"They gave him/her X months...

....and he/she has lived Y years and is still going strong."  I hear stories like this frequently and while I know that they are told as a means of encouragement, I always find myself a bit bemused by the apparent conclusion.  So, let me offer the following comments:

"They" -- Who are they anyway?  A common variant of the above statement is the "Doctors gave him...." which always strikes me as particularly unlikely.  More likely a doctor cited data on median survival (drawn from the SEER database for example), which suggest that 50% of those that received some particular cancer diagnosis died within X months.  This is of course much different than saying to an individual patient "You have only X months to live."  [At the same time, I have no doubt that patients and loved ones frequently hear this even when it is not actually said -- largely because we have all heard so many of these "They gave him X month" stories.] For more on this see Gould's classic essay "The Median isn't the Message" that I noted previously (suggesting that this is a piece that every cancer patient, friend, or family member should read and comprehend).

"gave" -- another word choice that seems very strange.  On the one hand, it seems to offer some half-hearted assurance that one is likely to survive some particular interval; that time is a gift that can somehow be conferred or given by omnipotent caregivers.  On the other, it sounds as if survival beyond that interval is highly unlikely and that there is a very narrow time window for "getting your affairs in order."  Once again these estimates are derived from typical patterns emerging in large databases. 

"X months" -- as near as I can tell this number must be based on median survival data.  To put it bluntly,  how long does it take until 50% of patients with a particular diagnosis are dead.  Note that "survivorship cohorts" can be stratitfied (by sex and/or age and or ethnicity for example) such that we can say that 50% of 50 year old caucasian males diagnosed with some given cancer die within 19 months.  Yet, as my friend Jack Reynolds often reminds me, as an individual cancer patient you represent a sample size of one.  We know that for even some of the most lethal cancers, some individuals live far beyond median survivorship estimates.  At it stands, we are now beginning to identify particular molecular markers that are associated with extended survival and a better understanding of the advantages such genes convey will likely translate into more effective therapies for all.

So, the real question for me is what can I do to shift survival probabilites in my favor?  We know that diet matters (more on this in a subsequent post) and that a supportive community is also beneficial (on that score, we are truly bleesed!).  /dps