This story gave balanced coverage and the right tone to an ongoing area of research: chemotherapy for pancreatic cancer. A few more sentences would have plugged the holes and added important context about why the study compared these two regimens in the first place.
New strategies are needed in the war against pancreatic cancer. The JAMA editorial accompanying the study called such cancers “arguably the most challenging of human malignancies.” An effective new treatment option could offer hope and extended life for many people. It is equally important to cover studies that didn’t stop the presses, those that tried to find a new option but failed. Scientific studies are important because of what they tell us, not what we want them to tell us, and the value of studies like this one lie in their quality and the way they advance the science.
This review points out some areas that we think could have benefited from a little more clarity. For example, why was the study done in the first place? Is adjuvant therapy not regularly done? Is gemcitabine an experimental agent not currently being used widely? And why, as the independent expert says, are these results important, even if they won’t change treatment? The published trial and editorial provide answers to these questions, and none would make a snappy headline, as they deal with the study’s incremental additions to knowledge from prior research. But even a few more words of context would have sufficed.
Costs of these chemotherapy agents are not discussed. The study compared a drug available only as a brand name to a regimen consisting of two drugs available generically.
Average survival times and survival rates at one and two years of follow-up were provided for both treatment groups.
Harms and tolerability are discussed, and the rates of serious side effects for each group are provided. Specific examples of those serious effects would’ve been ideal, such as were provided in the JAMA editorial: “more stomatitis and diarrhea [were] observed in the fluorouracil and leucovorin group and more myelosuppression in the gemcitabine group.”
Many details are given to put the quality in context: number of subjects, number of sites and their international locales, years the study was conducted, treatment regimens, duration of therapy, and follow-up period. We did see what seems to be an error in the story, highlighted by a confusing point. It names the treatment groups as “six-month chemotherapy groups” and then states that results were available “[a]fter nearly three years of treatment.” It seems from the published trial that the patients did indeed undergo chemotherapy for six months but then were followed, without treatment, for three years.
It also would have been helpful to note that this was a randomized trial and why that matters. Also, the investigators note that this study is the largest trial of adjuvant therapy for pancreatic cancer they are aware of, making the findings that much more significant.
The story does not engage in disease-mongering. Instead, it nicely draws boundaries on the target population for this treatment by saying that only a minority of patients with pancreatic cancer are candidates for surgery.
One independent source provides important big picture points about pancreatic cancer. More sources might have provided more context and filled in some of the holes.
The associations of the lead author and independent source were provided. The study authors themselves did not disclose any financial relationships.
The story details the comparison between two approaches. It wasn’t exactly clear about whether either was “new” vs “existing,” but, in fact, they are both existing approaches, with the one positioned as the “newer” approach, gemcitabine, currently the preferred agent according to the JAMA editorial. While we would have loved more clarity about the reason why the study compared these two approaches, overall, the comparative nature and tone of the story are clear and seem appropriate.
The story does not clearly establish whether gemcitabine or the other drugs mentioned are currently on the market. (They are.)
We would have liked to see more context about why did they select these two regimens. Was gemcitabine a new or uNPRoven agent, as it is somewhat positioned in the story? (Gemcitabine is currently available and is accepted as the standard of care.) What was known about it before? It sounds like we’re asking a lot for a brief article, but we really want to know, perhaps in one sentence, why the study was done, in part to help us understand what the study adds to our understanding of how to treat pancreatic cancer.
Also, the story does not make it clear which of the two regimens performed better? The way the authors of the editorial interpreted the results is at odds with the tone of the story, underscoring why more outside voices could have helped make this story stronger.
A JAMA press release seems to be the primary source, but an independent expert gets enough air time that we give the author the benefit of the doubt.