Proton beam therapy: Another reminder to never rely solely on press releases

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This is a guest column by Ivan Oransky, MD, who is executive editor of Reuters Health and blogs at Embargo Watch and Retraction Watch.

A press release came across my desk recently. It began:

“Proton beam therapy is safe and effective and may be superior to other conventional treatments for Stage I inoperable non-small cell lung cancer (NSCLC) patients, according to a study in the October issue of the International Journal of Radiation Oncology•Biology•Physics, the official journal of the American Society for Radiation Oncology (ASTRO).”

Anything that’s effective for treating inoperable lung cancer is potentially good news, so I asked to see the paper on which the release was based.

I was disappointed.

Nowhere in the paper were any data supporting the claim that proton beam therapy “may be superior to other conventional treatments for Stage I inoperable non-small cell lung cancer (NSCLC) patients.”

That’s because the study didn’t include any patients who got those conventional treatments. In other words, the researchers had made no comparisons at all, except to some historical data.

No wonder, then, that the authors’ conclusions were more muted – and more consistent with the findings:

“Proton beam therapy was effective and well tolerated in medically inoperable patients with Stage I NSCLC.”

(You can legitimately question the “effective” bit, since we can’t be quite sure what would have happened to these patients without any treatment. But this is, after all, a disease with a terrible prognosis, so maybe “effective” is a low bar.)

Perhaps this is what happens when your press release writers are paid by ASTRO, an organization whose members stand to benefit financially from exaggerated claims.

Then again, one of the study’s authors went far beyond the data in a quote included in the release:

“Proton beam therapy is safe and effective, if not superior to other nonsurgical modalities, for treating patients with inoperable Stage I NSCLC,” Hidetsugu Nakayama, M.D., Ph.D., lead author of the study and a physician at the Proton Medical Research Center in Tennoudai, Tsukuba, Ikbaraki, Japan, said. “The randomized clinical trial that compares proton beam therapy with stereotactic body radiotherapy is needed to clarify survival benefit.”

So perhaps peer review – even at an ASTRO journal – kept those claims in check. Press releases, of course, are not peer-reviewed.

This wasn’t the only weakness in the study, but in fairness, the others – in particular the fact that it was really just a series of 55 cases from one medical center – were not necessarily ones that would have kept us from reporting on the paper for a physician audience. With caveats, of course. Research on humans is imperfect, and often for good ethical reasons.

Still, we didn’t cover the study.

Why does this matter?

ASTRO is going to look for every opportunity – just as they did here – to claim that proton beam therapy is worth its high cost, usually in the tens of thousands of dollars. In prostate cancer, it’s being promoted as a better alternative to photon therapy, the most advanced form of which – intensity-modulated radiation therapy – can cost nearly as much.

Gary has written about how journalists are covering the fancy new technology, and the cheerleading ain’t pretty – although he recently highlighted a good skeptical take on related treatments.

We need more of that skepticism.

Let me be clear: I’ve lost an aunt to lung cancer. My wife lost her father to it. And there are others among my friends and family diagnosed with the terrible disease. If there’s an effective treatment out there, I want everyone to have it.

But when a press release makes an unsubstantiated claim about a highly expensive procedure, I’m going to ask questions. I know other good reporters will join me in doing the same.

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