Users' Guides to the Medical Literature
Guyatt G, Rennie D, Meade MO, Cook DJ
Part E Prognosis
Chapter 18. Prognosis
Adrienne Randolph, Deborah J. Cook, Gordon Guyatt
health outcomes, measures of outcome, measuring prognostic studies, neuroblastoma, prognosis, prognostic study, stage 4s neuroblastoma
"Three months into pediatric internship, you saw a clinic patient
for her 12-month routine health checkup. Although she was healthy
except for her big stomach, you felt something in the abdomen that
you thought could be a tumor. During the next several weeks, the
infant undergoes abdominal ultrasonography and magnetic resonance
imaging, bone scintigraphy, a skeletal survey, and finally a bone
marrow and tumor biopsy. The day after tomorrow is your patient's
first birthday. You sat with the oncologist as she told the patient's
family that their infant daughter has neuroblastoma, the most common
intra-abdominal malignancy of infancy. The parents learn that, because
the infant was younger than 365 days on the initial diagnosis and
because her tumor markers and bone marrow involvement were consistent
with stage IV-S disease and a favorable prognosis, she
has at least an 85% chance of cure with surgical resection.
The oncologist also told the parents that children older than 1
year with different tumor markers and extent of disease usually
need additional chemotherapy and sometimes a bone marrow transplant.
Still numb and trying to take it all in, the parents have no questions
for the oncologist. Later, when you are following up with them in
the family waiting area, they express worry that their infant daughter was
diagnosed so close to the 365-day age cutoff. They ask you what
would have happened if her checkup had been 3 weeks later, when
it was originally scheduled. Would her prognosis then be worse?
You see their point. Their doubt makes you wonder where the oncologist
got the estimate of an 85% or higher cure. You decide to
check out the evidence for yourself...."
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