19 -What Is The Chance This Will Work Doctor?

Each patient must remember the critical differences between RR, PR, CR, OS, MDR, and Cure, and listen carefully for which one the doctor is talking about. Beware when treatment is described as some percentage chance of working, without "working" being defined. It often only means OR= objective response. That is any measurable response or tumor shrinkage less than 50% which may or may not be clinically meaningful to you in terms of quality or length of life: i.e. measurable but not beneficial.

 Notice that a treatment which works only 10% of the time and produces only minor shrinkage isn't worth much and never cures or prolongs life. Sadly, here is where a common and unintended miscommunication often happens between physician and patient. The doctor says the treatment has some chance of "working," meaning “working at least a little,” and the patient interprets “working” “as working a lot,” maybe for a long time, maybe even a cure. They see a glimmer of hope that they will return to their normal life but that is not what the physician has said and indeed it never happens in such a situation.

 It is essential to know that disease response, OR(Objective Response), PR(Partial Response), and sometimes even CR(Complete Response), do not necessarily increase the chance of prolonging life let alone a cure. Treatments may yet be worth attempting if they will decrease symptoms of the cancer. But if the toxicity of the medicine is worse than the symptoms of the cancer, then the medicine may not be worth taking if there is not a chance of cure or significant prolongation of quality life. So ask and be clear. No doctor will be upset with your question. Most likely they will be relieved to have the opportunity to be explicit.  

Therefore, be certain you fully understand what the doctor is saying about expectations and toxicities before signing up for more treatment. This is usually not a critical issue when someone is contemplating their first line treatment or maybe even second line. But it is an absolutely critical issue when considering salvage third or fourth line treatment. If the doc says a treatment might work or you may respond, he may just glossing over or avoiding talking about a dire reality by  basically providing a placebo and a false hope. Remember you are entitled to have every question answered in a way you understand. You may need to re-ask the question several times to get the answer you need; don’t be bashful.

Family and friends need to know that when treatment stops, it doesn’t mean that life will bounce back to exactly what it was pre-cancer. You will be different, physically, socially, and perhaps spiritually. In some ways better, some worse, but never the same.