Decision theory in cancer therapy

Decision theory, which has been greatly developed in the last two decades and which is today widely applied to economic, political and military problems, appears useful for decision making in cancer management. As an example, the application of its principles and practice to the so‐called “prophylactic neck dissection” is presented. This question, whether or not to carry out a radical neck dissection in a patient with oral cancer without palpable neck metastasis, has been the subject of controversy for more than 50 years, with nearly as many surgeons favoring it as rejecting it. Application of the decision theory, which requires only simple arithmetic, greatly clarifies the problem and shows that, if certain hypotheses are accepted, in most cases the best results can be expected after prophylactic neck dissection only in patients with primary cancers over 2 cm diameter. For clinical use, a “decision table” was developed, which without calculation permits the cancer therapist to find the optimal decision immediately. Copyright © 1967 American Cancer Society