1.  Give yourself the time you need to make your decisions… Cancers take years to grow to the point where they are detectable.  A newly diagnosed cancer patient can therefore be confident that three or four weeks of decision analysis should not jeopardize the effectiveness of whatever treatment is eventually-check with your doctor to be sure.  Three or four weeks of decision analysis now may prevent years of suffering later, in cases where decisions are difficult or impossible to reverse and costly in their implementation. Don’t let anyone rush you, including yourself.   

2.  …by managing your decisions like you manage other projects in your life…  Most of our clients are accustomed to managing complex projects in their professional and personal lives.  Often, the last thing they want to do is undertake responsibility for coordinating their breast cancer diagnosis and treatment decisions, on top of all their other burdens.  However, no one else can scrutinize their decisions with the vigilance and self-knowledge that they bring to the task.  If they do not act to ensure that their interests are served, someone with different interests will.  
In general, unless you seize the decision-making reins, you are at risk of having someone act in your behalf without acting in your interest.  Whatever you background or training, bring all you skills to bear on the task of managing your cancer project.  Your own established organizational and analytical skills will help you deal with all the controversies you may encounter in a way that’s comfortable for you.  If you’re a list maker, make lists.  If you like to contemplate your other projects in solitude, make time to do that for this one, too.  Approach your cancer project with as much confidence and strength as you can muster.
 
 3.  …giving yourself permission to experiment and learn… Very few decisions are “final” or irreversible.  Many clients fret about decisions because they want to be absolutely sure they are doing the right thing before they act.  In many cases, they fail to appreciate how much they may learn by trying some therapy.  Some are worried that once they begin radiation, IV chemotherapy (to name a couple interruptible treatments) that they will not be allowed to stop.  Those who feel supported and confident enough to approach some decisions as reversible experiments are often surprised at which therapies work well for them.  However, some damage from side effects may already be done by the time they stop.  Patients and doctors need to weigh that risk against the reward of discovering when an effective but frightening therapy is surprisingly tolerable.
 
 4.  …recognizing that your preferences are unique and worthwhile… While a broad range of information and alternatives are considered “acceptable” by people who deal with cancer patients, some of your caregivers may have difficulty accepting your preferences.  Some will make presumptions about your preferences concerning your quality of life, your body image, your state of mind, and other things which they think they know better than you.  If you know what you like, be wary of people treating you as if you like-or should like-something else.  You may not always know what you like, and in that case, consulting yourself, or even others, may make sense.  The experience of cancer often leads people to change the way they lead their lives because they realize what is really important to them.
 
5.  …delegating tasks to people you trust… Apart from the emotional support that you may find sustaining - and regardless of what your usual management style involves - you may want to delegate some of the overwhelming amount of work that your cancer recovery generates.  Cancer patients often can find friends to whom they can delegate logistical tasks necessitated by their everyday lives.  It may be possible to delegate other tasks, too, such as library or on-line research.
 
6.  …keeping records of your case… There are at least two reasons to maintain, in your possession, a complete record of your cancer project.  First, for your own education about your case, you will want to review it when it’s convenient for you.  Second, you will want all the material at your fingertips so that you can give copies of it to experts whom you consult for second opinions.  This is something you should do for any report which leads people to make recommendations, such as the pathology report.
Gathering and maintaining a complete record of your project may be one of those tasks that you can get your friends or volunteers to accomplish.  In addition, the best investment I think anyone facing cancer decisions can make is a portable tape recorder to audiotape the many consultations involving different specialists who try to devise treatments customized to your case.  Bring someone along to your meetings to deal with the tape recorder if it’s distracting or troublesome for you to do it yourself.
With audiotapes, and notes (ask for copies of notes made by any other participants in a meeting), you begin to have the material you need to educate yourself about your case.  In addition, you may want to obtain all the records maintained by the organizations involved in your care.  Many of these records may be initially indecipherable to you, but someone, somewhere will know how to translate them.  That sounds like a task you can delegate, too.
 
7.  …and last, but not least, maintaining your sense of humor! Laughter cannot be analyzed, which may be why it is so important in cancer decision-making.  Everyone needs to take a break.