1 / 33

Statistics and Medicine – Friends or Foes?

Statistics and Medicine – Friends or Foes?. Monika Krzyzanowska MD MPH Medical Oncologist, Princess Margaret Cancer Centre Associate Professor of Medicine, University of Toronto. Case. 61 year old male tailor Presented with iron deficiency anemia Colonoscopy: tumour in colon

annot
Download Presentation

Statistics and Medicine – Friends or Foes?

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Statistics and Medicine – Friends or Foes? Monika Krzyzanowska MD MPH Medical Oncologist, Princess Margaret Cancer Centre Associate Professor of Medicine, University of Toronto

  2. Case • 61 year old male tailor • Presented with iron deficiency anemia • Colonoscopy: tumour in colon • Sent to general surgeon who removed the primary cancer from the colon • The surgeon has referred the patient to you (medical oncologist) for an opinion regarding what to do next?

  3. What do you need to know to advise the patient on next steps? • How serious is the cancer? • What are the “treatment” options? • What are the benefits of treatment? • What are the risks?

  4. Evidence Pyramid

  5. What do you need to know to advise the patient on next steps? • How serious is the cancer? • What are the “treatment” options? • What are the benefits of treatment? • What are the risks?

  6. How serious is the cancer? PROGNOSIS

  7. Colorectal Cancer Stages

  8. TNM Staging System • T: depth of invasion into bowel wall • T1 Invasion of submucosa • T2 Invasion into muscularis propria • T3 Invasion through muscularis into serosa • T4 Invasion of other organs +/- perforation • N: regional nodes • N0 No nodal mets • N1 Mets to 1-3 lymph nodes • N2 Mets in  4 nodes • M: distant metastases

  9. TNM Staging System

  10. Case Revisited • CT scans – no spread of disease • Pathology • Adenocarcinoma • invading through the muscularis into serosa • 7/15 LN involved with tumour Stage: pT3N2M0 (Stage 3)

  11. TNM Staging

  12. Adjuvant! Online https://www.newadjuvant.com/default2.aspx

  13. What do you need to know to advise the patient on next steps? • How serious is the cancer? • What are the “treatment” options? • What are the benefits of treatment? • What are the risks?

  14. What are the treatment options? • Do nothing • Surveillance • Chemotherapy http://www.psmag.com/health/evidence-of-a-need-for-change-4241/

  15. Adjuvant Therapy Treatment given after the primary treatment to increase the chances of a cure; may include chemotherapy, radiation therapy, hormone therapy, or biological therapy.

  16. What do you need to know to advise the patient on next steps? • How serious is the cancer? • What are the “treatment” options? • What are the benefits of treatment? • What are the risks?

  17. Chemotherapy Options for St 3 Colon Cancer in 2013 • Drug A -- 5-fluorouracil (5-FU) • Drug B – capecitabine • Combination therapy (Drug A or B plus other drugs)

  18. Drug A vs No Treatment

  19. MOSAIC Trial RANDOMI ZAT ION Drug A – 5FU St II & III colon n = 2,246 Combination Andre NEJM 2004

  20. Evidence Pyramid

  21. Adjuvant! Online https://www.newadjuvant.com/default2.aspx

  22. What do you need to know to advise the patient on next steps? • How serious is the cancer? • What are the “treatment” options? • What are the benefits of treatment? • What are the risks?

  23. MOSAIC Trial: Serious Toxicity

  24. MOSAIC Trial: Serious Toxicity

  25. Back to the Case • 61 year old male tailor • Stage 3 colon cancer What would you recommend? • Do nothing • Surveillance • Chemotherapy

  26. Evidence Based Medicine

  27. Guidelines https://www.cancercare.on.ca/common/pages/UserFile.aspx?fileId=14002

  28. Guideline Concordance

  29. Statistics & Medicine • Explain & describe disease • Natural history • Risk factors • Causes • Evaluate treatments • Benefit • Risk • Communicate with patient • Assess quality of care Friends or Foes?

More Related