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Cancer patients need all the good news we can give them. In the absence of a guarantee or cure (which often are absent), the next best thing is some hope that the disease will go away, and stay away, for a very long time.  “What are the odds?” is the first question many patients ask when diagnosed with cancer. Depending on how we look at things, this question is surprisingly complicated. The odds of survival may be different for a patient at the time of diagnosis than they are 2 and 5 years later. This is the principle of “conditional survival,” and Dr. Benjamin J. Miller’s (Fig. 1) group explored it for patients with osteosarcoma and Ewing’s sarcoma. Happily, the news for our patients is good.    Fig. 1  The study by Miller, shown here, and colleagues primarily focused on the risk of cancer mortality regardless of the details of treatment. The challenge was finding the best approach to enhance understanding of the reality and gravity of the situation ...    In short, for each year a patient survives after the diagnosis, the likelihood of surviving 5 more years goes up; for a patient with osteosarcoma who has no metastases at the time of diagnosis, the odds of surviving 5 years was 75%. If that patient survives 5 years, the odds of surviving another 5 years increase to more than 91%. The numbers were similar for patients with Ewing’s sarcoma.  Of course, numbers do not tell the entire story. A cancer “survivor” with whom I am very close has said to me that until she dies of something else, she will not know that she’s “cured” of cancer. The work of Dr. Miller’s group suggests that vigilance indeed is called for — the good news implied by these conditional survival data is, itself, conditional. Some patients will die of their disease 10 or even 20 years after they believed they beat the disease. Odds are not everything, and most cancer patients will take these kinds of reassurances with a large lump of salt anyway — 75% (or even 91%) may not be too reassuring for patients who find themselves on the short end of a 1:200,000 ratio (the approximate prevalence of osteosarcoma in patients younger than the age of 20).  Even so, conditional survival is a useful statistic when counseling patients who receive diagnoses that carry existential threat. Hope is precious.

Editor’s Spotlight/Take 5: Conditional Survival Greater Than Overall Survival at Diagnosis for Ewing’s and Osteosarcoma