Transcript how to interpret and present information from

Can Europe cope with the rising burden of cancer?
Off the record briefing
June 2012
Part 2: Skill or cure
Peter McIntyre
Stories from research reports:
How can we tell a story that is not
about ‘breakthroughs’?
Reporting research results
Informing
What’s the problem?
attitudes
and beliefs
about
cancer
• Researchers complain that
media misrepresent research
• Public find health messages
confusing
• Too many scare stories
• Lots of ‘breakthroughs’ – many
fewer cures
Informing
attitudes
and beliefs
about
cancer
Studies report correlation,
not causation
• Teenage sex "leads to bad
moods" in later life
• Dogs walked by men are more
aggressive
• Religious experiences shrink
part of the brain
• Sincere smiling promotes
longevity
Headlines logged by Correlation or Causation?
http://jfmueller.faculty.noctrl.edu/100/correlation_or_causation.htm
Reporting research results
Informing
attitudes
and beliefs
Researchers use a
secret language
about
cancer
“These findings indicate that
greater AEE may be protective
against cognitive impairment in a
dose-response manner.”
Archives in Internal Medicine
• Media headline: “Exercise
reduces dementia risk” is more
informative
Reporting research results
Informing
The role of journalists
attitudes
and beliefs
about
cancer
Journalists have twin objectives:
• To capture and broadcast an
arresting story
• To be accurate and informative.
• There has to be a story or we
cannot report it……
Reporting research results
Informing
attitudes
and beliefs
When journalists are
short of time….
about
cancer
• It is easier to follow a press
release than to read a full
research report
• This leads to stories about
‘breakthroughs’
• May come from ‘business news’
(or marketing)
Reporting research results
Informing
attitudes
and beliefs
about
cancer
Breakthroughs that fail
to deliver
• Medical Journal of Australia
looked at cancer ‘breakthrough’
stories in the Sydney Morning
Herald a decade earlier – and
asked experts what had
happened since
•
Report by Ethel S Ooi, MB BS, MPH and Simon Chapman, School of
Public Health, University of Sydney MJA Vol 179 1/15 December 2003
Informing
attitudes
Experts reviewed 30
cancer ‘breakthroughs’
and beliefs
about
cancer
• 13 (43%) were judged ‘not
supported by further research’
• Three (10%) had been refuted,
• 16 (53%) still had potential with
more research required.
• Eight (27%) were or would soon
be incorporated into practice
Who was responsible?
Informing
attitudes
and beliefs
about
cancer
Editors of medical journals “would
do well to require authors to
include perspectives … intelligible
to lay people and address”:
• What questions remain before this
research could be of benefit to patients?
• Have patient trials been conducted – with
what results?
• How long before findings pass through
regulatory processes and become
available to patients?
Reporting research results
Informing
Leukaemia link
attitudes
and beliefs
Cancer link claimed in ovary fertility drugs
about
cancer
IVF drugs linked to childhood cancer
Fertility-boosting drugs could more than double the risk of
subsequent offspring developing childhood leukaemia,
academics warn today
Fertility drugs 'more than double the chances
of children developing leukaemia'
April 23/24 2012
Reporting research results
Informing
attitudes
and beliefs
about
cancer
Leukaemia link
• Figures relate to acute lymphoblastic
leukaemia (ALL) in children
• 2,445 French children and their mothers
took part in study
• 764 children diagnosed with leukaemia
• 1,681 without leukaemia.
• Mothers asked about time to conceive
and about treatments
• Risk of ALL 2.6 times higher in children
of those who took fertility drugs – claim
Reporting research results
Informing
Leukaemia link
attitudes
and beliefs
about
cancer
• Risk In absolute terms still small – from
0.1% to 0.26%
• Represents an increase from one case per
1,000 children born without fertility drugs to
• 2.5 cases per 1,000 children born when
mothers had taken fertility drugs
• Dr Jeremie Rudant, INSERM research
institute in Villejuif, Paris, presented data at
Childhood Cancer 2012 conference in UK,
hosted by the charity Children with Cancer
Leukaemia link
Informing
attitudes
and beliefs
about
cancer
• Research not yet published in
peer review publication
• No association shown between
IVF and childhood leukaemia –
• All media contained cautionary
notes
• What is our verdict?
Reporting research results
Informing
Brain tumour link
attitudes
and beliefs
about
cancer
CT scans in childhood can triple
brain tumor, leukemia risk: study
As few as two CT scans of the head in childhood
can triple the risk of developing brain tumors,
while five to 10 such scans can triple the risk of
leukemia, British researchers reported
Wednesday.
LA Times June 2012
Informing
attitudes
and beliefs
about
cancer
Radiation exposure from CT scans in
childhood and subsequent risk of
leukaemia and brain tumours: a
retrospective cohort study
“Because these cancers are relatively rare, the
cumulative absolute risks are small: in the 10
years after the first scan for patients younger
than 10 years, one excess case of leukaemia
and one excess case of brain tumour per
10 000 head CT scans is estimated to occur. “
Reporting research results
Informing
Drug trials
attitudes
and beliefs
about
cancer
• Drug trial reports are often trying
to tell (or spin?) a story
• Positive results reported more
often than negative results
• Often written to maximise the
benefits.
Informing
What is the study
trying to show?
attitudes
and beliefs
about
cancer
• A drug trial will be compared to
something – usually to standard
treatment or with current best
treatment.
• Is it better than what we have
now?
• Rarely is it better than placebo?
What is it measuring?
Informing
attitudes
and beliefs
about
cancer
•
•
•
•
Do drugs ‘cure’ cancer?
What do we mean by cure?
Is five year survival a cure?
Is there such a thing as a cure
for metastatic cancer?
Informing
Cancer becoming a
chronic disease
attitudes
and beliefs
about
cancer
• “Although some types of metastatic cancer
can be cured with current treatments, most
cannot. Nevertheless, treatments are
available for all patients with metastatic
cancer. In general, the primary goal … is to
control the growth of the cancer or to
relieve symptoms caused by it. In some
cases, metastatic cancer treatments may
help prolong life. However, most people
who die of cancer die of metastatic
disease.”
National Cancer Institute
Trials may measure
Informing
attitudes
and beliefs
about
cancer
•
•
•
•
•
•
Safety (Phase 1 trials)
‘Survival’
‘Progression-free survival’
Tumour shrinkage
Side effects
Quality of life?
Informing
Cancer becoming a
chronic disease
attitudes
and beliefs
about
cancer
• Length of survival of metastatic
breast cancer patients treated at
M.D. Anderson Cancer Center:
• Median survival doubled to 51
months in 1995-2000 from 27
months 1990-1994.
• 40 % of patients diagnosed with
metastatic disease still alive
compared with 29 % 1990-1994.
Informing
Successful drugs show
incremental benefits
attitudes
and beliefs
about
cancer
• Additional reduced risk offered
by adjuvant treatments after
surgery for breast cancer
Informing
Even best results are
partial victories
attitudes
and beliefs
about
cancer
• Herceptin trial was one of the
most dramatic in recent times.
• Treatment for women with
metastatic breast cancer that
over expressed HER2
• Reported in NEJM, March 2001
Informing
Herceptin – first
reports of success
attitudes
and beliefs
about
cancer
• Median time to disease progression
7.4 months, up from 4.6 months.
• Rate of response 50% from 32%
• Duration of response 9.1 months as
against 6.1 months
• One year death rate down by a third
from 33% to 22%
• “If confirmed in additional studies… our results
may affect treatment of this disease.”
Informing
attitudes
and beliefs
about
cancer
Avastin: progression delay
but no survival benefit
• NEJM reported in 2007 on
Paclitaxel plus Bevacizumab
(Avastin) versus Paclitaxel alone for
metastatic breast cancer
• 722 women with metastatic breast
cancer enrolled
• Progression free survival doubled
from 5.9 months to 11.8 months.
• Response rate 37% against 21%
Informing
attitudes
and beliefs
about
cancer
Avastin: progression delay
but no survival benefit
• But overall survival was not
significantly different….
• 26.7 with Avastin plus Paclitaxel
• 25.2 months with Paclitaxel alone
Avastin – who was in the
trial and what was the aim?
Informing
attitudes
and beliefs
about
cancer
• Primary end point was progression-free
survival, (time to disease progression or death)
• Secondary end points included response rate,
toxic effects, overall survival, and quality of life
• The trial enrolled women with metastatic breast
cancer for which this was their first treatment.
• Median age was 55/56 and their cancers were
HER2 negative.
• One in 10 to 1 in 12 of the women had
metastases in the bone. In 8 in 10 the cancer
had spread to other organs.
Avastin –what was the
conclusion?
Informing
attitudes
and beliefs
about
cancer
The authors concluded
• Despite a striking improvement in progression
free survival, the addition of bevacizumab did
not prolong overall survival in this study. …. it is
possible that resistance to bevacizumab results
in relative resistance to subsequent therapies.
• Alternatively, rebound increases in VEGF
(vascular growth factor) on discontinuation of
bevacizumab could result in more aggressive
disease.
• Resistance to paclitaxel …, could also cause
resistance to subsequent chemotherapy.
Informing
Who is excluded from
a trial?
attitudes
and beliefs
about
cancer
• Does the trial population reflect the
population with the disease?
• Patients are often excluded if they are
frail or have co-morbidities.
• This may result in the trial population
being younger, fitter and healthier
than the profile of the population with
the disease
• The trial may over estimate real world
impact as a result
Who is excluded?
Informing
attitudes
and beliefs
about
cancer
In the Avastin trial patients were
excluded if they had:
• History or evidence of central nervous system
disease
• Another cancer within 5 years
• Major surgery within 4 weeks or anti-tumour
therapy within 21 days
• A non-healing wound or fracture,
• An infection requiring antibiotics,
• Clinically significant cardiovascular disease.
Or were taking therapeutic anticoagulant agents,
nonsteroidal antiinflammatory agents, or more than 325 mg
of aspirin daily.
Informing
What about drop-outs
after the trial begins?
attitudes
and beliefs
about
cancer
• People who drop out of a trial
should be included in the results as
“intention to treat”
• Otherwise the trial results will
underestimate problems and
overstate success.
Points for discussion
Informing
attitudes
and beliefs
about
cancer
• What should we look for in reading
research reports?
• Are there special issues affecting
reports on new drugs or treatments?
• Do we portray the aims and
constraints of the trial?
• Does the public understand that
metastatic cancer is not generally
‘curable’?
• How do we avoid in the newsroom
promoting the ‘breakthrough’ myth?