First an apology:The server for this blog was down all day yesterday, so I was unable to post. Fortunately it is working this morning, so you are about to get two new ones.
If any one of us has not asked our doctor THE question, the "How long do I have, Doc?" question, we surely have thought about it. This is an especially urgent thought at the time of diagnosis, when we all spiral into panic and fear we will die very quickly, and then later for women who are dealing with metastatic cancer. We know that no doctor can really answer the question. No one knows. I have seen women who died shockingly quickly and suddenly and many others who had a great response to a new chemotherapy and got better for a long time. Years ago, one woman whom I knew made the difficult decision to move into a residential hospice as she lived alone and could not longer manage. After almost a year there, they threw her out, and she returned to her apartment and lived alone very well for another year or so. Her doctor had given her an old standby chemo drug which was a miracle for her.This is an excellent article from ASCO's Patient Net about how to have this conversation with your doctor. My strong advice would be to think long and hard before asking the question. Do you really want to know? Remembering that the answer will be a best guess, not a certainty, will it help you to have some sense of remaining time or will you be more depressed or anxious? If there is business to be completed or children to prepare, it may well be important to have a vague timeline. Many women, however, really do not want to know and do best by living each day, focusing on the quality of the immediate present.Here is the beginning and then a link:ASCO Expert Corner: Talking With the Doctor About PrognosisOne of the first questions a person may ask after receiving a cancer diagnosis is whether the disease can be treated successfully. Cancer.Net spoke with Ira R. Byock, MD, to find out what patients need to know about prognosis.Q: What does ?prognosis? mean?A: Prognosis is a term for the predicted course of a disease. People commonly use the word to refer to an individual?s life expectancy?how long the person is likely to live?however, prognosis can also refer to the chances that a disease can be cured, the outlook for recovery, and prospects for future function.Q: How does a doctor estimate a patient?s prognosis, and what are some concerns in making these estimates?A: Doctors typically estimate a patient?s likelihood of being cured, their extent of functional recovery, and their life expectancy by looking at studies of groups of people with the same or similar diagnosis. A person?s prognosis is always an estimate, and multiple studies have shown that it is often a rough estimate. It is always difficult to apply group statistics to individuals. The statement, ?No two people are exactly alike,? certainly applies to people living with cancer. So, in addition to looking at cure rates and the average survival of groups with similar cancers, a doctor must take into account the patient?s overall health and unique medical history when estimating his or her life expectancy.Some studies have shown that doctors tend to overestimate their patients? life expectancies. This may be because specialist physicians tend to think mostly about the diagnosis they are treating, while a patient may die from a complication caused by a separate condition. For instance, a person with cancer may die suddenly of a heart attack, unrelated to the cancer. It may also be true that doctors? hopes for their patients cause them to believe that the people they care for?and care about?will live longer than ?average patients.?When a person?s cancer grows and spreads, doctors often review a patient?s weight, energy level, activities, and function over time, including his or her ability to walk, climb stairs, and generally take care of him or herself. By recognizing any patterns of decline, it may be possible to estimate future function and longevity. These estimates, of course, are always subject to change based on new research and advances in treatment.Q: What are some benefits for patients in talking about prognosis with their doctor?A: Not everyone wants to know their chances of being cured or how long they can expect to live. Some people feel that knowing their prognosis is depressing or bad luck. In some cultures, people believe that talking about dying is unwise and can sometimes cause a person to die. In fact, many of us have some tendency to feel that talking about dying can somehow invite misfortune. We shush our ill mother or father if they bring up the possibility that they might not get better??Don?t talk like that!? we say, as if talking about it will make it come true.It is okay not to want to know your prognosis, but living with cancer certainly highlights the fact that life is precious and that every one of us will die one day.http://www.cancer.net/all-about-cancer/cancernet-feature-articles/expert-information-asco/asco-expert-corner-talking-doctor-about-prognosis