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If I were a patient with cancer or relative of cancer patient, questions that may come to mind would be; would this treatment cure me? If not, how long will it make me live longer? Also are there any sideffects and what are they?
The problem with the first question is cure can take on very specific definitions in medicine, such as surviving for 5 years then passing away (typically when talking about cancer), whereas a patient or relative is thinking in much longer time frames when hearing the word "cure.” This is also before we get into the concept of surviving x amount of years, but at what standard of quality of life ?
5 year survival rate for a particular cancer is not the same as mortality i.e living to an older age. Cancers are now detected earlier through screening,hence people survive longer because earlier diagnosis, but still die at the age they would have had they not been screened and cancer picked up based on symptoms. Five year survival can even increase while mortality from advanced cancer can stay same or even increase
Another common misleading communication is to tell the patient a certain therapy may have a 90 percent response rate to a treatment. This has nothing to do with overall mortality. It simply means the tumour shrinks for a certain time in response to a treatment, but may still not increase his/her survival overall.
It is worth remembering as patients, doctors and policy makers that when a treatment is said to have a significant effect the word normally conjures for most people images of big improvements and big numbers. This is not true. All it means that there is an effect of the treatment that was not due to chance and may be as small as 1%. It is is thus always worth asking ourselves exactly what the percentage improvement or range is and over what time frame
Figures expressed as relative mortality can be very misleading not only to patients, but medical practitioners as well. If a patient has 2% chance of surviving without treatment and treatment increases survival by 1% we can say there was an increase of relative mortality of 50%, obviously expressed like this treatment options may sound more appealing! But in reality absolute mortality has only increased 1%! The latter two scenarios conveying very different images, which only when fully understood can then be weighed against the inevitable risks
When talking of mortality in cancer, figures are represented for example as breast cancer mortality ( this strictly applies to those dying from this cancer- no other causes) was x amount, but when we add in all cause mortality ( that is deaths from all causes .e.g sideffects of treatment such as cancer or heart disease, then overall more patients may have died, benefitted very little or not at all from treatment). Thus it can be true that a treatment helps one cancer, but causes death or harm to patient by causing another cancer or sideffect, such as heart disease or osteoporosis.
For more information on understanding medical terminology please see the following helpful books:
- Doctoring data by Dr Malcolm Kendrick
- Overdiagnosed by Professor Dr.H. Gilbert welch, Dr Lisa M. Schwartz and Dr. Steven Woloshin all of Dartmouth University
- Should I be tested for cancer? by Professor H.Gilbert Welch of the Department of Medicine and Community and Family Medicine at Dartmouth Medical School and Codirector of the VA Outcomes group in the```Departmet of Veterans Affairs, Vermont)
The above involves informed consent. This is important in all areas of medicine, but particularly in cancer where treatments may range from completely ineffectual to minimally effective with:
at great financial cost to the NHS and to the great detriment of the patients health.
How and what questions are asked of patients will greatly change patient and doctor decisions.
Whether the patient has understood the full of implications of what is being told must be ascertained. This is a heightened concern in certain patient populations such as the elderly and even more worryingly in the elderly of a ethnic background where english might not be their first language, all of who will have to make decisions whilst suffering physically, mentally and emotionally or any combination thereof of their various illnesses.
If I were a patient with cancer or relative of cancer patient, questions that may come to mind would be; would this treatment cure me? If not, how long will it make me live longer? Also are there any sideffects and what are they?
The problem with the first question is cure can take on very specific definitions in medicine, such as surviving for 5 years then passing away (typically when talking about cancer), whereas a patient or relative is thinking in much longer time frames when hearing the word "cure.” This is also before we get into the concept of surviving x amount of years, but at what standard of quality of life ?
5 year survival rate for a particular cancer is not the same as mortality i.e living to an older age. Cancers are now detected earlier through screening,hence people survive longer because earlier diagnosis, but still die at the age they would have had they not been screened and cancer picked up based on symptoms. Five year survival can even increase while mortality from advanced cancer can stay same or even increase
Another common misleading communication is to tell the patient a certain therapy may have a 90 percent response rate to a treatment. This has nothing to do with overall mortality. It simply means the tumour shrinks for a certain time in response to a treatment, but may still not increase his/her survival overall.
It is worth remembering as patients, doctors and policy makers that when a treatment is said to have a significant effect the word normally conjures for most people images of big improvements and big numbers. This is not true. All it means that there is an effect of the treatment that was not due to chance and may be as small as 1%. It is is thus always worth asking ourselves exactly what the percentage improvement or range is and over what time frame
Figures expressed as relative mortality can be very misleading not only to patients, but medical practitioners as well. If a patient has 2% chance of surviving without treatment and treatment increases survival by 1% we can say there was an increase of relative mortality of 50%, obviously expressed like this treatment options may sound more appealing! But in reality absolute mortality has only increased 1%! The latter two scenarios conveying very different images, which only when fully understood can then be weighed against the inevitable risks
When talking of mortality in cancer, figures are represented for example as breast cancer mortality ( this strictly applies to those dying from this cancer- no other causes) was x amount, but when we add in all cause mortality ( that is deaths from all causes .e.g sideffects of treatment such as cancer or heart disease, then overall more patients may have died, benefitted very little or not at all from treatment). Thus it can be true that a treatment helps one cancer, but causes death or harm to patient by causing another cancer or sideffect, such as heart disease or osteoporosis.
For more information on understanding medical terminology please see the following helpful books:
- Doctoring data by Dr Malcolm Kendrick
- Overdiagnosed by Professor Dr.H. Gilbert welch, Dr Lisa M. Schwartz and Dr. Steven Woloshin all of Dartmouth University
- Should I be tested for cancer? by Professor H.Gilbert Welch of the Department of Medicine and Community and Family Medicine at Dartmouth Medical School and Codirector of the VA Outcomes group in the```Departmet of Veterans Affairs, Vermont)
The above involves informed consent. This is important in all areas of medicine, but particularly in cancer where treatments may range from completely ineffectual to minimally effective with:
- regard to quality of life and/or
- Mortality
at great financial cost to the NHS and to the great detriment of the patients health.
How and what questions are asked of patients will greatly change patient and doctor decisions.
Whether the patient has understood the full of implications of what is being told must be ascertained. This is a heightened concern in certain patient populations such as the elderly and even more worryingly in the elderly of a ethnic background where english might not be their first language, all of who will have to make decisions whilst suffering physically, mentally and emotionally or any combination thereof of their various illnesses.
Quick Summary of basic medical Jargon in Cancer to look for
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