Every oncologist has had to straddle the uncomfortable line between offering patients hope and keeping expectations in check. Yet what makes these conversations even more challenging is the pressure to address promotional claims made by doctors’ own institutions. That’s especially the case if patients sought care because they were lured by things like emotional testimonials or advertisements promising access to clinical trials.
Two recent papers are encouraging cancer center executives to rethink how they position their services to potential patients. Although such direct-to-consumers (DTC) advertising has long been a concern since it was legalized in 1985 in the United States, the authors argued that the current competitive environment has led to a surge of ethically questionable practices.
“It’s more important than ever for health care institutions to provide truthful balanced information,” said Fay Hlubocky, PhD, a medical ethicist at the MacLean Center for Clinical Medical Ethics at the University of Chicago Medicine, the Cancer Research Center, and lead author of an article on DTC advertising that was published in the American Society of Clinical Oncology Educational Book.1 “For example, we need to ask if it’s ethical to feature a testimonial in which a patient went on a certain treatment and now 5 years later is running a marathon. Is that really possible for every patient? Is that really realistic?”
Such transparency is crucial during an era when patients are trying to understand the dizzying number of treatment options — some that claim to lead to dramatic recoveries — and clinical trials run by investigators who are eager to recruit them. And Dr Hlubocky said she’s concerned that such hype can lead to false hope for vulnerable patients and their families who spend a lot of time, emotion, and money traveling to brand-name cancer centers to participate in promoted clinical trials they later discover they’re not eligible for. “Although patient education through advertising is appropriate, misleading patients in the name of gaining market share, boosting profits, or even boosting trial accrual is not,” the authors argued in the paper.
They urge cancer center marketing teams to adopt ethical guidelines to ensure fair and balanced promotion of cancer services and institutions’ reputations, including publishing data on rates of treatment success and better defining the patients who would (as well as wouldn’t) meet eligibility criteria to enroll in a trial.
In the second paper, published May 2020 in JCO Oncology Practice, the authors identified ways cancer centers can advertise their institutions. Examples include shining a spotlight on the number of cases their staff treat, the expertise of the doctors, their experience in certain types of cancer, and the excellence of the nurses or social workers at any given center.
“If you’re going to advertise, then advertise factually. If you don’t have good enough facts, then work on improving them,” said lead author Leonard Berry, PhD, who is a professor of marketing at Texas A&M University in College Station.
In cases where there are solid facts to share, he suggests devoting some of the center’s marketing budget to focus on the ways in which the center enhances the experiences of patients and their families. “Improving clinical quality and the overall patient experience sends a message that it’s a culture of service,” he said. “That’s what will come to mind when someone mentions the brand.”
Dr Berry said calling attention to misleading advertising is a conversation that’s long overdue. “It’s something that clinicians and patient advocates have said needed to be said, but no one was saying it. It’s been putting physicians in awkward positions with their patients.”
- Hlubocky FJ, McFarland DF, Spears PA, et al. Direct-to-consumer advertising for cancer centers and institutes: Ethical dilemmas and practical implications. Am Soc of Clin Oncol Educ Book. 2020;40:e207-e217.
- Berry LL, Keiningham T, Aksoy L, Deming KA. When cancer centers mislead prospective patients. JCO Oncol Pract. 2020;16(5):219-222.