A comparison of radiation treatments for some patients with metastatic brain tumors produced useful evidence that adding whole brain radiation to radiation focused on just the tumors was associated with more cognitive declines and lower quality of life, without adding to survival. That’s a noteworthy finding, but the news release obscures the advance in clinical evidence behind a flurry of superlatives, while leaving out important context. One bright spot is that the release highlights the finding that the patients given both whole brain and focused radiation had cleaner brain scans, but then did not live any longer. That’s an important reminder that disease progression tests do not necessarily point to better outcomes.
The study results, as the release notes, could help spare many patients from over-treatment. But rather than promising a “better quality of life,” the release would have done better to stick to a more sober portrayal, that the study supports recommendations updated in recent years against using whole brain radiation in these patients.
When cancer that started in the lungs or other organs spreads to a patient’s brain, the outlook for a long survival dims. As the researchers quoted in the release note, for these patients the effects of treatments on the quality of life take center stage.
It’s a positive sign that more cancer researchers are studying a treatment’s outcomes on quality of life in addition to measuring tumor response. But it is important to maintain a sober tone about the likely scenarios, and resist implying that making the “right” choice of treatment will produce a substantially better quality of life, when the realistic goal is minimizing the rate of decline.
Since both the focused radiation and whole brain radiation are common treatments for brain tumors, an estimate of typical costs should have been included in the release.
There is likely to be a range of costs because of issues with the specific tumor target. However, the release could have made note of that.
The release is far more emphatic than the study. The release says focused radiation treatment alone proved to be “substantially less toxic” than a combination of focused and whole brain radiation treatment for these brain tumor patients. By contrast, the study referred to “less cognitive deterioration” and lower rates of decline in the quality of life. However, the lack of detail about benefits in the release is largely due to the lack of detail in the study itself, which reported only on a combined measure of cognitive function and did not spell out specific benefits. The same can be said of the discussion of survival rates, because the study itself said only that there was no significant difference between the treatment groups. The release should have included a vital point: that few patients in either group lived more than a few months. Indeed, 20 percent had died before the first evaluation just three months after treatment.
On the other hand, the release does a great service by highlighting the finding that although patients who received whole brain radiation in addition to focused radiation had better brain scan results, they did not live any longer than those whole were given only focused radiation treatment. The finding is yet another example of the danger of putting too much stock in measures of disease progression or other tests that logically seem to be related to important health outcomes, but often fall short.
The main point of the release, emphasized in several statements, is that whole brain radiation is more toxic to the brain than focused (or stereotactic radiation) without improving survival outcomes. So, while one might expect that the more targeted approach might cause harm by “missing” some of the cancer, the story does a good job of pointing out the LACK of additional harm by targeting the tumor rather than irradiating the entire brain.
The release does not describe the trial, either the features that make it noteworthy or its limitations.
This ruling is a close call. Although the claim in the release that the study results could apply to tens of thousands of patients with brain tumors may be a reasonable estimate, it fails to put that number in context. The study included only a select group of patients with three or fewer metastases in their brains. By failing to mention either that one out of five patients in the trial died before the first post-treatment evaluation or that many patients with brain tumors don’t match the description of those in the trial, readers are given an inflated sense of the relevance of these findings.
The funding source is not identified in the release. The release also makes no mention of conflicts of interest, but the journal article disclosure section notes only that one of the authors (not mentioned in the release) receives some industry funding.
The release is clear that the point of the study was a direct comparison of two commonly-used treatments. The release also points out that surgery is a treatment option for these patients.
It is clear that the treatments are currently in general use.
The release fails to tell readers that whole brain radiation for these patients is, as an accompanying editorial comment notes, “falling out of favor.” The editorial goes on to note that, “In 2014, the American Society of Radiation Oncology… indicated that WBRT [whole brain radiation treatment] should not routinely be added to SRS [stereotactic radiosurgery or focused radiation] for patients with a limited number of brain metastases.” So this research, informative to clinicians as it may be, is unlikely to change the underlying trend away from using whole brain radiation in the treatment of these patients.
The release doesn’t go overboard with sensational language. But as mentioned above, phrases such as “substantially less toxic” and “better quality of life” without quantification, along with tangential promotion of related research by the institution’s researchers, tilt the release toward marketing.
Systematic, Criteria-Driven
Monday at #ADA2021, an infectious disease epidemiologist, a journalist, and a researcher shared perspectives on communication of risk in the era of COVID-19: http://ow.ly/ROfR30rMeE7 @AstleyCM @garyschwitzer @berthahidalgo @ADA_DiabetesPro
Shoutouts to @susan_bewley @drkevinknopf @MichaelBaum11 in this call for more than fawning coverage from press releases for these kinds of stories.
Also, linked history inside goes back 5 years just on Grail apparently trying to become Holy Grail. https://twitter.com/garyschwitzer/status/1408849696416841731
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