Staying Hopeful When the Odds of Surviving Cancer Are Long: A Follow-Up

Why know the odds if they're useless?

A few weeks ago, I wrote an article in which I explained that odds were essentially meaningless for a specific person. I argued that the outcome was either going to happen or it wasn’t, and so the personal odds were either 100 percent or 0 percent. Since you didn’t know which of those two outcomes was going to happen to you personally, the odds were essentially useless. The trick to staying hopeful is to focus on living life and getting affairs in order in case there wasn’t much of it left.

So why know the odds at all? In fact, one of the leading breast oncologists I consulted for follow-up treatment for my own cancer refused to give me the information, saying that it would not affect my decision-making. I couldn’t disagree more strongly.

The first use of odds is to evaluate treatment options. Since almost all treatments have side effects and implications, you have the right to determine whether those consequences are worth the increased odds that treatment would provide. Not all physicians are interested in having you participate in the decision-making in that way, but without that information, you’re not able to participate in that way. As an example, I learned — but only with a great deal of persistence — that chemotherapy would reduce my likelihood of metastatic cancer by 2 to 3 percentage points. Given that my risk was starting at something less than 15 percent, this was simply not a significant enough risk reduction for me to suffer through the potential side effects of chemo. While that reduction was deemed significant enough to become the standard of care, it was simply not the care I wanted, given the tradeoffs. Without knowing the odds, though, and the effect of the proposed treatment on those odds, I wouldn’t have been able to make that decision.

The second use of odds is to set a context. I know I’ve said that odds don’t matter, but I think you live differently if you know you have a 5 percent chance of survival versus a 99 percent chance. We’re human, after all. Prudence would have us living the same way in both cases — most of us never know when we’re living our last day — and so we should be equally prepared. But the reality is that we’ll face our mortality more profoundly and deeply if it seems closer. Hope, though, still springs from truly and genuinely not knowing which group you’re in (the 100 percent or the 0 percent), and so you hope for the outcome you want ... and prepare. And again, I think it’s our right to have the context to use in whatever way we want.

Bottom line: Odds don’t have much to do with hope. Instead, odds help with practical decision making, both about our treatment options and being prepared, come what may.