Short abstract
The jargon and survival data used by oncologists to communicate with patients may not be fully understood by a patient, resulting in a hasty decision without a proper understanding of its implications. This letter to the editor calls for more patient‐friendly language to improve communication.
Cancer has proved to be a by‐product of modernity and civilization owing to the drastic increase in the incidence and mortality despite great advances in medicine. The introduction of new antitumor therapeutic strategies during the past few decades has propelled the concept of precision/personalized medicine with increased effectiveness of treatment and better survival rates, resulting in a paradigm shift in cancer management—the patients can make their own choices for their treatment based on personal, psychological, social, and financial factors. The clinical trial market is expanding at a rapid pace with an emphasis laid on patient‐centric clinical trial protocol design to improve patient recruitment. Still, the oncological jargon and the survival data that the oncologist uses during her/his course of interaction with the patient may perplex them, resulting in a hasty decision without a proper understanding of its implications. A large volume of cancer‐related patient information present over the internet, though easily available, is vague, complex, irrelevant, and not salutary to the patient.
Sullivan et al. [1] have raised a very pertinent issue of patients’ understanding of clinical endpoints in oncology and the need for evidence‐based patient‐friendly language. The patients’ decision‐making must be in light of a clear understanding of expected treatment outcomes, treatment‐related adverse events, and financial implications [2]. From a patient's perspective, the core area of concern is longevity (termed as overall survival [OS]) or discomfort‐free life (termed as the quality of life) with the treatment. How effectively we are able to convey the literal meaning of these parameters to our patients is of paramount importance for informed decision‐making. OS can be presented as median OS (the duration for which 50% of the patients would survive after their diagnosis) or survival rates (percentage of the patients surviving at different points of time after the diagnosis). We have observed that survival rates are a better way of communicating the benefit of different treatment strategies, as the phrase “median OS” has a negative connotation—the glass is half empty. While explaining the results of the CROSS trial [3] to the patients, the statement “Neoadjuvant chemotherapy followed by radiation therapy (NACT‐RT) will lead to a higher number of patients surviving compared with surgery alone at 5 years (47% vs. 33%)” is better understood than stating “NACT‐RT will increase median OS from 24 months to 48.6 months.” For a modest beneficial effect of a treatment regimen in recurrent/metastatic cancer, it is imperative for treating oncologists to be explicit about the absolute survival benefit (percentage change in median OS for baseline risk of a patient). An absolute gain of 2 weeks in median OS with a new treatment/intervention is a 20% relative survival benefit when the median OS without treatment is 10 weeks.
In conclusion, the aim of any therapy should be to make patients with cancer live either longer, better, or both. Trials reporting the therapeutic value of interventions (surgery, drugs, or radiation) in patients with cancer must uniformly report absolute therapeutic benefit. Rephrasing the oncological lexicon to patient‐friendly definition can be a potential reassuring strategy.
Disclosures
The authors indicated no financial relationships.
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References
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