Discussing Cancer Prognosis (audio/text)...and hope vs #'s

Discussing Cancer Prognosis (text)

audio (12.36 min)

The Limitations of ‘How much time do I have left?’

“How much time do I have left?” seems an inadequate way of asking your doctor about prognosis for a number of reasons. First, the question suggests that it can be answered with an absolute number—eg, 1 year—which patients often interpret literally. They feel cheated if they are short-changed, and if they surpass the deadline, they feel as though they are just waiting to die. Statistically, it confounds average and median survival. Survival is commonly measured in terms of median survival, but patients are rarely familiar with the concept of “median,” and understand it to mean “average.” Perhaps more importantly, it does not account for the fundamental statistical principle of range, an essential part of understanding survival curves. Finally, prognosis should be tailored to the individual in order to account for variables such as fitness, comorbidities, newer treatments, and better delivery of care. Prognosis should also offer hope, which an absolute number does not do.....