Friday, November 30, 2012

What is Progress?

 The last thing I want to do is be critical of oncologists. For one thing, it's psychologically counterproductive. For another, I'm genuinely impressed with their ability and their demeanor -- not just mine but so many of the doctors that I meet at Dana-Farber. Indeed, one of the things that I love about my job is working with such a talented group of caregivers who are uncommonly both talented and nice.

Still, I'm struck by a quote I read attributed to a long-time physician and researcher. As he looked back on a long career he recalled that nearly 40 years ago, patients with a certain cancer would have months to live. Now they can look at them and say that they have 10 years and more... and it's improving all the time.

Is that good? 

If you're 85, sure. If you're 45? 10 years is better than 10 months but that's hardly great news.

Clinically and statistically, the improvement in survivorship statistics is remarkable. If I were talking about advances in my work, I'd put a big check in the progress column for that. But as a patient, any timeline is an unwelcome limitation. Progress is defined by many patients as a cure -- whether that means a never-ending string of checkups showing No Evidence of Disease or the chronic management of disease to the point where, put bluntly, something else gets you before cancer.

Comparing the patients' and clinicians' perspective, there seems to be a natural tension between the clinical classification of scientific progress and an often unrealistic expectation of a total cure. 

As an editor of magazines and other copy that often quotes oncologists, I'm always on the lookout for these instances where the doctor is unintentionally cavalier with the numbers, knowing that for some readers those figures seem scarier than the aggregated statistics that they are.