Wednesday, 6 February 2013

My lucky fortune cookie?

Last Saturday Katie and I went to the England vs. Scotland Six Nations Rugby match at Twickenham. It's always a great thrill to be part of a crowd of 80,000 singing "Swing Low, Sweet Chariot", especially when England are in a comfortable lead! We stayed overnight in a very nice hotel in central Windsor - a great way to spend the weekend. 

Katie recently found some videos online of presentations from an oncology conference. One of the most interesting items included in these videos was a discussion on the importance of remembering a patient's condition and goals when selecting which treatment to use. The oncologist making the presentation described how three patients with the same disease but in three different situations might end up on different treatments:
  1. Patient one is an asymptomatic patient whose cancer has progressed too far to be cured. In such cases the degree to which a given drug may produce shrinkage in the patient's tumours is not of much importance. What is important is selecting a drug that is likely to hold the patient's disease stable for the longest period without causing severe side effects which would compromise the patient's quality of life.
  2. Patient two also has cancer that has progressed too far to be cured but in this case the patient's tumours are causing discomfort. A reduction in the size of the tumours may alleviate the discomfort so achieving shrinkage is an important aim of any treatment. In order to achieve the shrinkage the patient may be willing to endure some medium level side effects.
  3. Patient three is a patient whose cancer is thought to be curable. Here the degree of tumour shrinkage that the treatment may produce is much more important and the patient is likely to be more willing to accept even severe side effects if the treatment ultimately results in a cure.
Patients one, two and three could all end up selecting  different courses of treatment even though they have the same disease. I've found that my intuitive preference is for treatments that have the best chance of shrinking my tumours even though my condition matches patient one here. I believe this is a common bias amongst people with late stage cancer, it is difficult to get away from the feeling that shrinking the tumours must be the best course of action. In order to overcome this type of bias it is important for patients to double check that their treatment choices really do match their treatment goals. 
Finally I had my latest CT scan on Monday with the results due on Thursday 14th February. Waiting for a scan result is pretty stressful. Dinner at our local Chinese restaurant did provide an unexpected moment of light relief tonight when I opened a fortune cookie and found this message inside:

That made Katie and I smile. I just hope it turns out to be as accurate as it is relevant!

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