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Nov 16, 2019 04:31PM
Best, Worst, and Typical Cancer Survival: New Estimates Tool
"How much time have I got, Doc?" That's a question never far from the mind of most metastatic breast cancer patients. Unfortunately, accurate estimates are elusive. A new approach mitigates the difficulty of that tough task by offering not one but three estimates.
Belinda Kiely, MD, ...proposed offering patients best, worst, and typical scenarios derived from clinical trial data. Her system is not formalized as an online tool but is a simple math exercise.
...physicians who give advanced breast cancer patients one estimate, such as 12 months, are wrong 70% to 80% of the time.
Kiely's method involves using multiples based in part on overall survival curves from clinical trials...doctors estimate the expected survival time for a patient, **divide it by four to get the worst-case scenario, and then multiply by three to get the best-case scenario. The typical scenario is between a half and two times the doctors' estimated survival.**
...providing three scenarios helps patients prepare for the possible worst case and, at the same time, hope for the possible best case....subtype, extent of disease, comorbidities, and other factors determine outcomes. By using multiples derived from studies that closely reflect a given patient's situation, oncologists can offer a more nuanced assessment.
"Research shows that patients who discuss these issues with their doctor have better quality of life, are less likely to undergo aggressive end-of-life resuscitation, and are less likely to die in the hospital. But at the moment, we also know that many patients are not having these conversations."
"We must be willing to let go of the life we have planned, so as to have the life that is waiting for us." "If adventures will not befall a young lady in her own village, she must seek them abroad." "Buy the ticket, take the ride."
2015, DCIS/IDC, Right, 3cm, Stage IIA, Grade 3, 0/1 nodes, ER-/PR-, HER2+ (IHC)
1/14/2016 Herceptin (trastuzumab)
1/14/2016 Cytoxan (cyclophosphamide), Taxotere (docetaxel)
2017, IDC, Stage IV, metastasized to liver, ER-/PR-, HER2+