Cancer Prognosis: A Numbers Game?

I am living past my expiration date!

Cancer, it would appear, is a numbers game. From the minute each of us receive a diagnosis, we are assaulted with numbers: blood counts, enzymes, proteins, ratios, antigens, mutations and on and on. The numbers can be bewildering and many of us often struggle to wrap our minds around what all of the numbers mean. Quite often, the most daunting number that we encounter is the one related to the median survival from diagnosis. This is the number that I affectionately call the “expiration date.”

We are all familiar with expiration dates because we see so many of them plastered on consumer goods. They are guides to when products are best sold by or consumed by and most of us pay them at least a bit of heed. C’mon… When presented with two cartons of milk, you know that you are going to pick the one with the extra day or two of shelf life, right? But what about the stuff that is already in your fridge? It may be a day or two past its expiration date, but it looks and smells good. And so you drink it because it’s just fine, right? Those expiration dates on the vitamins? Just a guide. Expiration dates on medicine? Most of what is known about drug expiration dates comes from a study conducted by the US Food and Drug Administration at the request of the military. With a large and expensive stockpile of drugs, the military faced tossing out and replacing its drugs every few years. What they found from the study is 90% of more than 100 drugs, both prescription and over-the-counter, were perfectly good to use even 15 years after the expiration date. Turns out, these numbers are not quite the final arbiters of quality that we expect. So what about the expiration dates that cancer patients encounter on their own lives?

Our expiration dates are averages based upon data in the past up to a certain point. They represent a probability of likely average outcome based upon what the medical community knew, factually, up until the point in time represented by the actual data. The expiration dates do not take into account the day by day advances in cancer research and treatment. Further, they do not take into account the individual responses to treatment. Let’s face it: some of us don’t live in the middle of the bell curve from which averages are derived. In all candor, those expiration dates will likely have absolutely nothing to do with your own particular, individual situation. I know that they do not apply to me because I am now, officially past my expiration date.

I was that Type A guy who scoured the Internet in search of data, research and numbers when I got my diagnosis. I was horrified to learn that I was not expected to live to see my grandchildren be born or see my home getting paid off. The numbers were ugly and mean and knocked me off of my game. And they were also wrong. It took me a long time to understand that many of the numbers we deal with only look toward the past because they cannot know the future. And even though my marvelous cancer specialist went to great lengths to tell me to ignore the numbers, to know that I was very likely not going to die from this because we are learning so much, so fast… I stared at the expiration date. Now I am past that date and I am liberated.

In a few weeks I will be back at the hospital for my annual work up. I’m a little grayer. I’m beginning to embrace my inner curmudgeon and I am becoming somewhat set in my ways (the cats must get their treats while I am sitting in my chair at 5:00pm while turning on the local evening news). But I am also past my expiration date. The numbers were wrong. And I get to smile. A lot. In a few short months I will pay off that mortgage. And I know that I will get to welcome my grandchildren into this wonderful world. Even though neither of my daughters are married. Yet!