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How Long do I Have

Posted 1/24/2014

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This question is the central one for us all. When we hear our cancer diagnosis, and our ears start to ring, and our stomachs drop, and the world darkens around us, it is this question that is taking over. We assume that the answer is "not long", and we worry that the little time left will be grim.

  In fact, many people with cancer, and especially many women with breast cancer, do just fine. Of course there is never a promise, and we all must learn to live with some degree of uncertainty and anxiety hanging over us, but we go on. And, with luck, we go on and on and n, and the days become weeks, then months, then years.

  Women who are living with advanced/metastatic cancer hear this ringing question more loudly. There never is an answer. We are each an N of 1, and the statistics don't really tell us much beyond a range. There are always people in the tails of the curve, and we all hope to be on the good end of the tail. But, we know we can't count on it, so day to day living becomes an exercise in hoping for the best while preparing for the worst. And going on.

  This is a remarkable and wonderful essay from The New York Times, written by a young doctor with a bad cancer diagnosis. Here is the start and a link. This is well worth your time and attention to read.


How Long Have I Got Left?

by Paul Kalanithi


As soon as the CT scan was done, I began reviewing the images. The diagnosis was immediate: Masses matting the lungs and deforming the spine. Cancer. In my neurosurgical training, I had reviewed dozens of scans for fellow doctors to see if surgery offered any hope. I’d scribble in the chart, “Widely metastatic disease — no role for surgery” and move on. But this scan was different: It was my own.

I have sat with countless patients and families to discuss grim prognoses: It’s one of the most important jobs physicians have. It’s easier when the patient is 94, in the last stages of dementia and has a severe brain bleed. For young people like me — I am 36 — given a diagnosis of cancer, there aren’t many words. My standard pieces include “it’s a marathon, not a sprint, so get your daily rest” and “illness can drive a family apart or bring it together — be aware of each other’s needs and find extra support.”

I learned a few basic rules. Be honest about the prognosis but always leave some room for hope. Be vague but accurate: “days to a few weeks,” “weeks to a few months,” “months to a few years,” “a few years to a decade or more.” We never cite detailed statistics, and usually advise against Googling survival numbers, assuming the average patient doesn’t possess a nuanced understanding of statistics.

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