Prognosis: What the Numbers Mean

A median survival is the point at which half of a group of patients had died and half were still living. It says nothing about how long the longer-living half survived, and some people in that half live far beyond the median. It also blends together people of different ages, cell types, stages and treatments. If a figure seems frightening, remember that it describes the middle of a spread, not a limit. Ask your doctor where you might sit within that spread, given what they know about your case.

Survival studies need years of follow-up, so published numbers often reflect treatments that were standard a decade or more ago. Immunotherapy, refined surgical techniques and better supportive care have changed practice since many of those studies began. That does not mean outcomes are dramatically different for everyone, but it does mean older averages may not reflect current options. When you read a statistic, check when the patients were treated and which treatments they received before drawing conclusions. Studies also differ in who they include. A surgical series, for example, only reports on people healthy enough for an operation, which can make its numbers look better than those drawn from everyone diagnosed.

Your oncologist can often give a more meaningful sense of outlook by considering your cell type, stage, fitness, blood test results and how the cancer responds to the first treatments. Useful questions include: what is typical for someone with my profile, what would suggest things are going better or worse than expected, and how will we know if a treatment is working. Some people want detailed numbers and some prefer not to hear them. It is fine to tell your team how much information you want.

1. 1

   Ask your oncologist how your cell type and stage change the general statistics you have read.

2. 2

   Check the years patients were treated in any survival study before relying on its numbers.

3. 3

   Tell your care team how much detail about prognosis you want to hear.

4. 4

   Ask what signs on scans or in symptoms would suggest treatment is working.