As of now, almost two weeks into his treatment, Joe is tired—fatigued. He felt some brain fog in the first week, struggling to figure out what to do next, but this improved when his sodium level returned closer to normal. His appetite is poor, but he is only rarely a little nauseous. Despite not feeling great, he is on his feet working around the house most of the day. I love naps. Joe doesn’t see the point.
Joe has been concerned about getting lung cancer his entire adult life. He knew that his smoking put him at high risk and felt guilty that he could not quit. The more guilty he felt, the harder it seemed to stop. It’s a vicious cycle. During this past year of watching the suspicious nodule and waiting for the next test, and especially when the diagnosis was confirmed, Joe feared the worst. He felt like he should just crawl into a coffin. We both saw the diagnosis of lung cancer as a fatal blow.
So what are the odds? Based on the historical results for the treatment Joe is receiving, there is a 44% chance that he will live for 5 years or more. There is a 33% chance that his disease will not get any worse in the next five years. Compared to crawling in a coffin and waiting to die, these odds look marvelous. And these statistics are based on people diagnosed as long as 10 years ago. Who is to say that treatment isn’t even better now?
Joe is enrolled in a study evaluating early immunotherapy given concurrently with chemo radiation. He was randomized to the control arm of the study, though, so is getting the exact treatment that produced the results I referenced above: chemo radiation followed by a year of immunotherapy. One way of thinking about the odds is that Joe has a 44% chance of living for 5 years and a 33% chance of doing so without getting worse. I think it is more useful to realize that he either will respond to treatment or he won’t—a flip of the coin. Out of a 100 coins, 44 land heads up.
What will enhance Joe’s chances of landing heads up? That is worth learning and applying. Based on my preliminary research, everything that will improve Joe’s chances of doing well will enrich both our lives. Many of these things we do now but can do better. Some things we have ignored. Focusing on improving our health and well-being is our plan at the moment. I’m curious and excited to see what changes we can make.
