lung cancer illustration
The release, which summarizes a study of patients 80 or older who underwent stereotactic body radiation therapy (SBRT) for early stage lung cancer, should have stuck to what the researchers actually studied. In the headline, main text and quotes, the release makes unjustified claims about treatment effectiveness, claiming SBRT can “safely add years to the lives of elderly patients who have early stage lung cancer but cannot undergo an operation for it.”
However, the study was merely a look back at a few dozen cases that produced results the researchers considered evidence that age, by itself, should not disqualify patients. There was no comparison group that would allow any conclusions about effectiveness, including longer survival. The release does not mention cost nor does it report funding or author disclosures.
Many research studies investigating the benefits and risks of various therapies exclude very old individuals. As such, it is often difficult to provide evidence-based recommendations for this population. A study of elderly people, if evidence-based, would be helpful to patients, their families and physicians.
But it is important for news releases to be clear about what was studied and what was not. This summary of the experience of a few dozen elderly patients may provide some assurance that patients should not be disqualified from considering SBRT for early stage lung cancer merely because they are old. However, there was no control group, no comparison to other treatments that would support claims of effectiveness and added years of life.
Muddling study results with the opinions of researchers that are based on their clinical experience or interpretation of other studies produces a confusing picture of the evidence or lack thereof.
The release does not report the cost of stereotactic body radiation therapy (SBRT) or any alternatives a patient could consider.
The release provides some data on benefits with this statement: “At two years following definitive SBRT for lung cancer among elderly patients, survival rates were 73 percent for cancer specific survival (CSS) and 57 percent for overall survival (OS).”
So the release is claiming that SBRT can add years to the lives of elderly patients. But the study was merely a review of a series of cases and did not actually compare SBRT to any other treatment, so it provides no direct evidence of a survival benefit. The same section of the release refers to other studies, but provides no numerical description of the benefits from the other studies. In fact, other studies have relied on comparisons to historical controls, not randomized trials, so even though SBRT has become standard care for this sort of lung cancer patient when surgery is not an option, there is a lack of evidence about the precise benefits.
The release reports that just over one-third of the 58 patients experienced radiation pneumonitis (inflammation of lung tissue), and that two had cases severe enough to possibly require oxygen or steroid treatment. However, the release does not mention other harms of this sort of radiation treatment, which can include fatigue lasting for several weeks, neuropathic pain, rib fractures and other problems. There is no mention of any measurements of these other radiation effects.
The release reports that the study was a retrospective analysis of 58 patients with different types of tumors — adenocarcinomas (40 percent), squamous cell carcinomas (29 percent) and those not diagnosed with biopsy (31 percent). Half of those not receiving a biopsy had a previous history of lung cancer.
The fact that more than one-third of the tumors treated were not categorized is concerning.
We would have liked to see a clear note that this study was neither randomized nor blinded and that the study design is not able to provide evidence of effectiveness. Without this sort of clarifying statement, the release relies on readers to understand the generally low quality of evidence that a retrospective case series produces.
Because the results are not compared to any other treatments, it is impossible to state whether the treatment offered benefit, and if it did, how much.
It should be clear to readers that this study applies only to elderly patients with early stage lung cancer who are not able to undergo surgery.
The release does not report anything about the funding of the study or any disclosures by the researchers. There is a note about how to seek information about the author disclosures, but this information should be contained in the release itself.
The release claims that SBRT is effective, without mentioning other types of radiation therapy or other options for lung cancer patients who are not candidates for surgery. It is unclear to the reader what this “new” treatment is meant to replace.
The release notes that SBRT is a common choice for early stage lung cancer patients who are not candidates for surgery. But it’s not clear how widely available this treatment is. This study was done “across four academic sites within Emory between 2010 and 2015.” This implies that it may be available at academic institutions, but it doesn’t state anywhere whether this is widely available in other treatment settings.
It is clear that this study provides new information about the experiences of some elderly patients.
The use of “curative” in the headline and the suggestion that SBRT is a “curative treatment” is misleading. The release doesn’t say whether the tumors treated originated in the lung or if they metastasized from some other part of the body. Particularly in the case of metastasized tumors, the treatment would be “palliative,” but not curative.
The claims of treatment effectiveness and added survival are not supported by this study. What’s more, evidence from other studies is weaker than the release implies. It is not justifiable for a researcher to plainly state the “SBRT can effectively and safely add years to the lives of elderly patients” when the study did not compare treatments. It would have been better for the release to limit itself to the actual results of the study; that is, that this group of elderly patients appeared to do as well as their doctors expected, and so age itself should not be used to disqualify patients from considering SBRT.
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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