ACADEMY PUBLIC POLICIES

The first thing that some patients (or their loved ones) think when they are told that they have cancer is that they might die soon.

This is natural. In fact, few people die of cancer soon after they are diagnosed, although rapidly fatal cancers can occur. More people are living longer with cancer than ever before, and a cornucopia of new drugs being tested today offers real hope to cancer patients.

As might be expected of all good accountants, M. walked into my office, greeted me cordially, sat down, opened a notebook, took pen in hand, and prepared to discuss “the facts.”

The facts, however, were not a client’s tax returns but rather M. returns after meeting with a renowned surgeon in search of a radical cure for his newly diagnosed cancer.

Many oncologists, like myself, feel a tremendous emotional burden when they have to convey to another human being that they have an incurable illness (never could I have imagined earlier in my life that I would regularly have to do this). This discussion is made all the more stressful when a patient insists on knowing how long he or she will survive.

Some cancers have “prognostic models,” “scoring systems,” or “nomograms” in which several aspects of the cancer and patient are combined to determine the chances that the disease will return (relapse) after initial therapy. Some of the more commonly used models are for prostate cancer (Partin Tables and several others), kidney cancer (MemorialSloan-Kettering Cancer Center, or MSKCC, criteria), non-Hodgkin’s lymphoma (International Prognostic Index, for diffuse large cell and follicular types), and multiple myeloma (International Scoring System).