Monday, May 7, 2012

DOC GAVE ME THREE YEARS


“I can’t take any more numbers” said a man in our cancer support group. “This chemo has a forty percent chance of working. Two out of three chances you’ll live five years. Five percent mortality. It drives me crazy. The only numbers I’m interested in these days are a hundred percent and zero. Either I’m here or I’m not.”

“How much time do I have, Doc?” is arguably the question oncologists hear most often. It’s understandable that we want to know, but the answer, of course, is that no can know. So the doc offers us statistics, maybe saying something like, “Well, eighty percent of people with your diagnosis survive two years.”

There are three problems with our use of statistics. One is that by definition they cannot describe characteristics of an individual, only of a group. If you’re informed that of one hundred people in your situation, twenty will be gone in two years, what does that mean to you? You might be among those twenty, you might not. In my mind, the number doesn’t illuminate much. As our group member put it, you’ll be one hundred percent here or zero here.

Another problem is that people unfamiliar with statistics misinterpret them, and almost uniformly toward the negative. You’re told, for example, that median survival time for this particular illness at this particular stage is three years. You go home and tell the family, “Doc gave me three years.” Nope. Three years was the median, meaning that half the group will die before three years and half beyond that time—in fact, some will die decades beyond that time.

A third problem is that we tend to see statistics not as descriptive, but prescriptive, actually a self-fulfilling prophecy. Believing the doc gave you three years, you can unconsciously store the figure in the back of your mind, where it continues to reiterate the message, diminishing your optimism until voila!, you die right on time.

For all these reasons, I know an increasing number of physicians who are reluctant to offer any statistics at all. Yet when knowledgeable about statistics, you can use them to your advantage. We traditionally describe survival rates with a mathematical model called a “bell curve,” which looks like this:


The curve says a small number of patients die relatively soon, a similar number survive a long time (the lower sides of the bell), and the majority fall in between. When you hear a statistic involving you, all you know for sure is that you’re somewhere in that curve. (In fact, even if you’re not sick, you, being as mortal as ever, are somewhere in that curve.) You also know that you want to be as far to the right in the curve as possible.

Bell curves are usually built from data that take just a few categories into account: type and stage of cancer, maybe age of patient, and maybe gender, for example. Within those categories are people with poor nutrition, no support, toxic habits, and who feel helpless and hopeless, along with those who take excellent care of themselves—people who eat well, manage stress skillfully, enjoy high quality relationships, and so on. But those latter practices, being difficult to quantify, aren’t often taken into account. So if you’re leading a healthy life, the bell curve that ostensibly includes you is actually inaccurate. All else equal, you’re already to the right of its median, and by continuing to adopt healthy habits, you’ll extend your life expectancy even further. So here’s my prescription for statistics: take them with a grain of salt.

6 comments:

  1. Couldn't have read this at a better time, having just returned from oncologist appt. Most are giving me no hope at all for cure - and not being sanguine about quality of life for however long I survive. Today's onc basically said he could send us home smiling but that's not his job.
    Thanks for giving me just the tiniest speck of hope, Jeff. And a smile.
    Lori
    www.lorihope.com

    ReplyDelete
  2. And here is Tim Egan blogging about his mother's death - note what the oncologist says:
    http://opinionator.blogs.nytimes.com/2012/05/10/the-last-mothers-day/?src=me&ref=general

    ReplyDelete
  3. Thanks, Suzan!!

    From the article:
    "But hadn’t the neurologist given her six months?

    'You know, these projections, four months, six months — they really shouldn’t do that. Make your peace with her.'”

    Absolutely. The only truths we're sure of is that we're alive now, will one day be gone, and so we should make our peace with one another now, as we go.

    ReplyDelete
  4. This is an excellent article with good advice, Jeff!

    When I was doing my neurology rotation in school, my Intern asked me to cover the service for one hour because he had to leave early and his replacement would soon be there.

    No sooner did he leave when I got an emergency page telling me that one of our patients had died! Rushing to the room, I was greeted by the deceased man's son who said, "But they told me he would be fine!"

    You can't make up stories like these!

    ReplyDelete
  5. I felt moved to write a response to your open and positive outlook. Having had my husband diagnosed with stage 4 lung cancer just 3 weeks ago, we have been thrown into turmoil. He is 39 and we have three beautiful boys aged 4, 6 and 7. There is no time for despair just fight , fight, fight and hope.

    We are not prepared to believe the stats we have been given, he will beat it or we will at least do everything in our power trying and drag out his life expectancy for many years to come..

    We had a healthy diet but have gone super healthy and have moved to the organic side, chicken and fish only, no fats, no alcohol, alkaline fruits and veg. Reiki, hypnotherapy, meditation and Qi Gong are all being explored. We will leave the medical side to our oncologist but as he is cynical about our diet, we are about his non belief in general wellbeing, diet and exercise being linked to health.

    We would love to be in touch with anyone to share tips/experiences with.

    Thank you and lots of love to you

    Charlie, Leeds, UK

    ReplyDelete
  6. Thanks for this post, Could you never mind if i put my link here for more shared-useful information?
    Motivation to lose weight
    Fat burning foods
    Best way to lose weight
    Short hairstyles for thick hair

    ReplyDelete