Treatment choice in gastric carcinoma. A decision-analytic approach

Physicians frequently face decisions whether or not to undertake a treatment that carries an immediate risk but offers a potential cure. However, data directly comparing life expectancies of similar groups of patients with and without that treatment are rarely available and in fact could not ethically be obtained. We present an indirect mathematical technique for computing the two life expectancies and specifically apply this approach to evaluating surgery for patients with gastric carcinoma without known metastases. We demonstrate that surgery increases life expectancy for average men and women up to age 80 and does not alter life expectancy at age 90. Hence surgery is the appropriate treatment for patients who are either risk-neutral or risk-seeking in their attitudes comparing the short-term hazards with the long-term benefits of surgery.