The Power of Choice in Cancer Care: Why It Matters

CHICAGO — Erica Neubert Campbell took a deep breath and announced to her colleagues that she would be taking time off for a double mastectomy.

No drama. Nothing too emotional. Just the matter-of-fact announcement she had planned. 

Then, a new coworker pulled her aside and said that she, too, had undergone a double mastectomy with reconstruction several years earlier. The coworker leaned in and whispered, “Do you want to see my breasts?”

“Now, I was desperately trying to stay professional,” Campbell recalled.

But yes, she did want to see them, she realized.

Campbell, a memoirist and patient advocate, shared her story during the American Society of Clinical Oncology Voices session at the American Society of Clinical Oncology (ASCO) 2025.

She recalled the cathartic moment when the two women found a private bathroom down the hall and locked the door.

“They looked so real. Her scars were so faint,” Campbell said. “I could hardly believe she’d had a mastectomy, and she gave me hope.

“And then she said something so profound,” Campbell continued. “She said she chose to have her mastectomy, and she was happy about her decision, and it hit me — the power of choice.

“Cancer takes so much…and the thing it threatens the most is your sense of control, and I wasn’t willing to give that up,” Campbell said. “So, in that quiet moment in the bathroom, I decided to stop my pity party and take back my power.”

The Mastectomy She Always Wanted

Perhaps her upcoming mastectomy wasn’t a punishment or something to dread. Perhaps it was a choice she could make to help save her life — not something to be done to her, but for her.

“Maybe I could choose to make this the mastectomy I always wanted,” she thought to herself at the time.

Two decades prior, her mother had made a choice, too. It wasn’t the choice Campbell wanted for her mother, who had been diagnosed with breast cancer and chose lumpectomy over mastectomy. When the cancer relapsed, her mother chose her own trusted doctor over the “world-class cancer center” Campbell said she had in mind.

“I was so mad, and I thought she was giving up,” Campbell said, recalling the resentment she felt after her mom died from the disease. “This haunted me for years.”

Things might be different if only her mother had made the “right” choice, she thought.

Then, many years later, Campbell faced her own breast cancer diagnosis.

“All I could think about was, ‘This is what I feared all along,’” she said. “But that’s how I got the opportunity to make a different choice than my mother.

“It’s how I ended up choosing to make this the mastectomy I always wanted.”

It was the mastectomy she wanted for her mother and the preventive mastectomy she considered — begged for, even — as fear and anxiety overcame her with every mammogram in the years after her mother’s death. A compassionate physician helped her decide to continue annual screening instead. And when the time came, she made her choice.

“But let me be clear: This is my choice, and not the choice,” she stressed. “Because choice looks different on everybody.

“There’s no universal right answer. There’s only your answer and your choice,” she realized.

That realization helped her find peace.

“Ironically, my biggest regret in my life is the one fight I got into with my mom over her treatment,” she explained. “But my mother’s choice wasn’t the wrong choice — it was just her choice. She loved her doctor, she trusted him, and that’s what mattered.”

There is power in choice, Campbell stressed.

“If you are a patient, ask for a choice. If you’re a doctor, offer a choice. If you’re a caregiver, honor the choice,” she said. “Cancer takes away so much, but it cannot take away your ability to choose — and that is how you reclaim your control, your peace, and your power.

A Physician’s Perspective on Patient Choice

For Naga Cheedella, MD, recognizing the value and power in patient choice was practice changing.

Cheedella, who also spoke during the ASCO Voices session, described a 43-year-old patient with stage IV colon cancer who had been doing well. She was responding to chemotherapy and experiencing few side effects.

“She was vibrant and full of life,” recalled Cheedella, a medical hematologist and oncologist, clinical researcher, and author.

Then Cheedella got word that her patient wanted to see her. She was in intensive care, having suffered massive blood loss from a surgical complication.

“My heart sank. I dropped everything and rushed to the unit,” said Cheedella, who is currently an associate professor at Texas Tech University Health Sciences Center, Lubbock, Texas. “She grabbed my hand, looked into my eyes, and said her last words: ‘Thank you.’”

“This was the moment I realized that she was not thanking me for the chemotherapy I gave her or the clinical information I explained or the discussions I had with her in the clinic, but she was thanking me for being there, for spending that moment with her, for seeing her.”

It was a moment that changed her practice forever, Cheedella said.

“It was not what I wanted. It was exactly what she needed, and from that day on, whenever I see a patient on the oncology floor, deliver a new diagnosis, or talk about treatment options, one thing always comes to my mind: ‘What do my patients really want?’” she said.

The ‘Stop. Process. Act.’ Experience

Cheedella developed a new approach for her patient interactions: “Stop. Process. Act.”

“I call it SPA,” she explained. “The most powerful part of any cancer care is simply asking — and listening.”

Stop and listen to your patient, process what they say to help you understand what really matters to them, and then act, she advised.

“Take steps and offer options that align with their values,” she added.

Patient choice based on informed consent and shared decision-making is a cornerstone of oncology care, and research has long demonstrated that patient engagement in the decision-making process regarding cancer screening and treatment is associated with improved outcomes.

But offering and respecting patient choice goes beyond following guidelines and laying out options, Cheedella said.

Taking time to ask and listen has helped her guide many patients toward the choice that is right for them. Sometimes that means accepting what the patient needs rather than what the oncologist wants, she said.

And sometimes it means helping a scared patient find her way to a life-saving clinical trial rather than the palliative care option she initially requested after learning about her diagnosis, she said, recalling a patient with stage IV pancreatic cancer.

The patient had a friend who had a terrible experience with chemotherapy complications and side effects, and she knew she didn’t want to go through that.

“I held her hand, and we talked about the differences in her diagnosis,” Cheedella said. “She had a mutation that made her eligible for a clinical trial with treatment that had less side effects. She chose the trial, and she did great — and all of this happened because we paused, and I asked her what she wanted and why.

“So I keep asking, and I keep listening, because at the end of the day, it’s not about me curing cancer but about helping patients manage cancer and live with cancer,” she continued. “And that makes all the difference.”

Campbell is a patient advocate and author of the breast cancer memoir, “The Mastectomy I Always Wanted.” She reported having no other disclosures. Cheedella reported having no relevant financial disclosures.

Sharon Worcester is an award-winning medical journalist based in Birmingham, Alabama, writing for Medscape Medical News, MDedge, and other affiliate sites. She currently covers oncology, but she has also written on a variety of other medical specialties and healthcare topics. She can be reached at sworcester@mdedge.com or on X: @SW_MedReporter.