knowing the odds

Tuesday, May 31, 2011

Baseball is all about statistics from batting average and earned run average to WHIPs (walks and hits per innings pitched) and OPS (on base percentage and slugging average). While a season lasts 162 games, trends begin early and allow fans and players alike to predict what might happen with the next pitch. Statistics work the same way in medicine. How patients respond to past treatment protocols guide how the next patient will be treated. And so it’s sad to learn that Gary Carter, hall of fame catcher has been diagnosed with glioblastoma, a malignant tumor of the brain, the same type that caused the death of Senator Ted Kennedy.

Neurons are the superstars of the brain, transmitting the electrical impulses that allow movement, sensation ,thought, emotion and all the behind the scene activities, like breathing and blood pressure control that make the body function. Glial cells are the most abundant cells in the brain and spinal cord and are the worker bees that support the neurons. There are three types of glial cells: astrocytes that help with electrical transmission between neurons, oligodendrocytes that make the myelin or insulating coatings of the neurons and the microglia that help with immune of the brain.

Glioblastomas are tumors of the glial cells and are the most common malignant and deadly tumors of the brain. They can be a primary tumor becoming malignant immediately or can morph into a cancerous tumor from benign astrocytoma tumors. The most common initial symptom of a brain tumor is headache but it is often ignored. Diagnosis often happens when the tumor starts to affect body function and a dramatic event occurs; one sided weakness or paralysis (like a stroke), increased confusion and lethargy or a new onset seizure. Sometimes the presentation is more subtle like a change in personality, difficulty with concentration or vision changes. Symptoms worsen as the tumor grows, invading normal cells and causing swelling or edema with the brain itself. Ultimately, the diagnosis is made when the care provider arranges for a CT or MRI to image the brain and the abnormality is found.

Treatment for glioblastoma includes surgery, chemotherapy and radiation but the results remain difficult. With aggressive therapy including new immunology, patients can survive one to two years. This is where statistics come into play. Older patients do less well as do patients whose tumor cannot be removed easily. In the best case scenario, for patients who are younger than 50 and have good mental function at time of diagnosis, the average survival time is only 17 months and a survival rate at three years of 20%. For the elderly with poor function those numbers fall to less than 8 months and 1% survival at 3 years.

Baseball players are stars if their batting average is above .300 or put another way, they fail seven out of ten times. In medicine, those numbers would be staggeringly bad and that is the case for glioblastoma. Once the shock of the diagnosis passes, the importance of knowing the statistics allows the care provider, the patient and the family to develop an understanding as to what the future might bring. Ultimately, the patient needs to decide how much or how little treatment to accept for a disease where cure is unlikely. Discussions about quality and quantity of life are difficult and beating the odds means knowing what they are in the first place.

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