Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Article
  • Clinical Research
  • Published:

Exposure to direct-to-consumer advertising is associated with overestimation of benefits regarding ultrahypofractionated radiation therapy for prostate cancer

Prostate Cancer and Prostatic Diseases volume 23, pages 670–679 (2020)Cite this article

Subjects

Abstract

Background

While direct-to-consumer (DTC) medical advertising can provide useful information, it also risks oversimplification and being misleading. For an abbreviated prostate cancer treatment regimen called “ultrahypofractionation” (UHF), advertising has been used for CyberKnife (CK), a common delivery system for stereotactic body radiation therapy. We hypothesized that those viewing an advertisement for CK versus factual information would have inaccurate impressions of effectiveness and safety.

Methods

400 men aged 40–80 were randomly assigned to one of four arms: a de-identified CK advertisement, the same advertisement with disclaimers, scientific information obtained from review of contemporary peer-reviewed literature, and a control. Subjects answered questions regarding risks/benefits of CK and likelihood of pursuing CK versus other treatments. Regression analysis was performed to determine factors associated with CK preference.

Results

400 men were included. Compared to controls, those who viewed any of the three interventions were more likely to pursue CK over other treatments (p < 0.01), with a greater increase in the advertisement groups. Respondents who viewed scientific information were less likely to agree CK is superior regarding impotence and urinary dysfunction. Disclaimers decreased positive impressions of CK’s side effects, but not effectiveness. Both advertisement and advertisement with disclaimer respondents were more likely to consider CK superior.

Conclusions

DTC medical advertisements can be misleading and impact laypersons’ impressions. In this case, viewing an advertisement created inaccurate impressions regarding effectiveness and safety of UHF for prostate cancer.

This is a preview of subscription content, access via your institution

Access options

Buy this article

  • Purchase on Springer Link
  • Instant access to full article PDF
Buy now

Prices may be subject to local taxes which are calculated during checkout

Fig. 1: Experimental conditions subjects were exposed to in each group before the survey.
Fig. 2: Proportion of respondents indicating CyberKnife as preferred treatment.
Fig. 3: Belief about CyberKnife risks and benefits reported as the mean selecting “True” to the statements.

Similar content being viewed by others

References

  1. Schwartz LM, Woloshin S. Medical marketing in the United States, 1997–2016. JAMA. 2019;321:80–96.

    Article  Google Scholar 

  2. Schwartz LM, Woloshin S. Cancer center advertising-where hope meets hype. JAMA Intern Med. 2016;176:1068–70.

    Article  Google Scholar 

  3. Vater LB, Donohue JM, Arnold R, White DB, Chu E, Schenker Y. What are cancer centers advertising to the public? A content analysis. Ann Intern Med. 2014;160:813–20.

    Article  Google Scholar 

  4. Corkum MT, Liu W, Palma DA, Bauman GS, Dinniwell RE, Warner A, et al. Online advertising and marketing claims by providers of proton beam therapy: are they guideline-based? Radiat Oncol. 2018;13:43.

    Article  Google Scholar 

  5. Division of Cancer Prevention and Control CfDCaP. https://www.cdc.gov/cancer/prostate/statistics/index.htm. Accessed 29 May 2018.

  6. Dearnaley D, Syndikus I, Mossop H, Khoo V, Birtle A, Bloomfield D, et al. Conventional versus hypofractionated high-dose intensity-modulated radiotherapy for prostate cancer: 5-year outcomes of the randomised, non-inferiority, phase 3 CHHiP trial. Lancet Oncol. 2016;17:1047–60.

    Article  Google Scholar 

  7. Catton CN, Lukka H, Gu CS, Martin JM, Supiot S, Chung PWM, et al. Randomized trial of a hypofractionated radiation regimen for the treatment of localized prostate cancer. J Clin Oncol. 2017;35:1884–90.

    Article  CAS  Google Scholar 

  8. Incrocci L, Wortel RC, Alemayehu WG, Aluwini S, Schimmel E, Krol S, et al. Hypofractionated versus conventionally fractionated radiotherapy for patients with localised prostate cancer (HYPRO): final efficacy results from a randomised, multicentre, open-label, phase 3 trial. Lancet Oncol. 2016;17:1061–9.

    Article  Google Scholar 

  9. Lee WR, Dignam JJ, Amin MB, Bruner DW, Low D, Swanson GP, et al. Randomized phase iii noninferiority study comparing two radiotherapy fractionation schedules in patients with low-risk prostate cancer. J Clin Oncol. 2016;34:2325–32.

    Article  Google Scholar 

  10. Pollack A, Walker G, Horwitz EM, Price R, Feigenberg S, Konski AA, et al. Randomized trial of hypofractionated external-beam radiotherapy for prostate cancer. J Clin Oncol. 2013;31:3860–8.

    Article  Google Scholar 

  11. Morgan SC, Hoffman K, Loblaw DA, Buyyounouski MK, Patton C, Barocas D, et al. Hypofractionated radiation therapy for localized prostate cancer: an ASTRO, ASCO, and AUA evidence-based guideline. J Urol. 2018;8:354–360.

  12. Sanda MG, Cadeddu JA, Kirkby E, Chen RC, Crispino T, Fontanarosa J, et al. Clinically localized prostate cancer: AUA/ASTRO/SUO guideline. Part I: risk stratification, shared decision making, and care options. J Urol. 2018;199:683–90.

    Article  Google Scholar 

  13. Federal Trade Commission. https://www.ftc.gov/news-events/press-releases/1996/03/companies-purport-successfully-treat-cancer-agree-settle-ftc. Accessed 13 March 1996.

  14. Widmark A, Gunnlaugsson A, Beckman L, Thellenberg-Karlsson C, Hoyer M, Lagerlund M, et al. Ultra-hypofractionated versus conventionally fractionated radiotherapy for prostate cancer: 5-year outcomes of the HYPO-RT-PC randomised, non-inferiority, phase 3 trial. Lancet. 2019;394:385–95.

    Article  Google Scholar 

  15. Zimmermann M, Taussky D, Menkarios C, Vigneault E, Beauchemin MC, Bahary JP, et al. Prospective phase II trial of once-weekly hypofractionated radiation therapy for low-risk adenocarcinoma of the prostate: late toxicities and outcomes. Clin Oncol. 2016;28:386–92.

    Article  CAS  Google Scholar 

  16. Jackson WC, Silva J, Hartman HE, Dess RT, Kishan AU, Beeler WH, et al. Stereotactic Body radiation therapy for localized prostate cancer: a systematic review and meta-analysis of over 6000 patients treated on prospective studies. Int J Radiat Oncol Biol Phys. 2019;104:778–89.

    Article  Google Scholar 

  17. Zakaria AS, Dragomir A, Brimo F, Kassouf W, Tanguay S, Aprikian A. Changes in the outcome of prostate biopsies after preventive task force recommendation against prostate-specific antigen screening. BMC Urol. 2018;18:69.

    Article  Google Scholar 

  18. Botejue M, Abbott D, Danella J, Fonshell C, Ginzburg S, Guzzo TJ, et al. Active surveillance as initial management of newly diagnosed prostate cancer: data from the PURC. J Urol. 2019;201:929–36.

    Article  Google Scholar 

  19. Brand DH, Tree AC, Ostler P, van der Voet H, Loblaw A, Chu W, et al. Intensity-modulated fractionated radiotherapy versus stereotactic body radiotherapy for prostate cancer (PACE-B): acute toxicity findings from an international, randomised, open-label, phase 3, non-inferiority trial. Lancet Oncol. 2019;20:1531–43.

    Article  Google Scholar 

  20. Yu JB, Cramer LD, Herrin J, Soulos PR, Potosky AL, Gross CP. Stereotactic body radiation therapy versus intensity-modulated radiation therapy for prostate cancer: comparison of toxicity. J Clin Oncol. 2014;32:1195–201.

    Article  Google Scholar 

  21. Fuller DB. Regarding relative toxicities of stereotactic body radiation therapy versus intensity-modulated radiation therapy for prostate cancer. J Clin Oncol. 2014;32:3455–6.

    Article  Google Scholar 

  22. Dess RT, Hartman HE, Aghdam N, Jackson WC, Soni PD, Abugharib AE, et al. Erectile function after stereotactic body radiotherapy for localized prostate cancer. BJU Int. 2018;121:61–68.

    Article  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Urology, NewYork-Presbyterian Columbia University Medical Center, 161 Fort Washington Avenue, 11th Floor, New York, NY, 10032, USA

    Joseph M. Caputo & Elias S. Hyams

  2. Department of Radiation Oncology, NewYork-Presbyterian Lawrence Hospital, 55 Palmer Avenue, Bronxville, NY, 10708, USA

    Henry J. Lee

  3. Columbia University Business School, 3022 Broadway, Rm 703, New York, NY, 10027, USA

    Bennett Chiles

Authors
  1. Joseph M. Caputo
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Henry J. Lee
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Bennett Chiles
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Elias S. Hyams
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

JMC: study design, writing, revisions, literature search, data analysis, data interpretation; HJL: revisions, data interpretation; BC: study design, revisions, figures, data collection, data analysis, data interpretation; ESH: study design, writing, revisions, literature search, data analysis, data interpretation

Corresponding author

Correspondence to Elias S. Hyams.

Ethics declarations

Conflict of interest

All authors have no conflicts of interest to disclose

Ethical approval

This research project is approved by the Columbia University Medical Center IRB.

Additional information

Publisher’s note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Caputo, J.M., Lee, H.J., Chiles, B. et al. Exposure to direct-to-consumer advertising is associated with overestimation of benefits regarding ultrahypofractionated radiation therapy for prostate cancer. Prostate Cancer Prostatic Dis 23, 670–679 (2020). https://doi.org/10.1038/s41391-020-0234-2

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/s41391-020-0234-2

Search

Advanced search

Quick links