An analysis of newspaper reports of cancer breakthroughs: hope or hype?

A Media Biopsy: Examining the Quality of Cancer Reporting in Australia, 1997 and 2017

This article investigates the quality of cancer reporting from a time of prosperity to a time of austerity for the press. Australia is a useful case study because of its concentrated press media market that has experienced a decline in the number of newsroom reporters from the 20^th to the 21^st century. We undertake a content analysis of news stories published in 1997 and 2017 about cancer treatments and cancer medical research. Using keyword searching techniques of the news database Factiva, 633 news reports about cancer were detected. Of these, 120 stories met the research criteria. Each story was assessed across eight variables using a coding tool, the Media Quality Index (MQI). The study finds 2017 stories had lower scores (equating to less quality) across all eight variables compared to the 1997 cohort. Of statistical significance, 2017 stories were less likely to quantify the benefits of a proposed intervention, while stories discussing medical research were less comprehensive about research findings. The 2017 stories were less likely to discuss side effects or the potential for harm, and were more sensational, with incongruent headlines compared to content. The empirical evidence pointing to a deterioration in mainstream media reporting about cancer has implications for broader health literacy. It may foster unrealistic patient expectations about clinical practice and treatment options, with public policy implications such as overutilization of health services. The study serves as a reminder to medical practitioners that health communication directly with patients is vital as media reporting alone cannot reliably inform patients about their cancer diagnosis and treatment.

The evaluation of mental disorders research reported in British and Irish newspapers between 2002 and 2013, and a comparison with the relative disease burdens and with research outputs in the two countries

Mental disorders are a major contributor to the disease burden in Europe. We studied how research on them was communicated to British and Irish newspaper readers through an analysis of stories in the Daily Mail (DML) and The Guardian (GDN) in the UK and the Irish Times (IET) in Ireland, in 2002-13, and whether the coverage reflected the relative burdens of mental disorders, or the amount of research, in the two countries. The cited papers were identified through the newspapers' archive or the Factiva database, and their details and those of the research they cited from the Web of Science, with 1,128 stories in total. Alzheimer's and other dementias was the leading UK press research topic, but depression was for Ireland. The countries whose research was most cited were the United States, followed by Canada and Europe, notably the UK and Ireland in their respective newspapers. Over 68% of the Irish research papers cited by IET were supported by the state, compared with only 38% of all Irish mental disorders research. The UK newspapers had many stories on lifestyle factors (DML) or drug treatments (GDN); IET gave more space to epidemiology. The UK papers gave little attention to non-drug treatments. Many stories quoted commentators, who in the UK were often charities, but the IET tended to use academics.

Discursive constructions of youth cancer: findings from creative methods research with healthy young people

PURPOSE

As part of work to understand the experiences of young people who had cancer, we were keen to examine the perspectives of peers who share their social worlds. Our study aimed to examine how cancer in young people, young people with cancer and young cancer survivors are represented through language, metaphor and performance.

METHODS

We generated data using creative activities and focus group discussions with three high school drama classes and used Foucauldian discourse analysis to identify the discursive constructions of youth cancer.

RESULTS

Our analysis identified two prevailing discursive constructions: youth cancer as an inevitable decline towards death and as overwhelming personhood by reducing the young person with cancer to 'cancer victim'.

CONCLUSIONS

If we are to understand life after cancer treatment and how to support young people who have been treated for cancer, we need a sophisticated understanding of the social contexts they return to. Discourses shape the way young people talk and think about youth cancer; cancer as an inevitable decline towards death and as overwhelming personhood is a key discursive construction that young people draw on when a friend discloses cancer.

IMPLICATIONS FOR CANCER SURVIVORS

The way cancer is constructed shapes how friends react to and relate to a young person with cancer. These constructions are likely to shape challenging social dynamics, such as bullying, that many young cancer survivors experience. Awareness of these discursive constructions can better equip young cancer survivors, their family and health professionals negotiate life after cancer.

A standardised, generic, validated approach to stratify the magnitude of clinical benefit that can be anticipated from anti-cancer therapies: the European Society for Medical Oncology Magnitude of Clinical Benefit Scale (ESMO-MCBS)

The value of any new therapeutic strategy or treatment is determined by the magnitude of its clinical benefit balanced against its cost. Evidence for clinical benefit from new treatment options is derived from clinical research, in particular phase III randomised trials, which generate unbiased data regarding the efficacy, benefit and safety of new therapeutic approaches. To date, there is no standard tool for grading the magnitude of clinical benefit of cancer therapies, which may range from trivial (median progression-free survival advantage of only a few weeks) to substantial (improved long-term survival). Indeed, in the absence of a standardised approach for grading the magnitude of clinical benefit, conclusions and recommendations derived from studies are often hotly disputed and very modest incremental advances have often been presented, discussed and promoted as major advances or 'breakthroughs'. Recognising the importance of presenting clear and unbiased statements regarding the magnitude of the clinical benefit from new therapeutic approaches derived from high-quality clinical trials, the European Society for Medical Oncology (ESMO) has developed a validated and reproducible tool to assess the magnitude of clinical benefit for cancer medicines, the ESMO Magnitude of Clinical Benefit Scale (ESMO-MCBS). This tool uses a rational, structured and consistent approach to derive a relative ranking of the magnitude of clinically meaningful benefit that can be expected from a new anti-cancer treatment. The ESMO-MCBS is an important first step to the critical public policy issue of value in cancer care, helping to frame the appropriate use of limited public and personal resources to deliver cost-effective and affordable cancer care. The ESMO-MCBS will be a dynamic tool and its criteria will be revised on a regular basis.

Portrayal of psychiatric genetics in Australian print news media, 1996-2009

OBJECTIVE

To investigate how Australian print news media portray psychiatric genetics.

DESIGN AND SETTING

Content and framing analysis of a structured sample of print news items about psychiatric genetics published in Australian newspapers between 1996 and 2009.

MAIN OUTCOME MEASURES

Identify dominant discourses about aetiology of mental illness, and perceived clinical outcomes and implications of psychiatric genetics research.

RESULTS

We analysed 406 eligible items about the genetics of psychiatric disorders. News coverage of psychiatric genetics has steadily increased since 1996. Items attributing the aetiology of psychiatric disorders to gene-environment interactions (51%) outnumbered items attributing only genetic (30%) or only environmental factors (20%). Of items that referred to heritability of mental illness, frames of genetic determinism (78%) occurred more frequently than probabilistic frames (22%). Of frames related to genetic prophesy, genetic optimism frames (78%) were used more frequently than frames of genetic pessimism (22%). Psychosocial and ethical implications of psychiatric genetics received comparatively relatively little coverage (23%). The analysis identified 22 predictions about psychiatric genetic discoveries and the availability of molecular-based interventions in psychiatry, most of which (20/22, 91%) failed to manifest by the predicted year.

CONCLUSIONS

Excessive optimism about the power of genetic technology in psychiatric health care, perceived clinical benefits, and largely unfulfilled predictions about availability of these benefits could encourage unrealistic expectations about future molecular-based treatment options for mental health.

How is cancer recently portrayed in Canadian newspapers compared to 20 years ago?

This study investigated cancer portrayals in newspapers now and 20 years ago. Six major daily newspapers from regions across Canada were studied. All articles from a 3-month period in 2008 (n = 576) and 1988 or 1989 (n = 412) focusing on cancer were analyzed. Cancer is a more prevalent topic and is depicted in a more positive light in newspapers now when compared to 20 years ago. In 2008, the most common cancer-related themes were cancer research (27%), risk factors (26%), treatment (24%), education/prevention (20%), and fundraising events (19%). Compared to 1988/1989, in 2008, there was a significant decrease in articles covering the end of life and surgery, while there was a significant increase in articles portraying the senior population, male issues, individual stories depicting people suffering from cancer, the health care system, fundraising events, and ethics and law. The percentage of articles on psychosocial aspects of the cancer experience remained the same in 1988/1989 compared with 2008, with 16% of articles covering psychological aspects (vs. 17% in 2008), 5.6% social aspects (vs. 3.9% in 2008), and 0.2% spiritual aspects (vs. 0.5% in 2008). In 2008, few cancer articles spoke in-depth about palliative care (2.8%), issues concerning death and dying (5%), or bereavement (1%). Cancer newspaper reporting mostly focuses on the physical aspects of cancer rather than presenting a more holistic approach including psychosocial issues. Implications of the shifts in tone and content of newspaper reporting are discussed. We highlight the importance of promoting coverage of distress as the sixth vital sign in newspaper press so as to inform readers about the experience of cancer and the existence of psychosocial services designed to optimize quality of life.

Hope, life, and death: a qualitative analysis of dying cancer patients' talk about hope

Although deemed vital to patient well-being, hope in persons who are terminally ill is often thought to be problematic, particularly when centered on cure. As part of a study on end-of-life decision-making, we asked 28 patients with cancer, believed to be within weeks of their death, to talk about hope. Responses were transcribed and discursively analyzed, with 3 versions of hope, each of which connected hope and life, identified--hope as essential to, and for, life; hope, life, death, and others; and, hope/s changing during (or in) life. Hope for cure was common. Rather than death-denying, patients' hope appeared life-affirming, functioning to value patients, their lives, and connections with others.

Media reporting of health interventions: signs of improvement, but major problems persist

Background

Studies have persistently shown deficiencies in medical reporting by the mainstream media. We have been monitoring the accuracy and comprehensiveness of medical news reporting in Australia since mid 2004. This analysis of more than 1200 stories in the Australian media compares different types of media outlets and examines reporting trends over time.

Methods and Findings

Between March 2004 and June 2008 1230 news stories were rated on a national medical news monitoring web site, Media Doctor Australia. These covered a variety of health interventions ranging from drugs, diagnostic tests and surgery to dietary and complementary therapies. Each story was independently assessed by two reviewers using ten criteria. Scores were expressed as percentages of total assessable items deemed satisfactory according to a coding guide. Analysis of variance was used to compare mean scores and Fishers exact test to compare proportions. Trends over time were analysed using un-weighted linear regression analysis. Broadsheet newspapers had the highest average satisfactory scores: 58% (95% CI 56–60%), compared with tabloid newspapers and online news outlets, 48% (95% CI 44–52) and 48% (95% CI 46–50) respectively. The lowest scores were assigned to stories broadcast by human interest/current affairs television programmes (average score 33% (95% CI 28–38)). While there was a non- significant increase in average scores for all outlets, a significant improvement was seen in the online news media: a rise of 5.1% (95%CI 1.32, 8.97; P 0.009). Statistically significant improvements were seen in coverage of the potential harms of interventions, the availability of treatment or diagnostic options, and accurate quantification of benefits.

Conclusion

Although the overall quality of medical reporting in the general media remains poor, this study showed modest improvements in some areas. However, the most striking finding was the continuing very poor coverage of health news by commercial current affairs television programs.

How do the media report cancer research? A study of the UK's BBC website

This study examined cancer research stories on the BBC web archive (July 1998–June 2006). There were about 260 BBC stories per year, of which about 170 were classed as relevant to reports of cancer research. The stories focused heavily on breast cancer, and over one-third of them mentioned this (compared with a cancer disease burden of 13%); the next most covered sites were lung and prostate cancers, although the former was much less mentioned than its cancer disease burden of almost 20% would have suggested. The focus of the stories was often on new or improved drugs or vaccines (20% of stories), with lifestyle choices (12%), genetic developments (9%), and food and drink (8%) also featuring fairly prominently. The BBC stories cited about 1380 research papers that could be identified as journal articles. About three-quarters of the cited papers were in the field of cancer. The papers of these authors came from over 60 countries, and 40% were from the United Kingdom and 36% from the United States. UK cancer research was heavily overcited, by about 6:1, relative to its presence in world oncology research and US research was cited about in proportion. That of most other countries, especially Japan, Germany, and Austria, was relatively undercited. These cited papers also acknowledged more funding bodies. Most of the BBC stories were put in context by external commentators, of whom the large majority was from the UK's cancer research charities.

Media influence on Herceptin subsidization in Australia: application of the rule of rescue?

BACKGROUND

In August 2006, the Australian government announced that Herceptin (Trastuzumab) would be added to the national Pharmaceutical Benefits Scheme (PBS) of government-subsidized drugs, for treatment with adjuvant chemotherapy of HER2 breast cancer. Following initial reticence, the health minister responded to a campaign by patients and patient advocacy groups by announcing PBS subsidization which lowered the cost of a weekly dose from A$1000 to A$30. The cost to the government would be A$470 million over three years for treatment of an estimated 2100 women annually.

DESIGN

We analysed the news frames used in all direct and attributed statements (n=239) in television news coverage of the discourse preceding the Herceptin decision by the Australian government.

SETTING

Five Sydney free-to-air channels between October 2005 and August 2006.

MAIN OUTCOME MEASURES

News frames or themes.

RESULTS

Of five news frames identified, one ('desperate, sick women in double jeopardy because of callous government/incompetent bureaucracy') accounted for 54% of all reported statements. Government financial parsimony was framed as responsible for the women's plight, with drug industry pricing never mentioned. Claimed benefits of Herceptin often conflated cancer non-recurrence and survival and favoured quantification rhetoric which emphasized percentage increases in improvement rather than the more modest increases in absolute survival.

CONCLUSIONS

News frames invoking key tenets of the 'rule of rescue' dominated television discourse on Herceptin. Clinicians, patients, their families and patient advocacy groups invoking the rule of rescue can increase the likelihood of achieving their objective of gaining access to expensive healthcare such as pharmaceuticals. Rational, criteria-based public health policy will find it hard to resist the rule of rescue imperative.

Cancer knowledge and disparities in the information age

Increasing information flow often leads to widening gaps in knowledge between different socioeconomic status (SES) groups as higher SES groups are more likely to acquire this new information at a faster rate than lower SES groups. These gaps in knowledge may offer a partial but robust explanation for differential risk behaviors and health disparities between different social groups. Drawing on the Health Information National Trends Survey (HINTS 2003), a national survey of communication behaviors conducted by the National Cancer Institute (NCI), we examine the relationship between publicity and knowledge gaps on two cancer topics that received different levels of publicity: knowledge about tobacco and sun exposure and their respective links to cancer. Analyses of the HINTS 2003 data suggest that differential knowledge levels of causes of cancer between SES groups are one potential explanation of cancer disparities that have been extensively reported in the literature. It is evident that high income and high education are associated with awareness about causes of major cancers such as lung and skin, and may allow people to protect themselves and minimize their risks. The data also show that heavier media attention could attenuate the knowledge gaps though moderate publicity or lack of news coverage may actually widen them. Last, the findings in this article suggest that it is necessary to take into account the SES variation within different racial and ethnic groups rather than mask them by treating the groups as one.

Science and society: the communications revolution and cancer control

Advances in communications technology, particularly with regards to computer-based media, have opened up exciting possibilities to intervene and influence the trajectory of cancer control, from disease prevention to survivorship, and to reduce the cancer burden. The resulting explosion in cancer information in the mass media and on the Internet, however, also offers challenges in terms of equality in access to information and the ability to act on it, as well as in making sure that it is accurate, readily available and easy to use.

Portrayal of genetic risk for breast cancer in ethnic and non-ethnic newspapers

There has been enormous attention paid to the genetics of breast cancer in this era of genomic medicine. A great deal of the interest has been generated through discourse in the public mass media. However, genetic risk is a probabilistic concept and one that requires adequate numeracy skills. The purpose of this qualitative content analysis was to describe and evaluate the portrayal of genetic risk for breast cancer in mass print media. Mass print newspapers targeting high (Ashkenazi Jews) and low (general Canadian population) genetic risk audiences and published at least monthly, available in English and accessible through public archives at the National Library of Canada, were identified and hand searched for articles on breast cancer. Approximately 47% of breast cancer articles in 6 Jewish newspapers and published between 1996-2000 identified genetics in the title, first or last paragraph compared with 17% of 145 articles in 6 provincial newspapers published in 2000. The description of breast cancer risk was equally problematic in print media targeting high and low risk audiences. Statistics were presented in complex and contradictory ways, with, for example, the confounding of individual and population based risk estimates. Inconsistent messages about the value of genetic screening for breast cancer characterized articles in both ethnic and non-ethnic newspapers. Deciphering the information into a comprehensible form is likely challenging, particularly in light of widespread numeric-literacy limitations. The publication of discrepant research findings and the perplexing statistical information consequently brought into question the credibility of the scientific process and the recommendations of health care professionals.

Ethnicity, genetics, and breast cancer: media portrayal of disease identities

OBJECTIVE

To describe, compare, and analyze how the risk of breast cancer is framed in newspapers directed towards an ethnic minority population (Jewish) with higher risk of inherited breast cancer compared with newspaper coverage for the general population (Anglo-Canadian) without this risk.

DESIGN

This investigation utilized a mixed methods (quantitative and qualitative) approach. The design emphasized a content analysis conducted on ethnically specific and non-ethnic newspaper articles.

RESULTS

It is noteworthy that the 'Jewish' newspapers devote a substantially larger proportion of articles on breast cancer to genetic risk as the key risk factor for this disease. Articles in the Jewish newspapers tend to link being a Jewish woman with being at risk for a diagnosis of breast cancer. This ethnic 'identity' is reinforced through the repeated association of Jewish heritage and genetic breast cancer risk at the exclusion of other known risk factors. This isolated genetic link to breast cancer is not a message that is replicated within the provincial newsprint articles.

CONCLUSIONS

These findings assist in the facilitation of prevention and treatment of those with or at risk of breast cancer. The health policy implications of this portrayal as well as suggestions for change are considered.

Ethics, stem cells and spinal cord repair

Attempted repair of human spinal cord injury by transplantation of stem cells depends on complex biological interactions between the host and graft. Extrapolating results from experimental therapy in animals to humans with spinal cord injury requires great caution. There is great pressure on surgeons to transplant stem cells into humans with spinal cord injury. However, as the efficacy of and exact indications for this therapy are still uncertain, and morbidity (such as rejection or late tumour development) may result, only carefully designed studies based on sound experimental work which attempts to eliminate placebo effects should proceed. Premature application of stem cell transplantation in humans with spinal cord injury should be discouraged.