According to the American Cancer Society, more than 1.4 million people developed some form of cancer in 2007. Though the technology to treat and cure cancer has improved immensely in the last few decades, cancer is still the second leading cause of death, with more than 1,500 Americans dying per day.

Thousands of patients and families across the nation face the wrenching challenge of fighting a losing battle. So, how do you react when the prognosis is dire? Keep fighting? Even when the evidence does not support it? Even when your insurance stops paying? How do you navigate the system with terminal cancer?

With the majority of health care costs spent in the final months of life, it's vital that Americans begin to understand the many challenges, dilemmas and options of treating a terminal illness.

First, it begins with the patient. Do your homework! Consult with a physician you trust, and find a strong patient advocate to help. Get second opinions and be educated about the specific form of cancer. The more you know, the easier it will be to make informed choices.

Patients and families must be very cautious and tempered when deciding on treatment plans. Always ask the oncologist whether the planned therapy will be of any benefit. Is there scientific evidence? Research may show that the planned treatment causes the tumor to shrink, relieves symptoms, or even prolongs life.

However, just as frequently there may be absolutely no evidence of benefit. Often the physician will say there is a one in 1,000 chance that the tumor will shrink. This provides some hope, but sadly, it's false. A one in 1,000 chance is no chance at all.

Despite the poor odds, many people still elect to have treatment. If therapy is selected, make sure that you communicate with the responsible physician and understand your choices, the details of the therapy, possible benefits, side effects and how success or failure of the planned treatment will be determined. Know how long the therapy will take and the amount of time you will need to stay in the hospital. Understand how long care in the hospital will be covered by your insurance policy, and make sure there is a plan for what will happen once continued stay in the hospital is either no longer needed or insurance will no longer cover the cost of care.

Always be aware that your insurance company may elect to stop coverage if the treatment is deemed unsuccessful, inappropriate or futile.

When insurance is denied, don't be surprised if you hear it from a hospital administrator first. In the worst-case scenario, a hospital may actually give patients a 24- or 48-hour window to leave because of the insurance company's refusal to pay.

This is an important warning — you must understand and track the progress of the disease and the therapy. Is the patient improving and, if not, is there anything else that should be done?

You cannot count on staying in the hospital indefinitely. Post-hospital treatment requires a completely different care plan. Where will you go? Who will provide care and treatment? Unfortunately, most care plans only account for the time spent in-hospital. Upon admission to the hospital, meet and develop a relationship with a hospital social worker, who is far and away the most knowledgeable about discharge planning, and the choices available to you once you leave the hospital.

Finally, whenever a patient confronts terminal cancer, the issue of hospice care must arise. Hospice and palliative care are excellent options for many patients. Choosing hospice care is not about "giving up" or "not fighting" — it is an expression of how you choose to live out your final days. The goal of hospice care is to minimize pain and any negative side effects, making it as easy as possible for the patient. For many people, hospice care is the key to a peaceful, dignified death.

Regardless of how you battle terminal cancer, you must take an active role in determining your path. Do not rely on your physician to create the best, most optimal treatment plan. As an empowered consumer of health care, you must learn to navigate our complex and dysfunctional health care system — especially when battling terminal illness.

Dr. David Lipschitz is the author of the book "Breaking the Rules of Aging." To find out more about Dr. David Lipschitz and read features by other Creators Syndicate writers and cartoonists, visit the Creators Syndicate Web page at www.creators.com. More information is available at www.drdavidhealth.com.

COPYRIGHT 2008 CREATORS SYNDICATE INC.