Imagine, for a moment, that you are a cancer patient in an examination room. Your doctor enters and tells you that there are two treatment options. One assures you of 18 additional months of survival, but no more. The other will either extend your life by 3 years, or not at all. Which option do you choose?
In most areas of life, people opt for the sure bet. Approach someone on the street and tell them you’ll hand them $150 — or let them flip a coin, double-or-nothing — and they’ll take the $150. But when it comes to cancer care, a survey of cancer patients found that 77 percent would take the 50/50 gamble on getting three extra years of survival, according to research in the latest edition of the journal Health Affairs.
While the paper delves into detail on why, exactly, we seem more likely to take what the authors call a “hopeful gamble” (patients with short life expectancy may feel that they have less to lose), the results are important to health communicators for another reason: it gives insight into the way that patients themselves want to choose treatments, and how patients view statistical descriptions of a drug’s effectiveness.
In the hypothetical presented in the Health Affairs paper, both of the fictional drugs had exactly the same median overall survival: 18 months. From a strictly statistical point of view (and from the point of view of the U.S. Food and Drug Administration), the two medications are identical, despite the fact that deaths are clustered in two vastly different ways. But just because they are indistinguishable to the statistician does mean that a patient would see no difference. Indeed, patients in the study said that not only did they prefer taking the hopeful gamble, a quarter of the breast cancer patients surveyed said they’d be willing to pay an extra $90,000 for the opportunity to flip the coin. The value of the gamble far outstrips that of the safe bet, for the patient anyway.
It’s a reminder that though it’s important to talk about median survival, which remains the gold standard for regulators, we do patients a service when communication about a drug’s efficacy includes other metrics, such as the percentage of patients alive after a given number of years, that might help quantify how much hope is built into those survival statistics. With that need for additional information comes addition responsibilities — patients examining a hopeful gamble need to understand the consequences when the gamble doesn’t pay off — but it’s clear from the Health Affairs paper that patients value that information. Our job, as communicators, is to make sure they get it.