This is a story about a large scale study which demonstrated that the use of hormone therapy in older men with localized prostate cancer failed to reduce the chance that they would die of prostate cancer or increase the length of time that they would live. It provided a lot of facts and figures taken from the study which are informative and yet it obscured the very simple and clear take home message of the study.
The results of the study in question show that at least in this case (older men with localized prostate cancer) that the drive to do something does not necessarily result in doing better. As the story indicated, hormone therapy, like most treatments, is not without important side effects that affect health and quality of life and so its use needs to be considered in terms of the benefit it has been demonstrated to provide.
While the article provided useful information about hormone treatment outcomes and complications, these important messages were obscured by the following flaws:
We’re told how much the nation spent on the drug but we’re not told how much individuals were charged.
The story was about a lack of benefit in terms of overall death or prostate cancer specific death. The story was clear that hormone therapy for the treatment of localized prostate caner does not increase survival time.
The story included information about the source of the study (published in the Journal of the American Medical Association). Reading between the lines, as the story mentioned that the data came from national databases, it is possible to glean that this was a cohort study as opposed to a randomized clinical trial. It would be best to clearly explain that type of study the information came from and where that type of study ranks in terms of the hierarchy of evidence. Not all studies and study types are equal and journalists should begin educating readers about the differences in the quality of the evidence.
The article should have been clearer about the distinction between localized/early-stage vs. aggressive vs. advanced-stage cancers. These terms were used but not explained and an understanding of them is crucial to an understanding of prostate cancer. Hormone therapy is most useful for treating symptoms of advanced-stage cancers (where it has no survival benefit). There is no convincing evidence that it is a "powerful tool" when combined with surgery in treating aggressive cancers, though it does confer a survival benefit when combined with radiation. However, the "aggressive" tumors in these studies were also localized. Similarly, the comment about earlier studies showing less benefit from hormone therapy in less advanced tumors confuses the distinction between aggressive (based on the appearance of cancer cells) and stage (localized vs. advanced). The earlier studies showed less benefit for less aggressive cancers.
The story could have (should have?) commented on the use of PSA testing which has lead to a dramatic increase in the incidence of early-stage cancer. What we have been witness to is an increase in prostate cancer diagnosis without a change in rate of death from prostate cancer. This begs the question of whether diagnosing early stage prostate cancer, especially in the elderly has any value.
There were two physicians interviewed for this story in addition to one of the authors of the study detailed in the story. While the story did not explicitly mention that these two were not associated with the recently published study, they did not appear to be connected with it.
The story was about whether hormone therapy was a useful approach to treating prostate cancer in older men who chose to avoid surgery or radiation treatment. The story provided a good explanation for why some men choose hormone therapy (i.e. because they want to avoid surgery or radiation and yet were not comfortable with expectant management). It should have pointed out that even though expectant management may feel like ‘doing nothing’, the men who adopted this approach had similar outcomes to those who decided to have hormone therapy to fulfill a desire to ‘do something’.
The story explained that " the use of the drugs surged a decade ago, with an estimated 30% to 50% of such patients receiving the therapy" and then fell off in recent years after Medicare reduced reimbursement. So we get a sense of how widely available the therapy has become.
It’s clear from the story that the treatment has been use in for a long time and that, as one expert said, ""There is no clear data that has ever shown that patients with early-stage disease benefit from primary hormone therapy . . . and this is further evidence to support that." (However, the story should explain that medicalese jargon of what "primary" therapy means.)
Does not appear to rely on a press release.
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
Comments
Please note, comments are no longer published through this website. All previously made comments are still archived and available for viewing through select posts.
Our Comments Policy
But before leaving a comment, please review these notes about our policy.
You are responsible for any comments you leave on this site.
This site is primarily a forum for discussion about the quality (or lack thereof) in journalism or other media messages (advertising, marketing, public relations, medical journals, etc.) It is not intended to be a forum for definitive discussions about medicine or science.
We will delete comments that include personal attacks, unfounded allegations, unverified claims, product pitches, profanity or any from anyone who does not list a full name and a functioning email address. We will also end any thread of repetitive comments. We don”t give medical advice so we won”t respond to questions asking for it.
We don”t have sufficient staffing to contact each commenter who left such a message. If you have a question about why your comment was edited or removed, you can email us at feedback@healthnewsreview.org.
There has been a recent burst of attention to troubles with many comments left on science and science news/communication websites. Read “Online science comments: trolls, trash and treasure.”
The authors of the Retraction Watch comments policy urge commenters:
We”re also concerned about anonymous comments. We ask that all commenters leave their full name and provide an actual email address in case we feel we need to contact them. We may delete any comment left by someone who does not leave their name and a legitimate email address.
And, as noted, product pitches of any sort – pushing treatments, tests, products, procedures, physicians, medical centers, books, websites – are likely to be deleted. We don”t accept advertising on this site and are not going to give it away free.
The ability to leave comments expires after a certain period of time. So you may find that you’re unable to leave a comment on an article that is more than a few months old.
You might also like