According to this story from NPR, new study findings apparently challenge the conventional wisdom that surgery to remove lung cancer is too hard to bear for older adults.
The story overstates the findings, however, by saying patients “can benefit.” The study was observational only; it was a “competing risks analysis” to gather and assess data about the outcomes of surgery for early lung cancer.
The researchers’ chief conclusion was “In patients who undergo curative-intent resection of stage I NSCLC [non-small cell lung cancer], noncancer-specific mortality is a significant competing event, with an increasing impact as patient age increases.” In plain language, many older lung cancer patients die of non-cancer problems. Somehow NPR translated that to “Older Patients Can Benefit From Lung Cancer Surgery.” An optimistic and potentially true statement, but certainly not in line with the researchers’ more conservative conclusion as written in the journal where the findings were published. Unfortunately the NPR story relies more on anecdote rather than evidence, and didn’t push back enough on what this study can and can’t tell us.
The story may leave readers with the impression that this is solid evidence that surgery is a good option for older adults. The study gave researchers some insights into what happens to older adults after surgery, but it was not a randomized controlled trial that could show which interventions benefit patients most.
There is no mention of the costs associated with the surgery.
There is only one short paragraph dedicated to quantifying the benefits of surgery, and it’s inaccurate:
“One year after surgery, more people had died from other causes than died from lung cancer. And, after five years, almost 9 out of 10 patients were alive and cancer free.”
“9 out of 10” would mean 90% survived and 10% died within the five years. But as the study revealed, 19.9% of all patients had died within five years:
“The 30-day, 90-day, 1-year, and 5-year mortality rates were 0.7%(n=15), 1.2%(n=27), 4.1%(n=90), and 19.9%(n= 436).”
This means nearly twice as many people died than what the NPR study suggests.
The article admits the conventional wisdom is that older patients don’t tolerate surgery for lung cancer, but from headline to the final sentence the NPR story is about older lung cancer patients thriving, based on a personal story and and experts’ opinions. There is no meaningful discussion of the harms of surgery.
The story did not adequately explain how this study was performed and what it can and can’t reveal about surgery in older patients. For example, there was no control group to compare results. So it’s unclear how these patients would have fared if they hadn’t received surgery and instead been treated only with alternatives like radiation and chemotherapy. Unlike what the headline implies, we don’t actually know if patients “can benefit” from surgery.
The story included an independent source and we didn’t note any potential conflicts of interest.
For early stage lung cancer elderly patients who may be presented with a spectrum of choices from surgery to hospice, the article provides little evidence-based advice.
The surgery is clearly already available.
The article implicitly suggests the novelty of the study is that it overturns conventionally held beliefs about the benefits of surgery in older lunger cancer patients. But that’s not really the case.
The researchers chief conclusion was “In patients who undergo curative-intent resection of stage I NSCLC, noncancer-specific mortality is a significant competing event, with an increasing impact as patient age increases.” In plain language, many older lung cancer patients die of non-cancer problems. This doesn’t prove that lung cancer surgery is beneficial and leads to a longer, better lifespan than other options. Nor does it prove the surgery was the best choice.
The article does not appear to rely on a news release.
Systematic, Criteria-Driven
SPH adjunct associate professor @garyschwitzer presented to @Georgetown University public health students on how #covid19 has been "the perfect storm of politics, PR, and polluted messages to the public."
Watch the recorded zoom presentation here: https://www.healthnewsreview.org/2020/09/perfect-storm-of-politics-pr-polluted-messages-to-the-public/.
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