Terminal cancer patients should get best and worst survival time-frames ‘because doctors are wrong 80% of the time’
- Australian researchers say average survival times don’t give patients hope
- Claim giving them best and worst-case scenarios is more accurate and useful
- Surveyed hundreds of patients, majority of who preferred the new approach
Doctors who give patients with incurable breast cancer a survival prediction are wrong almost 80 per cent of the time, research shows.
Leading GPs are calling for sufferers to be given best and worst-case time frames to paint a more accurate picture of their future.
The majority of patients given a deadly diagnosis want to know how long they have left to live, according to Dr Belinda Kiely, an oncologist at the University of Sydney.
This is usually so they know whether they should stop working or sell their home, or if they can attend a loved one’s wedding, she claims.
But the GP said the average life expectancy they are given is only accurate 20 to 30 per cent of the time.
Doctors in the UK and US, similar to Australia, use their experience to predict how long patients will survive. There isn’t one set model.
Doctors who give patients with incurable breast cancer an average survival time are wrong almost 80 per cent of the time, research shows
They take into consideration patient age, physical condition and how aggressive their cancer is before cross-referencing it with average survival times and adjusting.
The problem with average survival times is that there is a 50 per cent chance the patient outlives this, according to Dr Kiely.
Speaking at the Advanced Breast Cancer Fifth International Consensus Conference in Lisbon, she said: ‘Every week in my clinic, I meet women of all ages with advanced breast cancer.
‘They frequently ask, “How long have I got?” They have very practical concerns and questions that they want help with.
‘For example, they might want to know whether they should cancel a planned holiday, whether they will be able to attend their daughter’s wedding, or whether they should stop working or sell their house.
‘However, oncologists are sometimes unsure about how to help. They may worry… whether it’s possible to give accurate information and how best to talk about this without destroying hope.’
Dr Kiely’s research has shown that it is better to provide estimates for the best-case, worst-case and typical survival times. She said this was more accurate and helpful to patients.
It involves doctors estimating the expected survival time for a patient, dividing it by four to get the worst-case scenario and multiplying it by three to get the best-case outcome.
The typical life expectancy for advanced breast cancer patients is between a half and two times the doctors’ estimate.
Dr Kiely told the conference: ‘If we tell a patient that her estimated median survival time is six months, that conveys no hope of a possible longer survival, even though she has a 50 per cent chance of living longer.
‘On the other hand, providing three scenarios helps patients prepare for the possible worst-case and, at the same time, hope for the possible best-case.
‘This is more helpful for patients making plans and decisions for the future.’
Dr Kiely and her colleagues conducted a trial with 33 oncologists who between them spoke to 146 patients with advanced cancer about their expected survival times.
Each patient was provided with a printed one-page summary of their individual best-case, typical and worst-case scenarios.
Ninety-one per cent of the patients said they found the printed information helpful, 88 per cent said it helped them to make plans and 88 per cent said it improved their understanding.
Seventy-seven per cent of patients said the scenarios were the same or better than they had expected.
Based on their findings, Dr Kiely and her colleagues are now promoting the ‘three-scenario’ approach with oncologists in Australia. They hope to encourage doctors around the world to do the same.
Chair of the conference, Dr Fatima Cardoso, director of the breast unit of the Champalimaud Clinical Centre in Lisbon, Portugal, endorsed the approach.
Leading GPs are calling for sufferers to be given best-case and worst-case time frames to paint a more accurate picture of their future
The doctor, who was not involved with the research, said: ‘This tool for calculating and sharing the three scenarios gives doctors the help they need to communicate with patients in a realistic and helpful way.
‘Research shows that patients who discuss these issues with their doctor have better quality of life, are less likely to undergo aggressive end-of-life resuscitation and are less likely to die in the hospital.
‘But at the moment, we also know that many patients are not having these conversations.
‘Most patients with advanced cancer want some information about how long they are likely to live, although many say they find it difficult to ask this question.’
One in eight women in the UK and US will develop breast cancer at some point in their lives, Cancer Research UK statistics show.
In the UK, triple negative breast cancer makes up 15 per cent of cases of the disease – around 7,500 people each year.
And in the US, it is responsible for 10-to-20 per cent of breast cancers, according to Breastcancer.org
The chances of long-term survival are better the earlier the cancer is diagnosed.
Around nine out of 10 of women live beyond five years if they are diagnosed with stage one breast cancer.
Stage one describes a tumour less than 2cm in length and cancer that has not spread around the body.
But five-year survival rates plummet to one in 10 for those diagnosed with stage four breast cancer – when cancer has spread to other organs around the body.
WHAT IS BREAST CANCER, HOW MANY PEOPLE DOES IT STRIKE AND WHAT ARE THE SYMPTOMS?
Breast cancer is one of the most common cancers in the world. Each year in the UK there are more than 55,000 new cases, and the disease claims the lives of 11,500 women. In the US, it strikes 266,000 each year and kills 40,000. But what causes it and how can it be treated?
What is breast cancer?
Breast cancer develops from a cancerous cell which develops in the lining of a duct or lobule in one of the breasts.
When the breast cancer has spread into surrounding breast tissue it is called an ‘invasive’ breast cancer. Some people are diagnosed with ‘carcinoma in situ’, where no cancer cells have grown beyond the duct or lobule.
Most cases develop in women over the age of 50 but younger women are sometimes affected. Breast cancer can develop in men though this is rare.
The cancerous cells are graded from stage one, which means a slow growth, up to stage four, which is the most aggressive.
What causes breast cancer?
A cancerous tumour starts from one abnormal cell. The exact reason why a cell becomes cancerous is unclear. It is thought that something damages or alters certain genes in the cell. This makes the cell abnormal and multiply ‘out of control’.
Although breast cancer can develop for no apparent reason, there are some risk factors that can increase the chance of developing breast cancer, such as genetics.
What are the symptoms of breast cancer?
The usual first symptom is a painless lump in the breast, although most breast lumps are not cancerous and are fluid filled cysts, which are benign.
The first place that breast cancer usually spreads to is the lymph nodes in the armpit. If this occurs you will develop a swelling or lump in an armpit.
How is breast cancer diagnosed?
- Initial assessment: A doctor examines the breasts and armpits. They may do tests such as a mammography, a special x-ray of the breast tissue which can indicate the possibility of tumours.
- Biopsy: A biopsy is when a small sample of tissue is removed from a part of the body. The sample is then examined under the microscope to look for abnormal cells. The sample can confirm or rule out cancer.
If you are confirmed to have breast cancer, further tests may be needed to assess if it has spread. For example, blood tests, an ultrasound scan of the liver or a chest x-ray.
How is breast cancer treated?
Treatment options which may be considered include surgery, chemotherapy, radiotherapy and hormone treatment. Often a combination of two or more of these treatments are used.
- Surgery: Breast-conserving surgery or the removal of the affected breast depending on the size of the tumour.
- Radiotherapy: A treatment which uses high energy beams of radiation focussed on cancerous tissue. This kills cancer cells, or stops cancer cells from multiplying. It is mainly used in addition to surgery.
- Chemotherapy: A treatment of cancer by using anti-cancer drugs which kill cancer cells, or stop them from multiplying
- Hormone treatments: Some types of breast cancer are affected by the ‘female’ hormone oestrogen, which can stimulate the cancer cells to divide and multiply. Treatments which reduce the level of these hormones, or prevent them from working, are commonly used in people with breast cancer.
How successful is treatment?
The outlook is best in those who are diagnosed when the cancer is still small, and has not spread. Surgical removal of a tumour in an early stage may then give a good chance of cure.
The routine mammography offered to women between the ages of 50 and 70 mean more breast cancers are being diagnosed and treated at an early stage.
For more information visit breastcancercare.org.uk or www.cancerhelp.org.uk
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