This magazine feature story falls firmly in the category of what science and medical journalists call an “explainer,” a relatively intensely reported effort to put context and common sense around an emerging and sometimes controversial discovery or treatment. In this case, it’s proton beam therapy (PBT), a sharply-focused form of radiation therapy whose tissue-sparing benefits are becoming somewhat clearer for pediatric cancer therapy, but whose rapidly expanding and heavily marketed availability still outstrips rigorous clinical evidence for wider use, especially in adult cancers of the prostate and other organs.
Although the article offers little quantitative data or clinical trial results, it does a good job (from the headline to the end) of describing the pros and cons, costs and benefits of the treatment.
For a parent with a child suffering from a life-threatening cancer, identifying the best new treatment regardless of cost or convenience would be the normal expectation. So that a new treatment, such as proton beam therapy, that sounds so reasonable–the potential for the same or higher level of radiation delivered to the cancer while sparing surrounding normal tissue–it would be hard not to want to have this for your child. This also leads to the challenge in that we actually don’t know if this theoretical benefit is in fact a real one.
Though not stated in this article, it would be very hard to randomly assign children to conventional and proton beam therapies because the latter is available and thought better. So the result is the expansion of a much more expensive treatment with little or no proven advantage, and no study in the wings to help in the future.
The article does an exemplary job of reporting details of access, insurance coverage, and direct costs. It cites a December 2015 journal article that concludes that PBT for a deadly form of childhood brain cancer is “cost-effective.” The article could have used more data and research results about clinical outcomes to support that statement, but that’s a minor issue on this front.
The only discussion of evidence was this passage, which includes no numbers: “Yock co-authored a study published in December 2015 in the journal Cancer, which compared the cost-effectiveness of proton radiation therapy versus traditional radiation among kids with medulloblastoma. The study, which used models to measure long-term side effects and related costs in treatment, work-force participation and quality of life, found that proton therapy was cost-effective.”
In pediatric brain cancer, while the numbers are relatively small, there are data to support the claims. Readers would have had a better picture of the controversy by some mention of the relatively sparse research results available about the value of PBT in prostate cancer in adults, for example, a source of heavy marketing by PBT treatment centers. Overall, the article needed more prevalence and outcome data for all forms of pediatric cancer and its therapies.
The article notes in some detail the various side effects of PBT and especially of standard forms of radiation and chemotherapy treatments for childhood brain and other cancers.
The story focuses on the potential long-term harms, but it would also have been helpful to know more about the short-term risks of these two forms of radiation, as well.
We are indirectly told that there’s not really much evidence on this therapy and that it is largely anecdotal: “Proton beam therapy is considered a big advance in cancer therapy by some experts. Others, however, hesitate to get caught up in the early hype without more long-term evidence.”
This isn’t a sufficient effort to assess the quality of evidence, so we are rating this Not Satisfactory.
The story appropriately comments upon the seriousness of these tumors and the first goal of cure and then the longer-term issue of treatment side effects.
The article uses quotes and opinions from a handful of well-placed pediatric oncologists. It could have found one or two sources to comment explicitly on the controversial marketing aspects of proton treatment centers, and perhaps put a bit more balance into the cheerleading aspects of the quotes, but overall, the article offers a calm and reasoned picture of PBT’s value.
The article does an excellent job of describing how PBT works compared to conventional radiation, and how newer forms of PBT are reducing “scatter” even more.
Very well reported here. The story highlights that there are a limited number of centers in the U.S. that offer this and that they are not evenly distributed around the country. Many patients need to make special travel/housing arrangements to complete a six-week course of therapy.
The report puts PBT’s benefits in good perspective and to its great credit, notes from the outset that the treatment is no “magic wand,” but has real potential to avoid one of the big challenges of childhood cancer therapy.
No evidence of that.
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
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