Is the Median All We Should Offer Our Patients?

Maurie Markman, MD
Published: Tuesday, Feb 27, 2018
Maurie Markman, MD

Maurie Markman, MD
In an elegant commentary discussing patients and their courageous decisions to fight cancer, Lawrence H. Einhorn, MD, a pioneer of modern oncology, highlights the differences between clinical oncologists’ textbook learning about outcomes and their actual real-world experience.1

Despite these daunting challenges, she was able to survive for 15 years and had the truly wonderful opportunity to watch her young children grow. Her clinical course and ultimate survival did not follow what is written in textbooks or what would likely be considered the “correct answer” on a medical oncology board examination. Einhorn suggests that “her love of life and family” may have had something to do with her atypical longevity.

Defying a Prediction

The personal experience of the late Stephen Jay Gould, PhD, an internationally acclaimed evolutionary biologist, must be included in any discussion of the critical difference between claims of prognostic certainty and the objective reality that prognostic data may not have direct relevance in individual cases of cancer.

In fact, although median survival is a reasonable endpoint to highlight, it is only 1 of many relevant outcome factors to discuss, and, most important, this mathematical figure simply does not define the survival of any particular patient.

Ovarian Cancer Survival Curves

A recent publication in the gynecologic cancer literature that explored the survival outcomes for women who experienced initial recurrence of epithelial ovarian cancer clearly emphasizes the point.3 The study involved an examination of Surveillance, Epidemiology, and End Results–Medicare database records of 2369 women in this most difficult clinical setting who were >65 years of age, who underwent primary surgical cytoreduction and platinum-based chemotherapy, and whose disease unfortunately recurred >3 months after diagnosis.
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