A randomized trial of rectal cancer treatment strategies is newsworthy, so why leave out numbers backing the claims?

Does the news release adequately discuss the costs of the intervention?

Not Satisfactory

There’s no discussion of costs. Perhaps just changing the timing of the same treatments is cost neutral, but maybe not. It would be interesting to know if delaying surgery affects total treatment costs, particularly if it results in fewer complications. One 2009 study put the mean total colon cancer cost per U.S. Medicare patient at $29,196, noting that the cost for rectal cancer is substantially higher.

Does the news release adequately quantify the benefits of the treatment/test/product/procedure?

Not Satisfactory

The news release itself does not quantify benefits. But according to the study, short-course radiation therapy with no delay in surgery resulted in postoperative complications 53 percent of the time, versus 41 percent of  cases in which surgery was delayed. The release would have been much stronger had it provided the outcomes of this randomized trial of 840 patients who were divided into different treatment arms.

We give the release credit for trying to convey what the study’s findings mean for patients through these statements:

The results of the study show that patients with delayed surgery develop fewer complications with equally good oncological outcomes. It also showed that there is no difference between long-course and short-course radiotherapy other than that the former considerably lengthens the time for treatment.

“The results of the study will give rise to improved therapeutic strategies, fewer complications with a sustained low incidence of local recurrence, and better survival rates for rectal cancer patients,” says Professor Martling. “The results can now be immediately put to clinical use to the considerable benefit of the patients.”

Does the news release adequately explain/quantify the harms of the intervention?

Not Satisfactory

This was a close call. The news release refers to harms/adverse effects from radiotherapy at least four times but does not name even one potential harm, so we’re rating it unsatisfactory for the omission.

According to the study, the most common postoperative complication was infection, which occurred in 18 percent of patients. The study also mentions bowel obstruction and pelvic abscesses. About 7 percent of patients whose surgery was delayed were hospitalized for radiation toxicity.

The news release (and the abstract of the journal article) avoid a thornier question. Could delaying surgery after radiation treatment of rectal cancer increase the chance that rectal cancer will come back? The study found rectal cancer recurred in 2.8% of patients an average of 19 months after delayed surgery and in 2.2% of patients an average 33 months after surgery at the usual time. The small difference seems to favor the usual timing of surgery. The authors take a scientifically valid position that if the difference in rate between options could have happened up to 5 percent of the time by random chance, then the new option is “noninferior” to the standard treatment, as is the case here. It is quite possible that cancer outcomes are slightly worse for the new timing of treatments, but justified by a much bigger improvement in complication rate. The absolute difference in local cancer recurrence is only 0.6% (with a large margin of possible error) whereas surgical complications were reduced by an absolute 12% (41 vs. 53%).

The study notes that one potential drawback of delaying surgery is that it delays the start of chemotherapy in  regimens that include chemotherapy after a tumor has been removed. But it says chemotherapy could be more effective if administered before surgery, so a delay would present an opportunity to administer chemo. Whether that would help patients would need to be determined by another research study.

Does the news release seem to grasp the quality of the evidence?

Not Satisfactory

The news release does not give basic information to help readers grasp the significance of the study, such as the fact that it included 840 patients recruited over a span of more than 14 years. Because the study was adjusted to the changing treatment protocols over the course of the long study, the results are not as clean as the news release makes them seem. Changing protocols affected the study’s design and the representation of various treatment groups. Also, the study does not include long-term quality of life data, which it says will be published separately.