Just Another Statistic?

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The problem is that these series of conservative management focus on a patient population as opposed to individuals with a high risk of competing causes of mortality, which is very different from the population of patients generally treated with aggressive therapy in which some have shown overall survivals superior to age-matched controls. It is fallacious and illogical to compare nonrandomized series of observation to those of aggressive therapy. In addition to the above problem, the use of DSS introduces another potential issue which we will call the bias of cause-of-death-interpretation.

All statistical endpoints e. There is no reason to believe that this problem does not occasionally occur with respect to defining a death as due to the index cancer or to intercurrent disease, even though this issue has been poorly studied. In many oncologic situations-for example, metastatic lung cancer-this form of bias does not exist. In some situations, such as head and neck cancer, this could be an intermediate problem Was that lethal chest tumor a second primary or a metastasis?. Would the fatal aspiration pneumonia have occurred if he still had a tongue?.

And what about Mr.

In some situations, particularly relatively "good prognosis" neoplasms, this could be a substantial problem, particularly if the adjudication of whether or not a death is cancer-related is performed solely by researchers who have an "interest" in demonstrating a good DSS. What we are most concerned about with this form of bias relates to recent series on observation, such as in early prostate cancer. Thus, it is implied that many prostate cancer metastases are usually not of themselves lethal, which is a misconception to anyone experienced in taking care of prostate cancer patients.

“Just Another Statistic”

This is inconsistent with U. It is possible that many deaths attributed to intercurrent disease in "watchful waiting" series were in fact prostate cancer-related, perhaps related to failure to thrive, urosepsis, or pulmonary emboli. We will not know without an independent review of the medical records of individual patients; in some cases, even the most detailed review, sometimes even an autopsy, will not be conclusive. There are only a few data available describing the problems created by cause-of-death-interpretation bias.

One small study, presented only in abstract form, assessed the cause of death in 50 randomly selected prostate cancer patients who died.

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Five experts in prostate cancer were asked to assign the cause of death as due to or not due to prostate cancer. Studies of autopsies, which are now rarely done in the U.

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There needs to be more research on the validity and interobserver reproducibility of the DSS. In the meantime, researchers should not report DSS without reporting OS and the reasons for intercurrent deaths should be described-peer reviewers should enforce this. As with so many other problems with statistics in the medical literature, it is the job of the reader to remain skeptical.

The rate of intercurrent deaths in a study should reflect the age and demographics of the study population.

I asked her why. How does the federal government support our public schools? None of these things happened. My entire life has been overcoming odds that should have made me fail.

I was born three months premature to a mother who preferred drugs to parenting. She did not marry my father and he was never around. He too was an addict and is currently incarcerated. When I was seven, my mother was murdered.

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She wanted to get clean and was facing some serious time in prison, so she made a deal and gave names to the police. When she was released, these people found out and they killed her. They were never held responsible. What I took from this experience was a belief that I was never going to end up like my mother or father.

References

I made up my mind that I was going to do whatever it took to be a good person. I had to grow up quickly. My sister and I moved around from aunts to grandparents to friends. Thankfully, my sister and I were never separated or placed in foster care. This is because we had a great social worker, Amy, whom I loved. She fought for us and made a difference. Through all of this I learned that if I did not become independent and become a fighter for myself, then nothing would get done.

I knew I would have to advocate on my behalf and I wanted to prove I was a hard worker. I learned that you are not going to have someone there to hold you up all the time; you have to learn to do things on your own. I was independent in life and in school. I had to sacrifice hanging out with friends to spend extra time studying and stayed after school to get help. I had to handle keeping my grades up as well as working a part-time job.

I was not involved in sports, because my free time was spent studying or at work. Beyond growing up quickly, I had to face another adversity.

Being born early resulted in some disabilities, so I was in special ed for all of elementary and middle school. In high school, I decided not to accept any more accommodations. I was a C student all the way up to the end of freshman year.

I became more committed to my schoolwork without the extra assistance, to prove I could do it on my own.

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• The Killing Trail
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• The Birth of Regret (The Scrolls of Animus Vorador Book 1)