Aug 4, 2020
Dr. Fay Hlubocky, a clinical psychologist and ethicist at the University of Chicago Medicine Comprehensive Cancer Center, discusses ethical dilemmas associated with direct-to-consumer-advertising in the cancer setting and shares guidance on promoting ethical marketing of services to patients.
Transcript
ASCO Daily News: Welcome to the ASCO Daily News podcast. I'm Geraldine Carroll, a reporter for the ASCO Daily News. I'm delighted to welcome Dr. Fay Hlubocky to the podcast today. Dr. Hlubocky is a clinical psychologist and ethicist at the University of Chicago Medicine Comprehensive Cancer Center, and the past chair of the ASCO Ethics Committee. She joins me today to discuss ethical dilemmas associated with direct-to-consumer- advertising in the cancer setting, and efforts to promote ethical, quality marketing information to patients with cancer. Dr. Hlubocky reports no conflicts of interest relating to the issues we'll discuss in the podcast. Full disclosures can be found on our episode pages. Dr. Hlubocky, it's great to have you on the podcast today.
Dr. Fay Hlubocky: Thank you, Geraldine, for your
lovely invitation, and wonderful to join you and all our ASCO
friends out there to discuss this important issue.
ASCO Daily News: This year, spending on
advertising by pharma companies, hospitals, and cancer centers
directly to consumers is projected to reach $173 billion according
to the Agency for Healthcare Research and Quality. That's about
three times more than was spent on advertising 20 years ago.
Patients with cancer, as we know, are a very vulnerable patient
population. So as an ethicist, what are your biggest concerns about
direct-to-consumer advertising in the cancer setting?
Dr. Fay Hlubocky: As an ethicist, our concern is
that we are promoting balanced and fair data-based information to
patients and their families. However, we're also very concerned
that this marketing is used as a powerful tool that can entice
patients in such a way to seek out treatment that might not be
appropriate for them. The psychology of advertisements very much
works on people's emotions, especially in the cancer setting, with
the vulnerable cancer patient that tends to have hope, and is also
fearful because of his/her disease.
So these ads work very powerfully because they're very relevant to
the patient. As well, that content of the ad, particularly if it's
visual ad or an auditory, by their words, by phrases, can be very
persuasive. So we really have to balance this marketing
information.
Again, as many have described, including cancer center directors,
the goal of marketing is to increase the market share for many
cancer center advertising. And now that there's a shortage of
patients seeking treatment, especially clinical trials, there is
this boom, this increase in marketing. So our goal in the community
is to have an open dialogue with the cancer centers, with pharma,
with all of us, to be able to truly and really talk about this
issue and provide balanced, honest, fair information for patients
and their families.
ASCO Daily News: Well, direct-to-consumer
advertising really is a controversial issue, but are there benefits
to it in the oncology field? Does the research show that
direct-to-consumer advertising truly improves access to care and
clinical trials?
Dr. Fay Hlubocky: So there are several advantages.
It's actually a great mechanism to be able to inform and educate
and bring awareness to the patient and family who might be seeking,
say, clinical trials or other treatments that aren't close to home.
We know that it can help to not necessarily, "improve the care"
directly, but definitely, there has been a great deal of research
by, for example, Vater et al., in 2014, that it does-- a
benefit is that it does increase access to, say, clinical trials.
But that said, because there is such a shortage of patients going
into, say, trials, we have to be very careful that that clinical
trial is also not just a tool, a mechanism, to invite cancer
patients in that might not be appropriate for such trials.
So there are advantages. We are able to engage clinicians with the
use of these tools, either through billboard, social media, to
engage clinicians who might not be aware of new medications, say,
new trials out there. Patients are also alerted to cancer symptoms
through some of these ads, so might be more willing to go to a
physician to say, 'I have this symptom,' and through testing, may
find out that it is a cancer or where that cancer may have spread
or originated. And so there are true advantages. Education is
key.
But we have to be also wary of the cons. Many ads are not
data-driven. They may not mention the negative outcome of the
particular treatment. Patients may actually have to access more
tests and use a lot more tests. False hope-- patients actually
might be very hopeful when they see this advertisement but then,
come in, become very anxious and upset because that specific ad and
that specific treatment or service might not fit that specific
cancer patient's needs.
And the use of patient testimonial-- again, another powerful tool
in that tool box, where patients could be misled, where these ads
do not mention, the patient eligibility, say, for trials? So within
these testimonials, again, the visuals and that relevancy to the
patient can be quite enticing and very persuasive. That may cause
the patient to then travel long distances, spend a lot of money on
travel and housing.
So we really have to balance this advertising, which, now, 56% of
is actually through social media, web-based platforms, internet,
TV, as well as print. Just even driving down the expressway on a
billboard, we see these ads. So again, although there are
significant benefits, we also have to be cautious of the
significant cons and disadvantages.
ASCO Daily News: Right. And so what's at
stake for oncologists who have a responsibility to educate their
patients and provide the best possible care while also supporting
the business interests of their institutions and managing the
influence of other parties?
Dr. Fay Hlubocky: So oncologists are placed at a
unique position. First and foremost, their obligation has to be to
the patient to provide patient-centered, quality care. So of course
as patients will, say, come to the cancer center, it's vital to be
able to talk about whether or not that cancer treatment or the
service that they are seeking is ideal for them, to truly talk
about the data that's associated with it, the risks and
benefits.
As I mentioned, in the study by Vater, and there have been many
studies, that really looked at the information on risks and
benefits; how these ads tend to infrequently provide that
information. So really going through that in an informed consent
discussion, a very rigorous informed consent discussion, to
describe the purpose, the risks and the benefits, as well as the
alternatives -- it's very, very vital, whether it's a physician
where the patient is seeking treatment or maybe even the patient's
physician, say, in the community who's seeking out this
information, to really truly sit down with the patient and the
family member and go through, step by step, why this treatment or
trial is right or not right for them. So in that aspect, the
obligation is always to the patient.
The challenge is, of course, for many, that the cancer center is
the place of business, the place where physicians are employed. As
well, the oncologist has an obligation to provide the appropriate
information on the treatments provided by their cancer center to
patients, to work and collaborate with the cancer center to be able
to communicate this information, and actually work with cancer
leadership, actually, in using these tools.
So that, as I think of the future direction, it is for the
oncologist to work with marketing to really convey the right
information, work with the cancer center so that that information
is balanced, it's fair, it's appropriate, it's ethical, that the
entire community feels that the right information is being
provided.
ASCO Daily News: Are there resources out there for
oncologists and patients to verify information, to verify whether
the information they're hearing is accurate about treatments, about
drugs, medical devices, et cetera?
Dr. Fay Hlubocky: We know the NCI has a great
reputation; has a wealth of information on their website when it
comes to, say, trials or treatments. And also, the cancer center, I
think, can be a fabulous resource in that aspect, to really educate
them, the patient, as consumer. But again, balancing it with that
information by talking about potential risks, talking specifically
about the data that was presented, and patient eligibility-- I
think that's the only, appropriate way that we will feel confident
in conveying the importance of this information to our
patients.
ASCO Daily News: So how do you foresee the future
direction of direct-to-consumer advertising in the cancer setting?
And perhaps you'd also like to talk about the article that you've
published in the Educational Book and any other work you're doing
in this area?
Dr. Fay Hlubocky: Yes. It's our hope that cancer
centers and the cancer community will adopt ethical guidelines that
can help the cancer center. Because truly, what is the best
mechanisms for advertising and marketing-- it has to really be
uniform.
So for us to truly adopt policies, uniform policies, that all
cancer centers can utilize is the most ideal. And we discuss this,
actually, in our article on the ethical implications of a cancer
center advertising for the ASCO20 Education Program in August. And
we really did quite an in-depth review of the literature out there
on, what are some of the issues that cancer centers need to
address?
And again, it's also even the physician communication. Physicians
have to feel empowered by their cancer centers to be able to talk
about these issues, and talk about it both with the patient, as
well, more broadly, for us to have greater discussions. And that's
actually a wonderful thing that we've been able to do with ASCO.
And we're so grateful to ASCO leadership on the Education Committee
that they have allowed us a platform to have an open dialogue so
that the cancer center, physicians, patients, all of us within the
community, can have an open dialogue on how to best market cancer
center services and treatments to patients and families as a whole.
So that's part of the future.
Part of the future, I think, will be also an increase in some of
these advertisements through social media, which tends to be the
primary source of a lot of these ads. As well, future research
needs to really look at the link between these ads and patients'
expectations for benefits. So how are these ads really, truly
influencing patients' decision-making? And I think with that
information, more longitudinal information, more rigorous testing
and research through patient interviews and really following the
patient experience -- it's our only way to identify what type of
harms, what types of benefits are patients experiencing from that?
But we can only do this together as a community and a partnership
as a whole within oncology.
ASCO Daily News: Absolutely. I'm afraid we'll have
to wrap things up now. But I thank you for sharing your insights
and your work to address this important and controversial
issue.
Dr. Fay Hlubocky: Thank you. Thank you so much,
Geraldine. And thank you to all the listeners out there.
ASCO Daily News: And I'll just remind our
listeners that they can find the article in the Educational Book,
entitled "Direct-to-Consumer Advertising for Cancer Centers and
Institutes: Ethical Dilemmas and Practical Implications."
Dr. Fay Hlubocky: Thank you, Geraldine. Thank you, everyone.
ASCO Daily News: And thank you to our listeners
for joining us today for this episode of the ASCO Daily News
podcast. If you're enjoying the content on the podcast, please take
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Disclaimer:
The purpose of this podcast is to educate and to inform. This is
not a substitute for professional medical care, and is not intended
for use in the diagnosis or treatment of individual conditions.
Guests on this podcast express their own opinions, experience, and
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COI Disclosure:
Dr. Fay Hlubocky - No Relationships to Disclose