Advanced cancer/ Stage 4: When Will I Die?

Mr C, who is in his early 60s, was diagnosed with metastatic prostate cancer came with his two daughters for consultation. At the end of the consultation, one of the daughter accompanied her dad to go for venepuncture.

The other daughter stayed back and ask, “Doc, how long will my dad be able to live?”

At certain point of time, everyone, dies. I’m not trying to downplay dying.

It’s the inevitable end for all my advanced/ metastatic cancer patients. They knew about it.

Some will tell me that it’s a death sentence.

Some will tell me it’s their second chance to make amends or be closer to God.

When will I die? What do I tell them?

I told them, “I honestly do not know but not so quick”.

Unlike those who died suddenly from sudden cardiac arrest or fatal motor vehicle accident, most of my patients will likely still be alive the next day, next week, next month or next few years, with appropriate treatments.

Multiple types of treatments, from palliative chemotherapy, biologic therapy, targeted therapy and now immunotherapy have allow many patients to live for years.

Besides, the emphasis on multidisciplinary discussions and use of multimodality treatments (surgery, intervention radiology, radiotherapy, etc.) help to improve survival even more.

cancer-survival-rates
Five year survival for different cancer sites (JNCI, 2017)

The inevitable can be delayed as long as there is still treatment available and as long as patients agree for treatment.

  • Treatments for stage 4 lung cancer prolong survival more than 2-3 years now (M Reck 2016, Mok 2018)
  • Treatment for stage 4 colorectal cancer prolong survival more than 2 years (F Ciardiello, 2016)
  • More than 50% of advanced melanoma patients still alive after 2 years (J Schachter, 2017)
  • In advanced prostate cancer, 66% of patients are still alive at 3 years (Fizazi K, 2017)
  • Even for patients with advanced pancreatic cancer, which carry very poor prognosis, patients can now survive up to a year (Conroy T, 2011)
Screen Shot 2018-06-25 at 10.45.37 PM.png
All stages 5-year survival rates for main types of cancer in developed countries (C Allemani, ‎2018)

Live longer.

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