Maurie Markman, MD
One of the cardinal principles of modern medicine, as practiced in the United States, is active participation by patients—and often their families—in the process of clinical decision making. Of course, there are rational and practical limits to this process. For example, patients generally will not be asked to decide what type of sutures to use in a surgical procedure or the specific antibiotic to be employed in managing an infection (except, of course, to inquire regarding the presence of prior allergic reactions).
Therefore, the question is whether the unequivocal improvement in clinical outcome for the overall population associated with the aggressive therapy is justified, considering that there is a 1 in 20 chance of treatment-related mortality in this carefully selected and managed patient group. Of course, there is no single correct answer, just a decision that should be made by the individual patient.
Interpreting Oncology Data
Turning to the realm of oncology, it is not difficult to find examples of study results in which individual patients may legitimately reach different conclusions regarding the interpretation of trial outcomes, including concerns about the risk of severe morbidity or treatment-related mortality versus the realistic potential for improved survival.
... to read the full story