Joy Victory is deputy managing editor of HealthNewsReview.org. She tweets as @thejoyvictory.
An important new study published in the New England Journal of Medicine provides clarity on outcomes of men with early prostate cancer who either received surgery, radiation or “active monitoring,” which means patients were given routine checks and only treated if the cancer was growing.
The study–the first of its kind to investigate this question using a randomized controlled trial, is a big deal–and, encouragingly, received the attention it deserves from U.S. news media, making headlines in many major publications.
We were pleased to see the coverage was overall solid, too: Robust sourcing, level-headed patient anecdotes and an accurate description of the findings were the norm in the dozen or so stories we looked at after the news came out this week.
Patient anecdotes revealed both positive and negatives of the treatment options
Too often, we see patient anecdotes in news stories that focus entirely on the benefits of treatment–overshadowing the hard truth that nearly all treatments come with side effects, harms and costs.
In this case, though, we appreciated the range of anecdotes we saw. For example, in STAT’s thorough and well-sourced story, we hear from a man who chose active monitoring when he was diagnosed with early prostate cancer in his 40s. We learn, importantly that he “dreaded the possibility of side effects of surgery or radiation, including incontinence and impotence.”
And CBS News’s story included input from two different men in the study, one who was assigned to surgery, and the other who received active monitoring. For both, we get a well-rounded sense of how the diagnosis and treatment affected them, helping exemplify how important it is for men to make a measured, informed decision before choosing a treatment.
“Maybe the first option shouldn’t be surgery or radiotherapy,” one man told CBS. “I’m quite happy to have avoided any of those side effects. I feel just fine now so maybe I never needed anything else.”
We did notice that several news stories (CBS, the New York Times) included interviews from the same study participants, which is a common public relations issue we’ve warned readers about recently. In this case, though, the patients’ stories seem to be relatively balanced depictions instead of the one “best-case scenario” that we usually see.
The Times story included not just patient stories, but also was the only one we saw that included the study’s findings on the mental impact among the men randomized into different treatment groups. We learn “there were no differences among the three groups in anxiety, depression or their feelings about how their health affected their quality of life.”
One hiccup: Stressing relative risk over absolute risk
“Men who were otherwise largely healthy and chose to be monitored were twice as likely as the others to see their cancer spread over the 10-year study period,” HealthDay’s story states in its third paragraph.
But this gives the readers the wrong opening impression, because the raw numbers themselves were very small. This is why we have repeatedly called for journalists to include absolute numbers.
To their credit, HealthDay did so, but much farther down in the story: “…cancer spread in 33 of the 545 men in the monitoring group compared to 13 of 553 in the surgery group and 16 of 545 in the radiation group.” We also learn that despite this, there were “no significant differences in the death rates between the three groups.”
NBC News also included relative risk numbers, citing the same stat that men in the watchful waiting group were “twice as likely to have their cancer spread” than those in the treatment groups. However, we learn that it was “nonetheless a very low number,” and an American Cancer Society physician says “the truth is, it’s 6 percent versus 3 percent at 10 years… it is much less than even I thought it would be.” Later in the story, actual numbers are given, too.
A missing factor from every story we looked at: The costs of treating vs not treating
Alan Cassels, a frequent contributor to this site and co-author of “Selling Sickness: How the World’s Biggest Pharmaceutical Companies are Turning us All into Patients,” has long believed that prostate cancer has been overtreated and the harms overlooked. Part of this is due to the persistent idea that PSA screening should be done on all men over 40–an issue we just looked at this week in “Despite thumbs down from professional groups, mass prostate cancer screening events continue, often with misleading promotions.”
The harms of overtreating prostate cancer include the personal and economic toll this takes on the bottom line. Yet cost was not discussed as an advantage of the active monitoring group in any of the stories we looked at.
“The big savings would come from the avoided cascade of costs related to surgery, chemo and drugs,” he said, “these can cause incontinence and impotence, resulting in needing all the related paraphernalia–the diapers, sexual enhancement aids, and other things you need to deal with the collateral damage of the treatment.”