A story today about how our mindset, notably our attitude to risk, can impact our choices, how we make decisions and the decisions we make.
This has a very real impact on business decisions, but the story I share with you today is current and personal and is about probabilities of, well, life or death. To be honest, as I sit here it doesn’t feel that dramatic, but the decisions are about minimising chances of cancer recurrence, so that is what it is all about.
Regular readers know I’ve recently had a rapid colon cancer journey, from diagnosis to operation in four weeks, then from an operation six weeks ago yesterday to now feeling so grateful that I feel (almost) 100%, and certainly back to my energetic self!
My cancer was picked up early through the NHS screening programme and the tumour itself was the lowest grade (good) classification. Unfortunately, they then picked up a “barely measurable” (0.4mm) growth in 1 of the 24 lymph nodes, so that automatically leads to a recommendation of chemotherapy to reduce further the risk of recurrence. The standard protocol for this is a dual drug cocktail for 4 cycles over 11 weeks. The projected outcome is excellent, and at the same time, the side effects can be quite significant, including nerve damage to fingers and toes.
In my case, the combination of a) very early-stage tumour and b) tiny involvement of only one lymph node, together had the experts note that to use the dual drug cocktail could be considered “over-treatment” for me, as the (in my own words) cost: benefit analysis is skewed. They then presented a “middle” option, to take tablets (one drug instead of two) only. These give around 80% of the benefit of the full dual drug protocol, so a significant positive impact on reducing recurrence risk. There may well be side effects from this single drug, but clearly less than with two at the same time. Oh, and one wrinkle is that the “tablets only” option runs for 8 cycles, so 23 weeks, so another consideration.
In listening to these options being presented, I said to the consultant: “it feels like some of this decision depends on the mindset and attitude to risk of the individual patient, about their psychology?”. Their smiling response was along the lines of: “this type of treatment is ALL about psychology”. I found this totally fascinating. Different clients may choose different paths, eg:
- One may choose to skip chemo, rely on the (approaching 90%) chance that they will never have a recurrence, then relax and go on with life
- Another may feel they absolutely must do everything to improve their odds (the highest on the calculator I found was a 96% chance, pretty strong, I’d say). That patient would weigh up the risks (costs) of side effects of the dual drug treatment and figure that, to them, the benefits of doing everything is the deciding factor.
- The middle ground is then the other choice, to feel one has done something to improve their chances and so not to worry unduly for the next few years (recurrence in this type of cancer tends to happen in the first 2-3 years post-surgery).
As I write this, I am going to see the consultant later today, a one-week check-in after thinking about it. Decision time, then chemo starts next week. As to that decision:
- I won’t be skipping chemo, though my chances would be very good, I would simply worry for the next few years about a recurrence, thinking “I could have done chemo”.
- I could do the full chemo and it would be over in 11 weeks instead of 23, but I am concerned about the potential long term side effects of the second drug in that cocktail
- I am highly likely (am not 100% on the decision, but, say, 95%!) decided to take that 23-week course of the single-drug therapy, the tablets. That way I feel I’ve taken my chance from already very good, to even better, plus reduced the risk of longer-term side effects.
Different people will make different choices in these situations, as the consultant said “it is all about psychology”.
As I commonly note, we are human BEings, not human DOings, we make decisions, after considering the rational data (sometimes, at least, most certainly in this case for me!) based on how we FEEL, not how we THINK.
See you soon, I will keep reporting from time to time. I’ve had the core cancer journey from the surgery and am told I’m now in the “low risk” category, now to start the chemo journey for 23 weeks, and then we move on to regular scans and tests for a few years. One step at a time, one day at time, each one precious x