Merry Christmas and Happy New Year!
Many people feel just as Mark Twain did when he famously said, “lies, damned lies, and statistics‘. This general feeling, that statistics can often tell any story the storyteller wants to tell…even a lie, is exacerbated when dealing with cancer. The doctor who is seemingly being honest when he tells a patient that he/she has five months to live is perhaps falling into this category. Unfortunately, statistics frequently allow the user to distance him/herself away from feelings and caring if not used with caution. On the other hand, care and feelings often do not evoke any statistical methodology and are thus often too unscientific. Let’s look at a cancer statistic and see the danger of how cancers can be reported and affect people perhaps negatively. Mesothelioma, if you look at the literature and clinical guidelines/statements is uniformly incurable and has a median mortality of eight months after diagnosis. Now that is scary…that seems hopeless and like most people you and I would be pretty depressed seeing or hearing that. But, wait…let’s see what the stats really mean.
It is still unclear why, but it is quite apparent from hundreds if not thousands of anecdotal if not scientifically valid studies that attitude matters and it matters in a big way when dealing with cancer. It is still not well-studied but this is probably related to the immune nervous system (read: brain) access. Negative statistical information (even if it’s not negative but it is PERCEIVED to be negative by the recipient) is absolutely harmful for people (like many of us) who are unsure of ourselves, or our conditions, or whom are nervous and scared and certainly not confident. It only helps to reinforce our feeling of helplessness, a less than strong purpose (or will) of living and so forth.
So does a median mortality of eight months really mean I will likely di of my cancer in eight months or not. Actually, this statistical information for this type of cancer that is relayed in clinical guidelines and in the literature (in reviews or after years of experience treating this type of cancer) is not really the case at all and thank goodness too as we have just stated that giving up is a sure way of hastening our demise. In fact, giving up means sometimes taking our doctors for their words without thinking for ourselves or giving us options or hopes. Due to our natural tendencies to see things as black and white and having sharp edges and distinct cut offs, we often miss the point when we look at statistical statements. All statistics no matter how precise the numbers are depend on variaton for their derivation and variation is the spice of life…that is how we evolved to how we are. When confronted with something like a median, it is often useful to not lump yourself in that median and conclude that you are doomed but to think about it this way….if median is half then there is the good half (those that live longer than 8 months) and the bad half (those that dont) and ask yourself what is it that makes me in the better half. ANother way of saying it is…why can’t and shouldn’t I be in the half that survives.
In fact, there are often really valid reasons that there are ‘good’ and ‘not good’ halves. In this cancer situation, being quite old or having this cancer caught at a later stage makes you more likely to be in the bad half, while being young, fit, healthy, and no other major medical complications helps to put you in the good category. So, ALWAYS ask yourself or your doctor….what are the factors that greatly contribute to bad out comes of the disease/cancer that you have. Don’t assume that you will follow what the median follows.
Here is another important point about this statistical information. The distribution might not be even when you are talking about the median. Median implies right down the middle. On one side of the middle is death before 8 months and the other side is death after 8 months. But, on the side of death before 8 months it might very well be likely that the distribution is even…most people die at between 7-8 months (just an example). However, on the other side of the median, those who survive longer, the distribution may be very skewed….people then to live 20 years more than the 8 months. Wow, now isn’t that different from what you might have originally have thought…now instead of resigning yourself to 8 months left, you might actually want to consider that you have a good 20 years or so more to go. So in general for a median of such a small number of months the curve on the left side (less than 8 months must be very sharp…between 0-8 months, but the curve of the right side can and is frequently very large….even the rest of someones life.
And here is one more piece of good news; the median mortality of 8 months for mesothelioma is only accurate for treatments that have been around prior to when you are reading them. So what this means is that if you are taking a new drug or an investigation drug, it might shift the median to many many years. That data wont be out for many years to come, but it certainly gives hope…novel therapies are not designed to shorten life…only extend them.
Well there you go! This is a case where positive attitudes combined with a little bit of knowledge (either yours or someone else’s) that can change you life. Please please and please don’t just listen to what the doctor says…think about what he/she says and think about what they may not know. Many doctors are not going to think about the distribution of the numbers or your exact chance of survival. They are thinking about the community and the survival of all their patients.
Thank you for reading and again do let me know if you have any questions about this or any other cancer related topic. Please do visit my website at www.cancermadesimple.com.
This information was partially derived from a wonderful article written by Dr. Steven Jay Gould and the original article can be found that this website….http://cancerguide.org/median_not_msg.html
Thanks Dr C.