Is Posting Survival Data on Websites an Answer?
What about Dr Joffe's suggestion that ads include the Internet address of a cancer center's website, where there's plenty of room to present survival and other data in greater detail? At least in one case that's been well studied, there were problems with this approach as well.
An in-depth investigation by Reuters of the for-profit Cancer Treatment Centers of America (CTCA) bore out the fears of Dana-Farber physicians that data from competing centers can be easily manipulated to make outcomes seem better than they are in the battle to attract patients.
CTCA posts a large amount of survival data for many types of cancer in great detail on its website. However, Reuters claimed that the company distorted its data, often showing its five hospitals outperforming SEER benchmarks for most types of cancers that were compared.
These were often apples-and-oranges comparisons, Reuters charged. To come out on top, CTCA excluded certain patients from its centers: It accepted only a minimal number of Medicare patients, even though cancer is a disease of the aged, and almost no Medicaid or uninsured patients.
In most cases, acceptance was conditioned on a privately insured patient's ability to pay for the cost of treatment. In addition, CTCA used only a subset of these patients to compare, choosing those with better survival odds, Reuters found.
Reuters asked nine independent biostatisticians with expertise in cancer statistics to analyze CTCA's numbers and statistical methodology. Their unanimous conclusion: CTCA's patients were different from those included in the SEER data set, skewing their survival data.
For patients hoping to improve their survival odds, how useful are such data?
Would Including Disclaimers Help?
Although nearly half of cancer centers use testimonials by patients, some of them celebrities, to attract new patients, Dr Schenker's study found, only 15% included disclaimers to the effect that the person in the ad isn't a typical patient and that viewers or readers may not experience the same results.
But even if the inclusion of such a disclaimer were mandatory, would it be enough to keep frightened cancer patients from thinking, "They cured her; maybe they can cure me," when reality is nearly always infinitely more complex?
Maybe not. In fact, the inclusion of a disclaimer may perversely have the opposite result. "Evidence indicates that such disclaimers may not have the intended effect of promoting accurate understanding and in some cases may increase acceptance or belief in an advertiser's message, because consumers assume that a disclaimer means that the advertisement has been properly reviewed and vetted," Dr Schenker and colleagues write.
Studies show that disclaimers increase consumers' vulnerability to the advertising message. "There's been some interesting work done showing that merely having a disclaimer there can lead to a sense of relief, as in, 'Oh good, I no longer have to worry about the facts being deceptive,'" Dr Schenker told Knowledge@Wharton, the online business journal of Penn's Wharton School. "So I don't think the issue of disclaimers is clear-cut."
Given such difficult-to-resolve ethical issues—and there are many others, too—should cancer center advertising simply be banned? Dr Joffe doesn't think so.
"Stepping back to think about the function that ads might have in the ecology of cancer medicine, they can serve a really useful purpose if done right," he says.
"That's not to suggest they are done right at the moment," Dr Joffe hastens to add. "I think we want cancer providers—whether they be individual clinicians in their offices or cancer centers—to compete with each other on things that are important to patients. Ads, if they are accurate, can serve that function."
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Cite this: Is Cancer Hospital Advertising Misleading Patients? - Medscape - Dec 04, 2014.