Newspaper and magazine reports about cancer appear more likely to discuss aggressive treatment and survival than death, treatment failure or adverse events, and almost none mention end-of-life palliative or hospice care, according to a report in the March 22 issue of Archives of Internal Medicine, one of theJAMA/Archives journals.
The report is one of three in the issue being released early to coincide with a JAMA media briefing on cancer in Washington, D.C. The March issues of Archives of Pediatrics & Adolescent Medicine, Archives of Neurology, Archives of Ophthalmology, Archives of Dermatology, Archives of Surgery, Archives of Facial Plastic Surgeryand Archives of Otolaryngology–Head & Neck Surgery have also published articles on this topic.
It is estimated that one in two men and one in three women will be diagnosed with cancer in their lifetime, according to background information in the article. Of these, approximately half will die of cancer or related complications; more than half a million Americans are expected to die of cancer every year. “These figures have given cancer a prominent place in news reporting,” the authors write.
Jessica Fishman, Ph.D., and colleagues at the University of Pennsylvania, Philadelphia, conducted a content analysis of cancer news reporting between 2005 and 2007 in eight large U.S. newspapers and five national magazines. Of 2,228 cancer-related articles that appeared, a random sample of 436 was selected (312 from newspapers and 124 from magazines). Trained coders determined the proportion of articles devoted to various cancer-related topics.
The articles were most likely to focus on breast cancer (35.1 percent) or prostate cancer (14.9 percent), and 87 (20 percent) discussed cancer in general. A total of 140 (32.1 percent) focused on individuals surviving or being cured of cancer, whereas 33 (7.6 percent) focused on one or more patients who were dying or had died of cancer. Ten articles (2.3 percent) focused on both survival and death.
“It is surprising that few articles discuss death and dying considering that half of all patients diagnosed as having cancer will not survive,” the authors write. “The findings are also surprising given that scientists, media critics and the lay public repeatedly criticize the news for focusing on death.”
In addition, few articles (57, or 13.1 percent) reported that aggressive cancer treatments can fail to extend life or cure the disease, or that some cancers are incurable. Less than one-third of the articles (131, or 30 percent) mentioned adverse events associated with cancer treatments, such as nausea, pain or hair loss.
Most articles (249, or 57.1 percent) discussed aggressive treatments exclusively, but almost none (two, or 0.5 percent) discussed end-of-life care only and only 11 (2.5 percent) discussed both. “For many patients with cancer, it is important to know about palliative and hospice care because this information can help them make decisions that realistically reflect their prognosis and the risks and potential benefits of treatment,” the authors write.
After adjusting for article length, there were no differences between magazine and newspaper articles in regards to any of these factors, the authors note.
“How often should the news media discuss treatment failure, adverse events, end-of-life care and death and dying? Although there is no quantifiable answer, the same educational goals that ideally drive news coverage of cancer treatment and survival should also compel news organizations to address these topics,” the authors conclude. “The media routinely report about aggressive treatment and survival presumably because cancer news coverage is relevant to a large portion of the population, and, for the same reason, similar attention should be devoted to the alternatives.”
Other studies featured in this issue include the following:
Study Evaluates Costs and Benefits Associated With New Colon Cancer Therapies
New chemotherapy agents appear associated with improvements in survival time for patients with metastastic colorectal cancer, but at substantial cost. David H. Howard, Ph.D., and colleagues at Emory University, Atlanta, used a cancer registry database to measure trends in life expectancy and lifetime medical costs in 4,665 patients age 66 and older diagnosed with metastastic colon cancer between 1995 and 2005. Patients were classified according to whether they received one or more of the six chemotherapeutic agents approved for the treatment of metastastic colon cancer between 1996 to 2004.
Among those who received the new agents, life expectancy increased by 6.8 months and lifetime costs increased by $37,100, equating to a cost of $66,200 per year of life gained. After additional adjustments, the cost for each quality-adjusted life year (a year of life in perfect health) gained was $99,100, the authors note.
“New chemotherapeutic agents for colorectal cancer have been singled out as examples of high-cost/low-value medical care; no doubt they are the types of therapies that would receive close scrutiny if Medicare and other payers were to consider cost-effectiveness in coverage decisions,” they write. “Our estimate of the cost per quality-adjusted life year gained, $100,000, is below most estimates of the willingness to pay for a life-year. However, continuation of Medicare’s open-ended coverage policy for new chemotherapeutic agents and other expensive technologies will prove difficult to sustain as costs for the program continue to rise.”
Arch Intern Med. 2010;170
Case Managers Help Low-Income Women Receive More Timely Breast Cancer Diagnosis
Case management appears to be associated with more appropriate follow-up and shorter time to diagnostic resolution among low-income women who receive an abnormal result on a mammogram. Rebecca Lobb, Sc.D., M.P.H., of the Centre for Research on Inner City Health, St. Michael’s Hospital, Toronto, and colleagues studied 2,252 participants in the National Breast and Cervical Cancer Early Detection Program, which funds breast cancer screening and diagnostic services for low-income, underinsured women. Case management was implemented into this program in 2001 to address barriers to follow-up care after abnormal mammograms, and free treatment was introduced in 2004.
Among women enrolled in the program between 1998 and 2007, the proportion experiencing a delay before diagnosis decreased from 33 percent to 23 percent after the implementation of case management, a risk reduction of 45 percent that did not differ by race or ethnicity. However, case management was not associated with changes in treatment delay. In addition, free treatment was not associated with the risk of delays in either diagnosis or treatment beyond the improvement associated with case management.
“Case management to assist women in overcoming logistic and psychosocial barriers to care may improve time to diagnosis among low-income women who receive free breast cancer screening and diagnostic services,” the authors conclude. “Programs that provide services to coordinate care, in addition to free screening and diagnostic tests, may improve population health.”