Wednesday, 12 June 2013

What is Survival?

Quite a lot has happened since my last post.  This has included the death of my brother-in-law from a combination of bladder cancer and a heart condition, and another work re-organisation and redundancy consultation (which I survived). But what is really occupying my mind today is the meaning, in Cancer-World, of the term "survival".

Three pieces of news have struck me this last week, and they are:

1. The prediction form Macmillan that in 2020 almost half the population of the UK will have a cancer diagnosis in their lifetime, but that 40% will "survive".

2. The death of Henry Cecil, race trainer.

3. The death of BBC broadcaster Rory Morrison.

Cecil was aged 70 and died of stomach cancer diagnosed in 2006, while Morrison was aged 48 and died of a lymphoma originally diagnosed in 2004.

So both of these men survived the five years that is all too often used as a bench mark for survival. Yet who could doubt that these men, and remember that Morrison was aged 48, died of cancer. Can we really say that they "survived" this disease?

As more modern treatments push back the boundaries of disease-free survival, we could be in danger of a public perception based on 5 year survival statistics that the battle, at least in some cancers, is almost won. It is true that more effective treatments combined, in some cases, with the possibility of earlier diagnoses, do mean that there are more "cures" (not a word I really like because the reality tends to be less simplistic) or at least, the staving off of the evil day to a time beyond that when other issues intervene. It is true that some people really are cured and won't see a return of the disease, and this is a wonderful advance. But for many more it is simply an extension of the evil day when disease "returns". I'm sure that if we were to ask someone what they would consider as survival it would not include dying of the disease nine years later, especially if that meant dying at age 48.

So while I am grateful for those advances that can put off that evil day, I know that there is still much work to be done before we can really say in any meaningful way that 40% of people diagnosed with cancer will survive it.

After all, I don't think I will say that being alive at age 56 means I've survived...