Communication in medicine and perhaps especially in cancer care rests on the interpretation of words.
Today I had to deal with the retort ‘but your colleague said that the chemotherapy I had was the best available for my cancer….so isn’t what you are offering me now not as good’.
So let’s strip this down. ‘The best available’ comes with caveats – the best available chemotherapy (just ignoring some of the new drugs) for melanoma has between 5 and 15% chance of shrinking deposits of melanoma. It is clear that ‘best available’ – at least in the eyes of the prescriber – is not the same as saying the treatment is effective for everybody. A treatment can be the best we have for all-comers but in reality the overall results can be pretty poor. The big problem is that most treatments don’t work for everybody: I can only get around this by saying that a treatment is the best option (compared to other options) and that even though a treatment is the ‘best’ for all-comers there is no way of predicting, for most drugs, which person will be the one who benefits.
Because of these vagaries we also need to be aware that just because one treatment didn’t work it doesn’t mean another might not – it may be that second treatment is better than the first – we just don’t currently have the means to predict which was the right treatment in the first place.
The trick for oncologists and other physicians – pick your words carefully – or take the time to explain what you mean.