How long do I have to live?
How long do I have to live?
Cancer treatments are usually aimed at prolonging life and improving symptoms, rather than at cure. Many people and their families value honest and empathic discussion around their possible prognosis. However, it is critical to understand that every individual is different, that clinical trials and ‘averages’ do not apply to individuals, and that the doctor will almost always be wrong if they give a specific number of months or years.
How do some doctors estimate prognosis? A single number measured in months may be a ‘median’ that represents the overall (average) outcomes of all people with mesothelioma. Alternatively, it may be a ‘median’ that represents how long people receiving a particular type of treatment on a clinical trial lived. The ‘median’ is the middle number – meaning that half the people lived longer, and half less time, than that given number. Hence, it’s almost impossible that this one number is going to represent an individual journey.
What is a better way of estimating prognosis? This is where a doctor’s clinical judgement and ability to take individual situations into account becomes important. For example, they may consider what personal and disease characteristics may help that person to live longer (younger age, successful treatment, less tumour, robust physical health) – or to not do so well (other health problems, type of mesothelioma). This information is best given as a range, rather than a single number of weeks, months or years.
What might be the best way of talking about prognosis? You or your family may wish to ask specifically for a best case scenario, a worst case scenario, and an expected timeframe. When asked these questions, the doctor should still consider a best and worst situation for that individual, and could provide a range that spans months or weeks, depending on the situation. Let’s take the example of someone who has no further treatments available for their cancer, but is still physically active and has few symptoms. A reasonable answer may be as follows: ‘in your situation, it’s possible that you could live for six months or more, however I think that two to four months is more realistic. Unfortunately, sometimes things can change quickly and if that happened we could even be looking at a shorter number of weeks’.
What is the take home message? Single numbers do not relate to individuals, and are usually taken from studies of groups of people with cancer. Check that your doctor has considered your individual situation when talking about prognosis, and consider asking what is the best that can be hoped for, the worst that should be planned for, and a range that might reasonably be expected. Remember, doctors get prognosis ‘wrong’ all the time, and you are so much more than a number.
The author Professor Anna Nowak reports no relevant disclosures for this article.