I went down to Denver to learn more about the chemo option. During the pre-admission interview, I asked the nurse for a graph of survival rates. Apparently, no one had asked for one before and she had (a) to find it, then (b) get permission to show it to me. This struck me as slightly weird unless the people you deal with are in extreme denial or don't care how quickly they might die. The annotated chart below is an updated version similar, but more elaborate, to the one I saw.
The treatment consisted of a cocktail of 6 or 7 toxic chemicals, each of which had shown some positive effect on melanoma. The side effects, as I understod them, were pretty horrendous - total incapacitation for 6 - 8 weeks, with a potential 40% weight loss. With some more strenuous digging, I finally deduced the that a successful treatment might improve my survival rate by about 3%.
The capper was when the doctor returned after about 40 minutes, his first comment was to the nurse, "What, he's still here? What are you doing making him your life work?"
She was obviously embarassed, I was slighty stunned, "Well, I thought, "I certainly hope so."
In any event, my conclusion was the that risk-reward did not warrant the reduction in the quality of my life and this wasn't the place for me.
Lessons Learned: Gather as much hard data as you can before making any decisions and don't ignore the human factors.
These graphs compare the relative survival up to 15 years for patients with localized melanoma (stages II and I), regional metastases (stage III), and distant metastases (stage IV). The numbers in parentheses represent the number of patients from the AJCC melanoma staging database used to calculate the survival rates. The differences between the curves are significant (p <.0001). Data from: Balch, CM, Buziad, AC, Seng-Jaw, S, et al. Final version of the American Joint Committee on Cancer staging system for cutaneous melanoma. J Clin Oncol 2001; 19:3636.
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