Doc, How Long Do I Have

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This question comes to physicians in several forms:

"Doctor, please tell me what stage is my cancer?"

"What is the prognosis of my disease condition?"

"Am I going to die soon?"

"Have long have I got?"

They usually asks for a simple answer. Time to live. In real world, however, the answers are far more complex and subtle.

The prognosis in cancer is often viewed as the chance that the disease (cancer) will likely to be treated successfully and that the patient
will recover.

There are many factors that influence the prognosis of a person diagnosed
with cancer. Among these, the most important factors are:

Type and location of the cancer

Stage of the disease (the extent of spread of cancer in the body)

Grade of the cancer (how abnormal the cancer cells look under a microscope)

Biological and genetic properties of the cancer cells

Patient's age

Overall general health

Response to treatment.


Recent
researches have shown that whenever asked to estimate time of survival for cancer, cardiovascular diseases, chronic kidney disease or Alzheimer's, doctors usually get it wrong. This is because, diseases are highly variable between varied persons producing varying results and death often comes from unexpected varied complications!

It is not reasonable to expect an accurate statement of survival. It also produces confusion, anxiety. For that reason, a better approach is to ask "Is this a curable disease at all? If not, what is likely to happen with this disease? What are the possible complications of this
condition? Doctor, in your personal experience, with all you have seen
previously, what might my future hold?"

A physician is not a deity and cannot see what is going to happen. Most probably, he has seen this type of illness many times and can offer a plan to cope up with the situation. Sometimes, physicians can have a hypnotic effect on patient's mind! Let me share a real life experience.

A few years ago, I had a hospitalized patient who was dying. This woman's cancer was growing slowly and gradually. But she was not clinically depressed or suicidal. She denied any chemotherapy. Finding no other way, I sat down to talk with her. She smiled to me. She said that she was not upset and was in fact at peace. Do you know why? It was because a physician had already told her she had twelve months to live. She had accepted this destination and died after twelve months! Game over.

This unfortunate patient did not give up. She just listened to peculiar medical advice and made it reality. After that incidence, I realized two important facts. Not to underestimate the incredible power of the human
brain in the mind-body connection. Second, be very careful how I answer
a question on prognosis.

About the Author

Dr Rezahaider's picture
Author: Dr Rezahaider

I am a physician by profession. I dream to work on medicine in the near future. I have completed my residency three years back. Now, I am planning to obtain MRCP. This is very hard exam and surely, I am always scared of it. I have also decided to do my specialization on cardiology. Before medical school, I never thought that our heart could be so complex! So pray for me. I usually don't have enough time to write due to my studies. But whenever I get time I love to write. I write on medical related issues. I try to make it simple for you.

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