When my oncologist said the words “median life expectancy is about thirty months,” I understood what they were doing.
They were not predicting my future.
They were naming the center of a curve.
Median is not a prophecy. It is a midpoint—half of patients fall on one side, half on the other. It flattens difference. It averages out biology, circumstance, resilience, and failure into something that can be spoken aloud without lying.
But medians only make sense if you belong to the group they describe.
And this is where performance status matters.
Who the “Median Patient” Actually Is
The median stage IV colorectal cancer patient with liver metastases is usually older than me. Often in their late 60s or 70s. They commonly arrive at diagnosis with other conditions already on board—diabetes, cardiovascular disease, reduced kidney function, sarcopenia, and fatigue.
They are rarely fully active.
Most fall into ECOG 1 or 2, meaning daily activity is already constrained. Treatment tolerance is limited. Dose reductions happen early. Therapy stops not because cancer wins outright, but because the body can’t stay in the fight long enough.
That reality shapes the curve.
What ECOG 0 Actually Means
ECOG 0 is not a mindset. It’s not motivation. It’s not discipline.
It’s a clinical description that says: this body is still doing what it did before.
Fully active. No restrictions. No baseline fatigue. No functional compromise.
In oncology, that single line item quietly reorganizes everything.
How ECOG 0 Shifts the Curve
Survival statistics don’t bend gently when performance status improves. They re-segment.
When outcomes are stratified by ECOG, ECOG 0 patients consistently live longer—not because they “fight harder,” but because they can stay on treatment, tolerate sequencing, and avoid the secondary failures that end trajectories early.
ECOG 0 patients:
- miss fewer infusions
- require fewer dose reductions
- recover faster between cycles
- qualify for more trials
- pivot when plans change
They don’t win because they’re exceptional. They remain eligible.
That eligibility compounds.
Why Oncologists Care More Than They Say
If you ask oncologists privately what variable they would change if they could, many would choose performance status over age, over lesion count, even over some molecular markers.
Because performance status governs what is possible next.
Cancer outcomes aren’t linear. They are negotiated through a series of gates. ECOG 0 keeps gates open longer.
What ECOG 0 Does Not Do
- It does not override aggressive biology.
- It does not guarantee response.
- It does not eliminate risk.
What it does is move you off the center of the curve and onto a different one.
Still uncertain. Still conditional. But no longer average.
Reframing the Thirty Months
The honest translation of “median thirty months” in my context isn’t optimism or denial. It’s this:
- That number describes a population where limitation is common.
- I am not limited yet.
Which means the statistic becomes a floor, not a forecast.
Time isn’t promised. It’s earned in segments—by staying eligible, by tolerating treatment, by remaining intact long enough for the next decision to matter.
That’s how the right side of the curve is lived.
Quietly. Iteratively. Without declarations.
I am not finished.