The Will Rogers Phenomenon

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Abstract

We found that a cohort of patients with lung cancer first treated in 1977 had higher six-month survival rates for the total group and for subgroups in each of the three main TNM stages (tumor, nodes, and metastases) than a cohort treated between 1953 and 1964 at the same institutions. The more recent cohort, however, had undergone many new diagnostic imaging procedures. According to the "old" diagnostic data for both cohorts, the recent cohort had a prognostically favorable "zero-time shift." In addition, by demonstrating metastases that had formerly been silent and unidentified, the new technological data resulted in a stage migration. Many patients who previously would have been classified in a "good" stage were assigned to a "bad" stage. Because the prognosis of those who migrated, although worse than that for other members of the good-stage group, was better than that for other members of the bad-stage group, survival rates rose in each group without any change in individual outcomes. When classified according to symptom stages that would be unaltered by changes in diagnostic techniques, the two cohorts had similar survival rates.

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An additional basic science for clinical medicine: IV. The development of clinimetrics.

Jeffrey Feinstein (1983)

The domain of clinimetrics is concerned with quantitative methods in the collection and analysis of comparative clinical data, and particularly with improved "measurement" of the distinctively clinical and personal phenomena of patient care. The main requirement for scientific quality in data is a consistent, reproducible process of observation and expression. This requirement can be attained with appropriate attention to basic descriptive activities and to the operational criteria that convert raw descriptions into the variables, categories, and composite aggregates of suitably chosen clinimetric scales. For this work, clinicians will be challenged to "dissect" and stipulate the components of decisions that are now made with unspecified methods or judgments. Clinimetric science provides opportunities for new approaches, new sites, and new personnel in an additional type of clinical investigation that can augment the scientific basis of clinical practice, while rehumanizing the contents of research data and restoring analytic emphasis to the art of patient care.

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Comorbid and clinical determinants of prognosis in endometrial cancer.

Carolyn K Wells (1984)

In cancers of the lung, larynx, rectum, and breast, the patients' initial clinical manifestations and comorbid diseases have shown important prognostic distinctions that are not evident in the customary systems of anatomic staging. This study was done to see whether the same phenomena occurred for cancer of the endometrium. In 142 consecutive cases of endometrial carcinoma, strikingly high five-year survival rates were found in women who had no symptoms attributable to the cancer or whose only symptoms might have been caused either by concomitant uterine or cervical disease or by replacement estrogen therapy. A distinct decline in survival was associated with systemic symptoms and with major comorbid ailments. Estimation of prognosis and evaluation of therapy can be improved with a new composite staging system, formed by combining the new clinical categories and the standard morphologic stages of the International Federation of Gynecology and Obstetrics (FIGO) system.