Development and validation of risk prediction equations to estimate survival in patients with colorectal cancer: cohort study
BMJ 2017; 357 doi: https://doi.org/10.1136/bmj.j2497 (Published 15 June 2017) Cite this as: BMJ 2017;357:j2497
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Dear Sir/Madam,
I read the paper by Hippisley-Cox and Coupland, as well as the accompanying editorial by Usher-Smith et al with great interest.[1, 2] The articles rightly highlight the advantages of the new QCancer 2017 model presented and discuss the potential advantages for clinicians and patients using the model when discussing treatment options for colorectal cancer.
I would further like to point out that the model actually may have an even more significant impact in illustrating what the survival rate may be if the patient decides to undertake no treatment.
The Choosing Wisely UK campaign says this of Shared Decision Making: "It explicitly acknowledges the fact that there is usually more than one way to treat a problem, including ‘no treatment’ and patients may require help to weigh up the benefits and harms of the options in order to determine the best choice for them."[3]
Clinicians generally lack the data to adequately counsel patients on what outcomes might be should they decide not to undertake complex and risky procedures or treatments which may result in iatrogenic complications.
This added information is very much welcome as patients and clinicians become increasingly aware that interventions may sometimes result in Pyrrhic victories where the surgery or chemotherapy has been a "success", but at the cost of good quality of life when that life may be very limited in duration.
References:
[1] J Hippisley-Cox, C Coupland. Development and validation of risk prediction equations to estimate survival in patients with colorectal cancer: cohort study. BMJ 2017; 357 doi: https://doi.org/10.1136/bmj.j2497
[2] J Usher-Smith, R Miller, S Griffin. Predicting survival in patients with colorectal cancer. BMJ 2017; 357 doi: https://doi.org/10.1136/bmj.j2772
[3] Shared decision making - Choosing Wisely UK. http://www.choosingwisely.co.uk/i-am-a-clinician/shared-decision-making/ Accessed 17 July 2017.
Competing interests: No competing interests
Colorectal survival risk calculator Re: Development and validation of risk prediction equations to estimate survival in patients with colorectal cancer: cohort study
The illustration provided in the risk calculator accompanying this valuable research article appears to suggest that an otherwise well (apart from her colorectal cancer) 38 year old woman has a >30% risk of dying from other causes by the age of 48. The 40% risk of death from colorectal cancer is entirely appropriate, but the >30% additional risk from other causes seems bizarre, unless I've totally misunderstood the histogram.
Competing interests: No competing interests