This was a strong overall story about an increasingly popular radiation treatment for non-melanoma skin cancers. Importantly, it cautions readers about the absence of long-term safety data, as well as the high costs of the treatment relative to more standard procedures such as freezing the tumor or surgically removing it. But the story’s heavy reliance on anecdotal testimonials, as well as a headline (“Many patients prefer the new x-ray treatment to surgical procedures”) and smiling patient photos that project undocumented patient enthusiasm for the treatment, may overwhelm these cautions. We encourage you to view the original story to get a sense of what we’re talking about.
Please also note that we gave the benefit of the doubt in a couple of instances which, if we’d swung the other way on our rating, would have brought this down to a 4-star score. But we always try to give that benefit, while offering constructive criticism for next time. The star score isn’t what’s most important. It’s what we write in our critique that we hope hits home.
Non-melanoma skin cancers are very common, but rarely represent a serious health concern. They only spread locally and don’t metastasize to organs or structures where damage could be life threatening. For cancers not on the face or in other hard-to-reach areas, simple, less costly treatments including topical therapies and surgical excision should be used. Concern is usually greater for cancers that develop on the face where they can be disfiguring and the goal is to remove the cancer while minimizing deformity/scarring and recurrence. In these cases, this new radiation treatment may represent an option that could compare to a variety of other treatments including Moh’s surgery. Though the testimonials provided in this story sound impressive, the lack of data — other than the potential for dramatically higher costs — is concerning. Given that these skin cancers rarely represent a dangerous condition, patient convenience and cost should also be considered in addition to effectiveness. The first patient profiled apparently had 16 treatments; this would be considerably more than would be expected with other treatments. Finally, the costs suggest that payers absolutely should balk at using our health care dollars when other established, less expensive treatments are available in the absence of compelling data.
This was a strong point of the piece. The story contrasts the much higher cost of eBx relative to standard skin cancer treatments, referencing an editorial in the journal JAMA Dermatology. The cost issue is situated high in the story, and the text then devotes space later in the story to a more detailed explanation.
This was a tricky one. The story certainly reflects the strong belief of two patients who were treated with eBx that their skin cancers were banished. And it gives ample space to representatives of two companies that manufacture the radiation device, one of whom describes the treatment as a “painless alternative” (a claim not supported by evidence in the story). The text also discusses findings from studies of older radiation techniques, but it rightly notes that these are not necessarily valid for judging the success rate of eBx. The story makes clear that skin cancer recurrences can take four or more years to appear, while the median follow-up time in studies of eBx to date can be measured in months.
The tiebreaker here for us is the headline and accompanying photos. Added to the anecdote-heavy text, these elements that radiate “benefits” throw the story out of balance. We acknowledge that the reporter on this story may not have had any control over those elements.
Radiation treatment can cause secondary cancers and other problems. The story mentions this and clearly explains that the incidence of such cancers is low. But, as noted above, existing studies do not track patients long enough to make a determination of harms feasible.
We’ll give the story the benefit of the doubt on this one, since it acknowledges that long-term data on the safety and effectiveness of eBx are not available. But it would have been nice for the story to explain where the short-term data it does cite comes from. It sounds as if the data comes from the manufacturer’s representative. No details about the 1300 patients said to have been studied are given.
Basal or squamous cell cancers afflict more Americans annually than all other cancers combined, according to the story. While generally not lethal, they require treatment, and that makes these types of cancers indeed a significant problem. What’s key to remember is that this treatment really should only be considered for the face or other areas where standard excisional surgery is not feasible. The other element that the story could have emphasized is that it is recommend only for older individuals, >50.
The story clearly identifies sources affiliated with the two companies that make the radiation device, as well as a researcher who is funded by one of the companies. These sources are offset by references to the JAMA Dermatology editorial and by comments from one of the editorial authors.
The story makes it clear that eBx is being positioned as an alternative to longstanding treatments such as topical creams, freezing and surgery. It doesn’t compare effectiveness outcomes between these competing approaches in a meaningful way, but we think the story does enough to clear the bar here.
The story discusses Medicare and private insurance coverage for the procedure, and that description gives readers some insight as to availability. “As of now, Medicare covers eBx in 21 Western and Midwestern states. It covers the treatment on a case-by-case basis in Texas and the South and doesn’t cover it in Florida or New England, where it is more difficult to find. Private insurance coverage also varies.”
Although radiation has been used for years to treat cancer, this does appear to be a novel use of radiation as a first-line therapy for these types of skin cancers.
There is enough original reporting that we can be sure the story didn’t rely on a press release.