Cancer Center Ads Use Emotion, Promise Cure

Fran Lowry

May 26, 2014

In their advertisements to the general public, cancer centers in the US use emotional appeals that evoke hope and fear, and rarely provide information about risks, benefits, costs, or insurance, a new study has found. The approach may lead to unrealistic expectations and inappropriate treatments, it warns.

The findings were published in the Annals of Internal Medicine.

"These direct-to-consumer ads are increasingly common and hard not to notice," senior author Yael Schenker, MD, from the University of Pittsburgh, Pennsylvania, told Medscape Medical News.

"There's a concern in general and among some physicians in particular that medical advertising may generate inappropriate demands for services or unrealistic hopes for benefit," Dr. Schenker said.

"There is also the argument that advertisements provide important information to patients, but until now, nobody had really looked systematically at cancer center advertising content," she said.

In the study, Dr. Schenker and her group analyzed 409 television and magazine advertisements for 102 cancer centers to characterize their informational and emotional content.

Dr Yael Schenker

Most (59%) of the advertisements were by for-profit centers, 16% were by National Cancer Institute (NCI) designated centers, and 59% were Commission on Cancer accredited, Dr. Schenker said.

The authors assessed each advert for the following 4 key areas: types of clinical services promoted; information provided about those services, including risks, benefits, costs, and insurance availability; use of emotional advertising appeals; and use of patient testimonials.

Their analysis showed that most ads (359 ads, 88%) promoted cancer treatments, but only 75 ads (18%) promoted cancer screening, and just 53 ads (13%) promoted supportive services.

Half of the ads did not specify the type of cancer treatment and instead used general terms such as, "The most advanced and accurate treatment options" or "Our team has saved lives through groundbreaking technology, personalized treatments, and research."

Only 8 ads (2%) mentioned palliative care or symptom management services. A little more than half of the centers (235 ads, 57%) mentioned treatment for a specific type of cancer, such as breast cancer (i.e., "Devoted exclusively to women fighting breast cancer") and only 9% (38 ads) mentioned cancer stage.

Just 7 ads (2%) mentioned an alternative to the advertised service (i.e., "CyberKnife may be an alternative to surgery" or "Breast brachytherapy is a 5-day alternative to 6 weeks of radiation").

One fourth of ads touted potential benefits of offered treatments, but only 2% of those ads quantified the benefits.

Less than 2% of ads mentioned the possibility of treatment risks and none quantified the level of potential risks.

Only 5% of ads mentioned costs or insurance coverage of advertised treatments and none mentioned availability of treatment under specific insurance plans.

Most Ads Appealed to Emotions

Emotional appeals were a cornerstone of most ads, with 347 ads (85%) using such an approach. Most stressed survival or potential for cure rather than comfort, quality of life, or patient-centered care.

The majority of ads (248 ads, 61%) also used language that evoked hope (e.g., "Your last hope" or "Our advanced care adds another dimension to cancer care. Hope").

Many of the ads (40%) described cancer as a fight or battle (e.g., "Knocking out cancer" or "I fought, I won") and 30% evoked fear ("I didn't know if anyone survived pancreatic cancer").

Patient testimonials were used in 44% of ads, and some (5%) even included endorsements by local or national celebrities.

The testimonials were about survival or cure (i.e., "I used to think that you had to go to NYC for anything serious, but after my experience, I don't know why anyone would go anywhere but the [X cancer center]. They saved my life" or "My doctor back home gave me only a few weeks to live. That's when I made the 1 decision that saved my life. I went to [X cancer center]. That was 7 years ago. And counting."

Only 15% of testimonials included a disclaimer (i.e., "most patients do not experience these results").

None of the ads mentioned outcomes that a typical patient might expect.

The researchers were also curious about whether these appeals and advertising techniques were unique to the for-profit or NCI-designated centers but found that, overall, there were no substantial differences.

Ads placed by NCI-designated centers were less likely than nonNCI-designated centers to promote cancer treatments (81% vs 90%) or supportive services (6% vs 15%). They were also more likely to mention costs or coverage of services (12% vs 3%). However, NCI-designated center ads used more emotional appeals and testimonials related to survival.

Both types of cancer centers failed to describe risks, benefits, and alternative treatments.

"I would say the similarities outweighed the differences, so these techniques are not unique to the for-profit or NCI-designated centers," Dr. Schenker said.

The next step, which will be more complicated, is to see if and how such direct-to-consumer advertising affects patients' treatment choices.

"Our study was purely descriptive of advertising content and did not look at how the ads would guide treatment choices. The most important and necessary next step is to actually look at advertising's effect on patients," she said.

Provocative Findings

Writing in an accompanying editorial, Gregory A. Abel, MD, MPH, of the Dana-Farber Cancer Institute, Boston, Massachusetts, congratulates the researchers on their "provocative findings" and agrees that the ultimate impact of cancer center advertising "remains uncertain."

Dr. Abel writes that the present analysis "should be followed up with further qualitative and quantitative studies to help tease out if and how cancer center advertising may truly affect patients with cancer."

But he notes that adding more quantified data may not make much sense "given their complex nature and the potential for misleading claims."

Dr. Abel also writes that such advertising may have a beneficial effect by normalizing and destigmatizing cancer and that banning such advertising may not be acceptable to consumers.

He concludes by commending the authors "for taking an essential first step" toward finding out how such advertising may affect cancer patients.

The study was funded by the National Center for Advancing Translational Sciences of the National Institutes of Health. Dr. Schenker and Dr. Abel reported no relevant financial relationships.

Ann Intern Med. Published online May 27, 2014 Abstract Editorial

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