Cancer-related, direct-to-consumer advertising (CR-DTCA) has the potential to promote misconceptions about the efficacy and toxic effects of new therapeutics, which could be detrimental to patients and the physician-patient relationship, argues a viewpoint article published in JAMA Oncology.
Recent technological advances have markedly increased patients’ access to information about their disease and possible therapeutic options. In one sense, this has helped to empower patients and make them more informed about their symptoms, but it has also led to problems in how cancer medications, cancer-related genetic testing, and even cancer centers are advertised to these same individuals.
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While there is still little evidence linking CR-DTCA to inappropriate treatment recommendations, Lowell E Schnipper, MD, Beth Israel Deaconess Medical Center (Boston, MA), and Gregory A Abel Dana-Farber Cancer Institute (Boston, MA) argue in a recent editorial that this practice is still liable to cause harm in a number of other ways. These include the potential to foster patient misinterpretations about the efficacy and toxicity of different drugs with concomitant harm to the patient-physician therapeutic relationship; encouraging patient interest in new drugs when their toxic effects are not fully appreciated; and failing to present alternative treatment approaches that may be less toxic or costly.
To begin, authors reference the broad enthusiasm that has surrounded immune-modulatory drugs, which have the potential to revolutionize treatment for patients with advanced cancers. However, television advertisements of these drugs, such as Opdivo, an anti–programmed cell death 1 (PD-1) monoclonal antibody from Bristol-Myers Squibb approved in 2015 for patients with squamous non–small cell lung cancer, do not explain anything about how much these therapies will cost or what the potential side effects are.
One commercial of Opdivo stresses that it reduced patients’ risk of dying by 41% compared with chemotherapy in a clinical trial; and while this is technically true, it is also incomplete. In the associated trial, Opdivo only extended median progression-free survival by 0.7 months and overall survival 3.2 months compared with chemotherapy. The authors say that a 1-page summary of the benefit and risk associated for each indication of a drug would be better than the “brief summary” currently utilized by advertisers; however, they also note that while the US Food and Drug Administration agrees with that idea, they are hesitant to insist that the current format be changed.
Further, authors stress that, when treating cancer, there is rarely an instance when a single treatment approach is utilized. Further, many regimens may differ little in efficacy or toxic effect, but do differ significantly in regards to cost. Yet, CR-DTCA does not include any detailed discussion about alternative treatment options or typical patient costs. In an era of rising cancer costs and significant financial distress, authors contend that it should be essential to include details about what patients are likely to pay and the potential alternatives.
The authors conclude that CR-DTCA poses a significant risk of harming patient-physician relationships and encouraging misconceptions about the effectiveness and toxicity of different treatment options, stating that the practice is “beneficial to neither patients nor the physician-patient relationship, nor the health of the public.”
