Misleading Advertising Claims by Proton Beam Therapy Centers

Roxanne Nelson, RN, BSN

June 03, 2019

CHICAGO — Proton beam therapy (PBT) is increasingly being used in a variety of cancers, but it remains controversial because of the huge cost of establishing and maintaining treatment facilities and the still-unanswered question of how it compares to conventional radiotherapy for many cancer types.

Nevertheless, the number of centers offering PBT is increasing exponentially, and consensus guidelines now support PBT use in a limited number of disease sites or on clinical trials.

However, direct-to-consumer advertising (DTCA) from PBT centers is telling a different story.

The information content and claims made by these centers are often inconsistent with international consensus guidelines, according to a new study.

Patients who are interested in PBT will often go to the website of a hospital or cancer center in order to obtain information about the procedure. Therefore, it can be problematic if the advertising is not accurate, say the researchers.

The results were presented (abstract 6599) here at the 2019 American Society of Clinical Oncology (ASCO) Annual Meeting.

DTCA has received the most attention for pharmaceuticals and has stirred up quite a bit of controversy. In 2015, the American Medical Association's (AMA) House of Delegates called for a ban on DTCA of prescription drugs and medical devices, although others have supported such advertising and feel that it can educate patients and spread valuable information about the particular product.

"DTCA is often controversial, but of course is not just limited to drug advertising," said lead author Mark T. Corkum, MD, of the University of Western Ontario, London, Canada.

"In comparison to many previous studies, our study of DTCA in proton beam therapy focused on online advertising content and claims by hospital/cancer center websites, versus more typical print/media advertising which must conform to nationally regulated standards," he explained.

In contrast to traditional media, online DTCA has no such oversight, and online DTCA has already been shown to be controversial in other technology-driven advancements, such as stereotactic body radiotherapy and robotic prostatectomy.

"Provisos that acknowledge treatments need to be individualized — 'ask your doctor if drug x is right for you' — are a mainstay of other forms of DTCA, but they were not a prominent feature of the websites we examined," he told Medscape Medical News. "Whether proton beam therapy can offer clinically meaningful differences to quality or quantity of life are not always clearly defined, and can be subject to interpretation."

Misleading Information

The goal of the study was to evaluate DTCA content and claims made by proton therapy center websites. Corkum and his colleagues identified English language websites worldwide using the Particle Therapy Co-Operative Group website and used eight international guidelines to determine the appropriate indications for PBT.

They looked at a total of 48 proton therapy centers with 46 English websites. More than half (58%) did not provide any references for the claims that they made regarding the use of PBT. These claims included improved disease control or cure (61%), fewer side effects (85%), or that PBT was the standard of care (13%).

The most frequently cited cancer sites indicated for PBT were prostate (87%), head and neck (87%), and pediatric (83%) cancers, and these were consistent with international guidelines.

However, pancreatobiliary (52%), breast (50%), and esophageal (44%) cancers were frequently advertised even though treatment with PBT has not been endorsed for these cancer types in any consensus guidelines.

"Randomized trials in proton radiation are lacking and have proven to be difficult to accrue to," said Corkum. "When one considers the significant additional costs of proton radiation, we believe there should be compelling data to support its use."

He pointed out that there are many examples in oncology where advances on paper or in single-arm studies, such as the dosimetric benefit in proton therapy, "may not pan out to be true benefits to patients."

Next Steps

Corkum commented that the first step is to acknowledge that a problem exists and for healthcare providers to be aware of what information is available to patients.

"Many patients with cancer will turn to the internet for information — however, it is worrisome that these patients may be finding information on hospital/cancer center websites not in keeping with clinical guidelines, particularly when these websites would be seen as more trustworthy than other internet sources," he said.

At the same time, Corkum added, it is important to keep in mind that DTCA by an institution does not necessarily reflect the level of discussion that occurs at the provider/patient level. "But it could potentially be a driver for increasing referral/treatment volumes to a particular center," he said. "Moving forward, we believe more can be done to standardize the messages patients are receiving."

Corkum has disclosed no relevant financial relationships. Coauthor Alexander V. Louie has disclosed a consulting or advisory role for Astrazeneca.

2019 American Society of Clinical Oncology (ASCO) Annual Meeting: Abstract 6599. Presented June 1, 2019.

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