Is Direct-to-Consumer Advertising for Cancer Drugs Beneficial to Patients?
In general, physicians tend to be against direct-to-consumer advertising (DTCA), as is evidenced by the American Medical Association’s call to ban the practice. In a recent opinion viewpoint published in JAMA Oncology, Lowell E. Schnipper, MD, Division of Hematology-Oncology and Cancer Center, Harvard Medical School, and Gregory A. Abel, MD, MPH, Dana-Farber Cancer Institute, Boston, tackle the issue from an oncologist perspective, arguing that DTCA for cancer drugs has the potential to hurt the patient–physician relationship, increase patients’ interest in drugs with potentially underappreciated toxicities, and fail to provide information about less costly treatment alternatives (Schnipper LE, Abel GA. JAMA Oncol. 2016 Aug 11. Epub ahead of print).
Drs Schnipper and Abel examine, as an example, a television advertisement for the PD-1 monoclonal antibody nivolumab (Opdivo), which was approved in 2015 for the treatment of patients with squamous non–small-cell lung cancer. They note, “The text is announced over uplifting music and features people who ostensibly have cancer and their families enjoying excellent quality of life in a beautiful city at sunset. Positive messages about the drug are projected on buildings as patients and families look on. Later, these same people are watching a baseball game, walking a dog in a lovely park, and playing with grandchildren.”
This, they say, leaves out important information, including the percentage of patients who are likely to benefit from this treatment, and information about the cost of treatment. And the advertisement does not show patients who have any side effects from the drug.
“Presenting patients with cancer enjoying excellent quality of life suggests a favorable response for all comers, which may prime patients to have unrealistic expectations that the drug will work even before they discuss it with their oncologist,” say Drs Schnipper and Abel.
They argue that this could affect the patient–physician relationship. When efficacy data are presented in a skewed way through DTCA, oncologists need to correct false impressions during patient visits. “Such confusion requires oncologists to spend valuable patient face time correcting misconceptions rather than counseling about the formidable clinical challenges ahead,” they state.
One survey showed that 86% of patients who were being treated for breast cancer or blood cancer were aware of cancer-related DTCA, and 11% of those patients said this advertising lowered their confidence in their oncologist’s decision-making (Abel GA, et al. J Clin Oncol. 2009;27:4182-4187).
“While physicians generally understand that the performance of a drug in a registration trial is unlikely to be identical to its impact when used in the ‘real world,’ patients are less likely to understand this difference,” Drs Schnipper and Abel point out.
The DTCA is likely not going away any time soon, because it is protected under freedom of speech. Although the FDA currently regulates prescription drug DTCA to ensure that a “fair balance of the risks and benefits of a medication” is presented, these 2 oncologists think that more can be done to mitigate misconceptions. They suggest the use of a “drug facts box” that summarizes the data for each indication of a drug.
The Case for Direct-to-Consumer Advertising
In an opposing opinion viewpoint published at the same time, Crystal Adams, PhD, MPH, Department of Sociology, University of Miami, FL, argues that DTCA of prescription drugs is beneficial to patients and works to inform and improve public health (Adams C. JAMA Oncol. 2016 Aug 11. Epub ahead of print).
“Better-educated patients can make well-informed decisions regarding their own health care,” Dr Adams comments, arguing that DTCA of prescription drugs is responsible for spreading educational information about the drug and the disease. Patients’ educational needs are often overlooked, because physicians are overworked and do not have the time during office visits to fully educate patients about their health problems.
Dr Adams notes that DTCA can provide general education and increase the chances that a patient will seek treatment. This is especially true for minorities, who, according to a 2004 survey, were more motivated than nonminorities to seek treatment after watching DTCA (Robinson AR, et al. Arch Intern Med. 2004;164:427-432).
Although DTCA is often criticized for disease mongering, it frequently promotes healthy lifestyles and patient empowerment, according to Dr Adams. “What has drawn little attention is the degree to which direct-to-consumer drug advertising encourages the adoption of healthy behaviors, fosters a new sense of patient empowerment, and emphasizes personal responsibility for individual health,” she points out.
In addition to educating patients and promoting healthy lifestyle, DTCA has been shown to increase patient involvement in their decision-making, increase treatment compliance, and create a dialogue between the patient and the physician.