Rushed COVID-19 Papers: 'Interpret With Caution,' Says JCO

Kate Johnson

July 01, 2020

Over the last few months during the pandemic, there has been a rush to publish papers on COVID-19 in medical journals, but unfortunately there have also been several highly publicized retractions of such papers.

"Medical journals are facing unprecedented times that will test our resolve to adhere to the tenets of good science and responsible reporting," says Stephen A. Cannistra, MD, from Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts.

He is also editor-in-chief of the Journal of Clinical Oncology (JCO), the official publication of the American Society of Clinical Oncology. His comments are published in a "special article" in the July 1 issue of the journal.

In the article, Cannistra and two co-authors clarify the journal's publication guidelines on COVID-19 research and include a veiled criticism of two major oncology journals and a caution against over-interpretation of evidence.

The authors highlight two studies on COVID-19 outcomes in cancer patients that were published early on in the pandemic: "Cancer Patients in SARS-CoV-2 Infection: a Nationwide Analysis in China," published online on February 14 in Lancet Oncology, and "SARS-CoV-2 Transmission in Patients With Cancer at a Tertiary Care Hospital in Wuhan, China," published online March 25 in JAMA Oncology.

While praising the study authors "for their heroic efforts to care for patients while at the same time collecting data to share with the rest of the world," Cannistra and colleagues say that both papers "illustrate how well-meaning attempts at educating the oncologic community must be interpreted with caution."

"Articles such as these represent early attempts to assess the impact of COVID-19 on our ability to deliver high-quality cancer care, but these reports are not definitive," they add, citing small numbers of patients and confounding factors among the reasons for their warning.

Asked to comment on the special article, Adil Shamoo, PhD, editor-in-chief of Accountability in Research, told Medscape Medical News, "I agree with their scientific analysis, but I don't agree with their policy implications.... Their conclusion was, we would not publish it, period.... They shouldn't dictate what other journals publish or do not publish, that depends on the philosophy of the journal."

Shamoo, a professor and former chair at the University of Maryland School of Medicine, Baltimore, said statistically JCO's conclusion is valid. "In principle they were correct: When you have a low number of subjects...the analysis is not strong statistically. However, any information, even a case study, is information that is helpful for the future. You don't make policy based on such studies, but it is valuable information for the rest of the scientific community for future research."

However, he said he sympathizes with the journal's sentiment, since his journal is also experiencing "an avalanche" of COVID-19 submissions. "Sometimes we reject them because we don't think they are contributing significantly new information. That's why some journals want to not spend time on studies with such low numbers."

Medscape Medical News also approached two researchers involved in the COVID-19 and Cancer Consortium (CCC19) for their reaction to the article, and both supported the JCO statement.

"I personally agree with the piece," said Toni Choueiri, MD, from the Dana-Farber Cancer Institute in Boston. "While it is very important to disseminate medical knowledge as fast as possible to the community, it is even more important to be aware to draw conclusions only with studies that are well-designed, well-powered, and ideally prospective ones. Many of the available 'rushed' studies have severe limitations and end up, unfortunately, with conclusions that are not validated later on," he told Medscape Medical News.

"Most of what we have learned about COVID-19 and its effect on patients with cancer has been from observational studies, some of which have been published in peer-reviewed journals and some of which have not," added CCC19's Jeremy Warner, MD, who is also associate editor of JCO Clinical Cancer Informatics and associate professor of medicine and biomedical informatics at Vanderbilt University, Nashville, Tennessee.

"The quality of these studies will vary but they should also not be dismissed out-of-hand, despite the bad name that the Surgisphere fiasco (which led to retractions of COVID-19 papers by The Lancet and The New England Journal of Medicine) has put on real-world evidence as a whole. As with all scientific evidence, the provenance, replicability, and generalizability of these studies are the key determinants of whether a finding can be trusted or not," Warner added.

JCO Publishing Guidelines Remain Unchanged

In addition to Cannistra, the special article was authored by Bruce Haffty, MD, from the Rutgers Cancer Institute of New Jersey, New Brunswick, and Karla Ballman, PhD, from the division of biostatistics at the Weill Cornell Medicine, New York City.

"The editors of Journal of Clinical Oncology want to assure our readers and patients that we endeavor to publish original research about COVID-19," they write, emphasizing that their pandemic publishing guidelines "represent levels of evidence that are no different from what JCO has always required."

For authors considering submission to JCO, higher priority will be given to prospective research, as well as research "that definitively shows which oncology populations...are at higher risk for COVID-19 infection and that convincingly identifies variables that confer higher risk of serious morbidity and mortality," they noted.

In addition, priority will be given to evidence on interventions; "in other words, high-quality research that asks a clinically relevant and actionable question and provides tangible solutions, so that our readers can improve their practice as soon as possible."

Cannistra and colleagues expressed concern that cancer patients may currently be foregoing needed treatment, believing their risk of COVID-19 outweighs any treatment benefit. "JCO is committed to providing our readers with the most credible and practice-changing research that has the potential to improve the lives of our patients with cancer during the COVID-19 pandemic," they concluded.

J Clin Oncol. 2020;38:2206-2207. Full text

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