quality of life. Most women find that the treatment shrinks the cancer or stops it from growing. However, for some women the treatment will not have an effect on the cancer and they will get the side effects of the treatment with little benefit.

Making decisions about treatment in these circumstances is always difficult, and you may want to discuss in detail with your doctor whether you wish to have treatment. If you choose not to, you can still be given supportive (palliative) care, with medicines to control any symptoms.

Before you have any treatment, your doctor will explain the aims of the treatment to you. They will usually ask you to sign a form saying that you give your permission (consent) for the hospital staff to give you the treatment. No medical treatment can be given without your consent, and before you are asked to sign the form you should be given full information about:

• the type and extent of the treatment you are advised to have
• the advantages and disadvantages of the treatment
• any other treatments that may be available
• any significant risks or side effects of the treatment.

If you don't understand what you have been told, let the staff know straight away so that they can explain again. Some cancer treatments are complex, so it's not unusual for people to need repeated explanations.

It is often a good idea to have a friend or relative with you when the treatment is explained, to help you remember the discussion more fully. You may also find it useful to write down a list of questions before you go to your appointment.

Patients often feel that hospital staff are too busy to answer their questions, but it is important for you to be aware of how the treatment is likely to affect you. The staff should be willing to make time for you to ask questions. You can always ask for more time to decide about the treatment if you feel that you can’t make a decision when it is first explained to you.

You are also free to choose not to have treatment. The staff can explain what may happen if you do not have it. It is essential to tell a doctor or the nurse in charge, so that they can record your decision in your medical notes. You do not have to give a reason for not wanting to have treatment, but it can be helpful to let the staff know your concerns so that they can give you the best advice.

Usually a number of cancer specialists work together as a team and they use national treatment guidelines to decide on the most suitable treatment for a patient. Even so, you may want to have another medical opinion. Either your specialist, or your GP, should be willing to refer you to another specialist for a second opinion if you feel it will be helpful. The second opinion may cause a delay in the start of your treatment, so you and your doctor need to be confident that it will give you useful information.

If you do go for a second opinion, it may be a good idea to take a friend or relative with you. You may find it useful to have a list of questions ready so that you can make sure your concerns are covered during the discussion