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Dr. Suraj Manjunath, Consultant - Surgical Oncology and Robotic Surgery, Manipal Comprehensive Cancer Centre, Manipal Hospital Old Airport Road & Millers Road discusses the concept of 5-year survival in cancer – a very common term used by oncologists which often gets misinterpreted among patients.
Early on in my career, I was counselling Mrs. T, a woman with stage I breast cancer. While explaining the diagnosis and its implications, I laid out the treatment plan, and told her - “You have a 98 per cent chance of a 5-year survival.” As I expected her to be pleased with this prognosis, I was taken aback when she burst into tears. She finally calmed herself and asked me a few questions, which I think many people have in their minds when they hear this phrase - “5 years of survival rate”:
“Doctor, Do I Only Have 5 Years to Live?”
“No, Mrs T. It actually means that 98 out of 100 women your age with this type and stage of cancer will still be alive at the end of 5 years.”
“So what happens after 5 years? Will I no longer be alive?”
“No, that is not what I mean. After 5 years, the number of recurrences of cancer and deaths drops dramatically. In simple terms, if you are healthy at the end of 5 years, your chances of being healthy and living a normal life are extremely high."
“So if I am OK at 5 years, does it mean that I am cured of cancer?”
“Unfortunately, we cannot guarantee that. Cancer can come back even after 5 years. However, for most cancers, including the one you have, recurrence beyond 5 years is a rare occurrence.”
After this discussion with Mrs. T, I have realized that there was a need to refine my counselling with patients, especially when it comes to discussing survival rates so that my patients and their families are clear on the idea of 5-year survival.
Other common questions my patients often ask me are:
“How did you get this number of 98 per cent?”
"This survival rate is generated from data collected from women of your age who have this specific type and stage of cancer. It is similar to saying that the average life expectancy of people in India is 70 years. But that doesn’t imply that every individual will live for exactly 70 years according to this data. It is merely a prediction that is made using the statistics available. The survival rate number also means the same as this.”
“Why do your oncologists talk about 5-year survival? Why not 2-year survival, or 10-year survival?”
In general, the longer a patient is cancer-free after treatment, the less the chance of cancer coming back. 5 years is a conventional benchmark and is a widely accepted standard measure in cancer care all over the world. The time frame of 5 years is reasonably long enough to evaluate the effectiveness of cancer treatments. At the same time, 5-year data is also short enough that it is practical to measure and report in clinical trials.
Oncology is a rapidly developing field with continuous newer and better treatments becoming available. Clinical trials use various outcome measures to evaluate if these newer treatments are superior to existing ones. In this context, improvement in the 5-year survival rate with the use of newer treatments is an important parameter. If we wish to compare a potential new treatment modality to an established standard form of therapy, then calculating the difference in 5-year survival can turn out to be quite useful in understanding whether it will be more or less effective than the existing treatment plan.
A 5-year survival rate strikes a balance between the requirement for long-term survival statistics and the practical constraints of collecting and analyzing data over a longer period.
However, other time-frames such as 2-year or 10-year survival rates are also sometimes used, depending on the specific type of cancer and the purpose of the analysis. For example, for cancers with a relatively short survival time, such as pancreatic cancer, a 2-year survival rate may be more appropriate. A 10-year survival rate, on the other hand, may be more meaningful for slow-growing cancers, such as prostate cancer.
“What are the other outcome measures in cancer care?”
Many statistical tools are used to scientifically assess clinical outcomes in modern cancer care. The 5-year survival rate is just one among them, but it is relatively simple to understand and widely used.
Depending on the particular outcome we are looking for (cure rates, improvement in survival, reduction in cancer symptoms, lesser side effects of treatment) and depending on the intent of treatment (potentially curative or palliative), we do use many other indicators as well.
“What can I do to improve my 5-year survival rate?”
For someone who has recently been diagnosed with cancer, there are several things they can do to maximize their chances of a long-term cure:
1. Complete your treatment
Make sure you undergo the entire treatment as advised by your team of oncologists. Cancer treatment in Bangalore can have several components (surgery, radiation therapy, chemotherapy, targeted therapies, etc). Also, the treatment often goes on for a long duration, and it is important that patients do not interrupt treatment or drop out of treatment mid-way.
2. Follow up regularly
Make sure you visit your oncologist regularly as per the schedule advised by them. Generally, follow-up visits are more frequent in the initial years (once in 3 to 6 months) and gradually become less frequent. After a few years, follow-up may no longer be required for certain cancers. The purpose of a follow-up visit is to ensure you are doing well post-treatment, to evaluate whether there are any after-effects of treatment, and to pick up any recurrence early enough so that it can still be easily treated.
3. Eliminate risk factors
Cancer could be a result of having risk factors. If you have a modifiable risk factor for developing cancer, for example, smoking, it is important to ensure that you give up smoking completely
4. Develop a healthy lifestyle
Eating a healthy diet with plenty of fresh fruit and vegetables, a physically active lifestyle, and maintaining optimal body weight –are important in maximizing the chances of a cancer-free life.
Consult an oncologist in Bangalore if you want to learn more about cancer treatment and cancer survival rates.
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