Immediate health risk must be weighed against radiation-induced cancer risk

Many of us are familiar with this risk calculation with respect to CT and PET scans, or Total Body Irradiation. Not easy, but most of us make the willing trade-off being living now and the longer-term risks. Trade-off is different of course for children (see CT Scans and Cancer: What Parents Need to Know and Do), and it is always good practice to discuss the need for scans and the trade-offs with one’s doctors:

“This must be considered when physicians make imaging decisions for their patients, because the timing of risks changes their relevance,” Dr. Pandharipande said. “Risks incurred later in life are not the same as those faced in the present. If you had to choose between the chance of incurring a serious risk now or later in life, most people would choose the latter.”

Immediate health risk must be weighed against radiation-induced cancer risk.


Week 27: Back to ‘Normal’ and ‘Thinking, Fast and Slow’

A normal week, at last. No major issues, eating and drinking well, lots of walks, normal showers post-Hickman and able to get on things. Even my weight has started to pick-up and the Prednisone tapering down has gone well.

I had my 6 month recall with the radiation oncologist responsible for my Total Body Irradiation (TBI). More a formality. His main concern was about  shortness of breath given  the main short-term risk was to the lungs, as they are more sensitive (and are shielded during TBI).

Given both the results from the Pulmonary Function Test as well as my experience with walking and other exercise, no issues. He noted that my strength should continue to build up over time. The only other thing flagged was to watch my thyroid given it is  potentially sensitive. No major precautions apart from minimizing sun exposure through sunscreen and clothing (and he said that all should do this anyway). And the best part of all, I don’t need to see him again!

I have finished the necessary but somewhat dry web search for the family tree. Took less time than expected and am now having more fun renewing, or making, contact with some of the family branches to check my work and more important, and interesting, capture some of the family stories behind the dull stuff. Much more creative and satisfying.

We saw the Iranian Oscar nominee for best foreign picture, A Separation, by Asghar Farhadi. Wonderful story telling, very good acting, and great depiction of family and class tension. And relatively edgy for an Iranian film made in Iran; while the film is not political, the undercurrents are (a great scene before the family court when the Mother blurts out that moving abroad with her daughter is so her daughter does not have to live in ‘these conditions’ before quickly retracting). Will be interesting to see the dynamics should it win; expect mixed feelings by the Iranian government as they try to stoke up yet manage tension with the ‘Great Satan’, should it lose it would play more into the narrative of Iranians as victims. Most Iranians would of course be proud. For those interested, an interesting short film by another Iranian director, Jafar Panahi, a sweet story with undertones, The Accordion (click on link to play).

We finally got around to seeing 50/50, the cancer ‘comedy’ about a 27-year old man, Adam, facing cancer, written by Will Reiser, and inspired by his own experience. While there was some good humour (more light than dark), the tone was more serious and less funny than expected. Overall, I found the film a credible depiction of someone younger going through their journey, with some quibbles on the details that were necessary to strengthen story (e.g., the warm comic-relief scenes with Adam and older cancer patients having chemo together – the protocols and timing would never work out to have a ‘chemo’ club and the chairs, at least in my hospital, are too far apart to chat). The major unrealistic part was the young, inexperience therapist who becomes the (Hollywood) love interest. Not credible to have someone so inexperienced assigned to such a patient, let alone the love aspect, and I found it more irritating than anything else. The ‘happy ending’ is getting through the treatment and on with your life, with no need for the artificial and forced add-on.

I finished Thinking, Fast and Slow, by Daniel Kahneman. There is much to recommend in this book, whether it be on a personal or professional level, in terms of the increased self-awareness it engenders on how one makes decisions or come to conclusions, and how the automatic (System 1) dominates the more deliberative (System 2).

As part of leadership training, I had been exposed to some of this before, but Kahneman takes it to another level, both in terms of understanding as well as some practical steps to avoid blind spots. Interestingly, he acknowledges that as individuals, we are notoriously ill-equipped to self-police (even himself who is super aware); however, institutions are better equipped to inoculate themselves (and even better when they have to work with other institutions), at least partially, from some of the main patterns:

  • tendency to jump to conclusions (System 1);
  • exaggerated faith in small sample sizes which are less reliable or representative than large sample sizes (e.g., exceptions catch our interest more);
  • anchoring effect to a specific number (e.g., house listing price) rather than more independent evaluation;
  • dramatic, personal or publicized events are stronger than probabilities based on large sample sizes (e.g., risk of cancer, plane crashes), and tend to be overestimated;
  • most exceptions regress to the mean – so if someone is having a winning streak, it is likely to end;
  • expert intuition is more reliable when concrete (e.g., firefighters, medical professionals) than not (e.g., social scientists, financial analysts);
  • prospect theory, or how we are inclined to take a sure gain but gamble to avoid the risk of a loss (loss aversion); and,
  • behavioural economics has corrected the classical economic view of people as ‘rational’ agents given these and other patterns.

While this may be somewhat of a caricature, Thinking, Fast and Slow provoked  reflection on the contrast between political and bureaucratic decision-making. The political level draws heavily on anecdotes, stories and what “people on the ground” are saying, with the impressions largely formed under System 1. The bureaucratic level draws more heavily on more impersonal, large-scale studies and research, or evidence-based policy, to have a wider base of information (System 2).

Of course, many politicians, in developing their political approach, have taken an intellectual journey that is more reflective and deliberative. And many officials, in selecting and citing large-scale studies, have their own automatic System 1 influencing the procedural and methodological choices (see this clip from Yes, Prime Minister at about the one minute mark for the extreme version). This is part of how the two systems work together in all of us.

My own experience with how this worked was in reshaping policies to address one of the government’s priorities. Our evidence base, while solid, was overly comfortable and reflected the priorities of earlier governments. Faced by Ministers and political aides saying that none of this resonated with what they were hearing in their interaction with a wide range of Canadians, we had to rethink and develop a broader evidence base.

Just as policy making by anecdote and broader evidence leads to bad policy (readers from any country can likely find a few examples), policy that ignores anecdote and public opinion for the more formal broader evidence base risks missing some of the granularity and not responding to public concern.

The combination of research and anecdotes, arguably makes for better policy and programs, as it respond to both more reliable evidence and to what people are saying in a democratic society.

Highly recommended for decision-makers in particular, although all will find his book and findings interesting and useful.

Looking forward to a good week as our son is back for reading week. I have my two-week clinic recall should confirm continuing the Prednisone tapering off. Hopefully, will stay the course.

Major advances in radiation therapy for cancer treatment

A good overview of some of the changes and developments in radiation therapy (I had Total Body Irradiation which is one of the older techniques but still appropriate for allo stem cell transplants).

Major advances in radiation therapy for cancer treatment.