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How Presentation of Recurrence Risk Influences Decision-Making
 

It's is all in the presentation. When no alternatives are presented, people will tend to seize what is available. When relative risk numbers that really do not relate to actual risk are given, it makes informed decision making even more difficult.

The method used to present information about chemotherapy influences treatment decisions. In deciding on endorsing chemotherapy, patients understand the information best when presented with data in the absolute survival benefit format, rather than those presented with data in the relative risk reduction information format. Absolute survival benefit is the most easily understood method of conveying the information regarding benefit of treatment.

Discussions between doctors and patients about the risks and benefits of chemotherapy need to be changed. Being told that chemotherapy reduces your risk by 30% of recurrence can be misleading and meaningless, unless you know your risk in the first place. If your risk of recurrence is 15%, you are only reducing it by 5%. And this doesn't even reflect the harm that could be done to those who don't need the treatment.

What is that harm? There are the toxicities that can end your life: leukemia and heart failure. There are toxicities that can ruin your life: loss of libido, loss of cognitive function, severe joint pain, and bone fractures. These harms are usually ignored or understated. One of the reasons is because they are understudied.

Source: Journal of Clinical Oncology, Vol 21, Issue 23 (December), 2003: 4299-4305