Progress in Cancer Care: The Hope and The Hype

You read that a new treatment offers significant advantage over standard therapies, and you think, "Fabulous!" Later you learn that the improvement is minimal. Huh? How did the gap between reality and perception grow so large?

In an article in the Journal of Clinical Oncology, Dr. Leonard B. Saltz explains:

"One important, and correctable, reason is a widely accepted use of terminology that inadvertently facilitates, and at times even encourages, an overly optimistic interpretation of stated results." One example is the use of the word 'significant.'"

If told a new treatment offers a "significant" survival advantage, you would understandably conclude the treatment yields a much longer survival. Actually, "significant' is a statistical term relating to the validity of the conclusion and not how great or small the improvement was. So a new treatment with a "significant" survival advantage may extend survival by a median of 6 weeks.

Saltz says, "The more precise term to use would have been a "statistically significant" survival advantage. By allowing the omission of the clarifying adverb, we at best permit, and at worst tacitly encourage, the assumption that "significant" is synonymous with "substantial." So my first recommendation for improved clarity in communication is that we not accept the unmodified word 'significant' when describing an advance in cancer care, but rather should require an appropriate modifier, such as 'statistically' significant..."

Healthy Survivors find out what is meant by "significant" improvement before making decisions.

Comments

[Finn]

Excellent point!

Another aspect of hype is all the ads and articles about "breakthroughs" when a new anticancer drug hits the market. Sometimes the new drug is substantially better than the old one, sometimes it's only marginally better or only better for a subset of the population, and sometimes if you dig through the journal articles you discover that the fabulous new drug that costs thousands of dollars per month only conveys a 2-3 month survival advantage over the older, cheaper drug. I think healthy survivors need to know costs as well as efficacy, especially if they don't have insurance or have percentage co-pays.

[susan]

Thanks for an important clarification. It helps interested parties trying to understand new information so they can manage their expectations--an important aspect in any recovery process.

[Felicity Lenes]

This is a point my professor in pre-medical biostatistics took extra trouble to point out, but I had not really remembered until reading this, Dr. Harpham. Thanks for the reminder: clarifying terms like this is a responsibility of the medical profession that I intend to take seriously.

[Debby]

You're always on target with pertinent information and helping cancer patients, survivors, journalists, scientists and others to communicate succinctly and realistically.