Lung cancer is a devastating diagnosis. Few tumors are caught early; those that are can be successfully treated with surgery. However, some patients are not eligible for surgery for various reasons. For them, radiation may not cure the cancer but may control it for some time. A new type of radiation, Stereotactic Body Radiation Therapy (SBRT) provides targeted, highly-focused radiation treatment to the tumor while leaving the surrounding tissue intact, important for those whose lung function may already be compromised. A small pilot study published in this week’s Journal of the American Medical Association found that SBRT provided improvements in 3-year survival compared to what other studies have shown is achieved with conventional radiation. However, because this was a small, single-institution study with no direct comparison to other treatments, some caution must be taken in interpreting the results.
This story could have been improved in the following ways:
This story narrowly avoids some of the pitfalls of a common scenario in contemporary health care reporting – preliminary results about a potentially better treatment for a bad disease – this time a new form of radiation for lung cancer. The key words here are "preliminary" and "potentially" – the best this article did was insert the tiny word "may" in the first line when referring to the fact that this treatment "may control" this cancer better than currently available treatment. Readers shouldn’t have such a hard time seeing the reality. Without it, one can see desperate patients and families clamouring for insurers or the government to pay for this lifesaving treatment. Only by making the facts clear, not sensationalized, can they see that hope isn’t proof, and that the clamour should be to get the definitive study under way.
The story does not mention costs or insurance coverage. Likely given how experimental the treatment is, insurance will not cover the procedure. Given that it is not an approved treatment, a simple statement about its cost relative to current therapy could have been helpful. For desperate patients and families struggling with the treatment options, uNPRoven treatments that are likely not to be covered by insurance would require out of pocket coverage.
The story adequately quantifies the benefits of treatment by providing the number and percentage of participants who had complete or partial response to the therapy. However, the story should have defined what "complete" or "partial" response means. More importantly, the story was not explicit about the fact that the observed results can only be compared to historical data, not concurrent "best" standard care. We know what happened to the study patients, but what would have happened if they got standard therapy can only be speculated on.
The story indicates that 16% experienced significant but non-deadly side effects of treatment. But what were those side effects? How serious were they? Did they occur more or less often with SBRT than conventional radiation?
The story describes one small study but does not comment on the strength of the evidence. While the results are compelling, this was not a controlled trial, meaning there was no comparison made to any other treatments. This makes the interpretation of the results very difficult and a follow-up study is needed that directly compares a larger number of individuals randomly assigned to SBRT or conventional radiation.
The story does not exaggerate the seriousness of lung cancer. The story is clear that the study was in the context of early-stage lung cancer, however it could have pointed out more clearly that the results can’t be applied to later-stage cancer patients.
The story does not quote any sources other than the lead author of the study. Independent experts could have provided some much-needed perspective on the importance of the new findings.
The story describes surgery and conventional radiation as possible alternatives to SBRT.
The story states that SBRT is not FDA approved and is still "experimental" and in clinical trials. The story could have provided some information on how someone with inoperable lung tumors could get access to the clinical trial.
While radiation is not a new idea, stereotactic body radiation therapy is relatively new and has not been evaluated in lung cancer.
There is no way to know if the story relied on a press release as the sole source of information.