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Debate surrounds new prostate-cancer treatment
August 04, 2009
Excellent, provocative exploration of critical issues involving the tension between prostate cancer treatment options, payment responsibility, patient choice, and evidence on risks and benefits.
Our Review Summary
This was an excellent, provocative exploration of some of the critical issues involving the tension between treatment options, payment responsibility, patient choice, and evidence on risks and benefits. There are a great number of uncertainties about prostate cancer itself, whether active treatment is called for and if so, which is the most appropriate choice for individual patients. Combining this with financial interests of those providing treatment adds another layer of difficulty in making good individual choices. While the article, overall, did a good job of shedding light on these tensions - it is unfortunate to end the piece with an anecdote that serves to disrupt the balance.
Instead, a better ending take-home point might have been the physician’s quote that appears earlier: "There's a lot of politics involved in this. There's a lot of self-interest. There's a lot of greed.”
Overall, though, high marks for a terrific enterprise piece that helps readers understand an important health policy and health care reform topic.
Click on Criteria for definitions.
The story indicated that insurance coverage for CyberKnife radiosurgery, one of the options available for the treatment of prostate cancer was not uniform - even within a defined geographical location. This obviously reflects on availability.
The story provided information on the costs of various approaches to the treatment of prostate cancer and discussed varying policies on insurance coverage.
This story did not engage in overt disease mongering. Rather than worrying readers unnecessarily, this piece provided background that could help a reader understand the somewhat counter-intuitive idea that prostate cancer is treated more often than it needs to be.
The story mentioned that data about CyberKnife radiosurgery was very immature.
Additionally- the story doesn't challenge the Brady comment about CyberKnife vs IMRT outcomes being similar. This is misleading because patient selection for the two procedures could vary considerably and "results" is not defined. Also, the comment about the cornucopia of effective treatments is not supported by the evidence--the only high-quality data is for radical prostatectomy vs. watchful waiting.
The story listed the side effects associated with prostate cancer treatments such as impotence, urinary and bowel problems, though it failed to indicate differences among the treatments for how often each occurs. Although the story focused on Cyberknife radiosurgery, there was actually no specific discussion about the short term side effects associated with this treatment other than to share one patient's satisfaction with his experience and to indicate that number of treatment sessions was lower.
We don't think it's adequate to accept at face value a comment from one physician about his experience with 70 to 80 patients over the last 18 months, reporting "few side effects" and not "even a hint of a failure." What WERE those side effects? Exactly how few? How did patients feel about them? And how do you measure success or failure in such a short time span?
You can't proclaim an absence of side effects as the results of the procedure are something men will live with the rest of their lives.
This was the one glaring shortcoming of the story.
The story was clear about the relative newcomer status of Cyberknife radiosurgery.
The story noted something that rarely gets mentioned: "a recent Agency for Healthcare Research and Quality study, which found that no prostate-cancer treatment was superior to the others. The report also noted the lack of good comparative studies."
Does not appear to rely on a press release.
A number of sources of information were used for this article.
The story mentioned a variety of treatment options, including active surveillance for prostate cancer
Total Score: 9 of 10 Satisfactory
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