This news release summarizes a review article published in Nature Reviews Clinical Oncology which assesses the available evidence and makes recommendations concerning the treatment of advanced ovarian cancer. The author of the review argues that adopting a more aggressive standard of treatment for this cancer type that involves locally directed adjuvant chemotherapy could increase cure rates from 20% to 50%. The news release uses some of the language in the review but, unsurprisingly, it appears more optimistic than the perspective piece. The release doesn’t address costs or harms related to such a course of treatment, nor does it give readers any information about how the original article reached the conclusion that survival rates could be increased up to 50 percent. Exceptional claims require exceptional evidence, and that’s missing here.
Ovarian cancer is a dismal disease with a dismal prognosis. More than 90% of women who die from ovarian cancer have been at the advanced stage. The prospect of curing or significantly extending life with advanced cancer is, understandably, exciting and well worth covering. According to the CDC, ovarian cancer is diagnosed in more than 20,000 women in the United States each year and is the fifth leading cause of cancer death among U.S. women.
The release doesn’t discuss cost at all. This may be due to the fact that the researcher who wrote the opinion piece, and the institution that wrote the news release, are based in Canada, which has socialized health insurance plans. However, given the expense associated with surgery and chemotherapy, and the fact that the release was promoted through a U.S.-based online science news service (and thus, theoretically, aimed at least in part at U.S. audiences), there should have been at least some effort to address the cost. Even if the cost of the proposed standard of care is comparable to other treatment options for advanced stage ovarian cancer, it could have said that.
The key benefit here is the survival rate and, on this point, the release is fairly clear. It notes that the current survival rate for advanced stage ovarian cancer is 20%, and that adopting a new standard of treatment could increase that survival rate up to 50%. The release would have added clarity by including an explanation of what is meant by “up to 50 percent” survival. It’s a bold claim about a devastating disease so precision is desirable. The reviewer uses 12-year survival as a proxy for cure in the original article but the release equates this to being “cured” of ovarian cancer. Some might debate that long-term survival equates to a cure — we’ll give the benefit of the doubt here and dock points below under the “Unjustifiable Language” criterion.
There is no discussion of potential harms. For example, there is no discussion of the risks associated with aggressive surgery to remove ovarian cancer tumors. As the Mayo Clinic notes on its site, ovarian cancer surgery “generally involves removing both ovaries, the fallopian tubes, the uterus as well as nearby lymph nodes and a fold of fatty abdominal tissue (omentum) where ovarian cancer often spreads.” All surgery poses some risk, and this surgery is extensive. Chemotherapy also poses risk. In addition, the release stresses a specific order in which treatment should be given. It states “women should be first treated with aggressive surgery to remove all clinically-detectable cancer cells, followed by targeted chemotherapy to the abdomen (intraperitoneal chemotherapy).” While the surgery first technique may well have greater chances of survival, reducing tumor bulk with chemotherapy first reduces the peri-operative complications. This trade-off is not discussed.
When a news release is explicitly advocating for a very specific standard of treatment, it’s important to articulate the risks as well as the potential benefits, so that healthcare providers and patients can make informed decisions.
The release does not provide any information on how the opinion piece arrived at its conclusion that survival rates could be increased to 50 percent. On what types of studies was this conclusion based? We realize that in a perspective piece, there is no quantitative summary to rely on, but the release should have given some sense of where the 50 percent number came from. The studies the author uses to marshal his argument are mostly observational studies. This is fine, sometimes observational studies are all you have. But to reflect this, the news release could have included a short statement to the effect of “observational studies report superiority of adjuvant chemotherapy.” This is easily the single weakest point in the release. Review articles still need to provide strong evidence, even if they are expert opinions.
No disease mongering here. The release takes a balanced tone when discussing late-stage ovarian cancer. However, we always like to see some broader context of where a disease falls in terms of incidence, survival rates, etc.
The release doesn’t mention funding sources and conflicts of interest, but there do not appear to be any conflicts of interest since the release is highlighting an opinion piece that analyzes previous research studies. Because the research isn’t advocating use of a specific drug or technology and because the published review states the author has no competing interests, we’ll give them the benefit of the doubt.
The release discusses several other conventional treatment options for advanced-stage ovarian cancer.
It is clear from the release that the treatment options being urged as the standard of treatment are already well established.
We think the PR release fails to establish novelty. The perspective piece is a battle cry for adjuvant chemotherapy but the news release misses this nuance and, as a result, doesn’t emphasize current standard of care as much as it should. Another thing that is missing from the release is the extent to which the specific combination of treatment options being urged as a standard of care is already in use. Is this the treatment that most women with advanced stage ovarian cancer already receive? If not, why not? Presumably doctors and patients have a rationale for their decisions. If this treatment is not what most patients already receive, the release would benefit significantly from some discussion (however brief) of why the treatment is not in more widespread use.
We think great care needs to be used when discussing potential cures for cancer and this release doesn’t meet our standard. The first problem is the claim that “up to 50 percent of women with advanced stage ovarian cancer could be cured,” which is repeated three times in the release. Where does that number come from? What evidence supports such a claim? The release doesn’t tell us. And the fact that women lived for a long time after their treatment does not necessarily mean that they were cured of the disease. They may have survived in spite of relapses.
Second, the release makes some curious statements. For example, the release states “we should offer all women the possibility of a cure.” This intimates that many medical professionals treating advanced stage ovarian cancer patients are not trying to cure their patients. In addition, according to the release itself, there is already a 20% survival rate for advanced stage ovarian cancer patients, meaning there is already a “possibility of a cure.” We suspect that the release was trying to stress that the new standard of care it is endorsing could significantly improve the likelihood of patient survival. If so, it should have simply said that.