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October 25, 2000

Do Increased 5-Year Survival Rates in Prostate Cancer Indicate Better Outcomes?—Reply

Author Affiliations

Stephen J.LurieMD, PhD, Senior EditorIndividualAuthorPhil B.FontanarosaMD, Executive Deputy EditorIndividualAuthor

JAMA. 2000;284(16):2053-2055. doi:10.1001/jama.284.16.2053

To the Editor: Dr Welch and colleagues1 correctly question the status of 5-year survival rates as evidence of treatment success in cancer. Their analysis points to technical limitations in the interpretation and use of this measure, notably linked to changes in diagnosis. However, this analysis completely misses the mark in regard to the deeper system of values that underpin the use of survival data in evaluating health care. A patient who lives for 5 years and 1 day counts as a "success" whereas the patient who lives 4 years and 11 months counts as a "failure." However, the cost of surviving beyond that 5-year threshold may have been to endure years of pain and suffering, whereas the shorter survival might have been associated with a less distressing life. The use of 5-year survival rates in this way implies that life expectancy necessarily dominates all other parameters, including any consideration of patients' health-related quality of life.