As Economy Turns, Cancer CentersEmploying Watchful WaitingBY ERIC T. ROSENTHAL

[ A L S O ]Ovarian Cancer: ‘Dark Side’ of IP Chemo in Advanced Disease. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9

DCIS: Big Increase in Use of Prophylactic Mastectomy . . 16

GIST Registry Shows Unexpected Practice Patterns . . . . . 26

ShopTalk . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 54

POETRY by Caregivers: Connie Achord, RN, BC, OCN. . . 56

Misconceptions Keeping Latinas from Timely Breast-Cancer Treatment . . . . . . . . . . . . . . . . . . . . . . . . . . 58

Conferences. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 59

The leaders of a sampling of comprehensive cancer centers of varying

size, structures, and geographic locales tell how they are faring in

the new economic reality. The good news is that so far the recession

appears not to have been a detriment to providing continuing quality

cancer care. Still, none are taking anything for granted, and continue to

take a prudent, “hoping for the best, preparing for the worst” approach.

See Page 28

PERIODICALS

ONCOLOGYTIMES

Years

Publishing for

31

The Oncology & Hematology Source

[ News ✽ Analysis ✽ Commentary ✽ Controversy ]www.oncology-times.comMarch 25, 2009 ✽ Vol. 31 ✽ No. 6

IOM Says RethinkPhase III Trials &NCI CooperativeGroups

p. 35

Joe Simone: ‘EricHoffer’s Profound &Continuing Influenceon Me’

p. 4

Study: Cash-StrappedCancer SurvivorsSkimping on Health Care p. 5

ASCO KRAS-Test GuidelinesAre First of New Way to GiveClinical Advice

p. 41

I’m sure you have opinions about newscoverage of health and medicine. Theyprobably often begin “What?” or “Oh,

no!” or even “(&$%#*+…).”Reporters on the health beat have their

own opinions. Some of those opinionshave been captured in a new report: “TheState of Health Journalism in the U.S.” byGary Schwitzer, Associate Professor atthe University of Minnesota School ofJournalism and Mass Communication.The Kaiser Family Foundation supportedthe report and a survey done with theAssociation of Health Care Journalists(AHCJ).

Health journalists are battered by eco-nomic upheavals in the news business thatrun deeper than the current general finan-cial crisis. Indeed, almost 40% of survey re-spondents say it is at least somewhat likelytheir jobs will be eliminated in the nextthree years. And even while they have theirjobs, they see advertisers, industry, andnaïve managers pushing and pulling theircoverage.

And yet, health journalists see strong de-mand for their stories, most see opportuni-ties in the new Internet platforms they writefor, and above all, they declare a commit-ment to the purpose and possibilities of ourbeat.

Notice that I switched from “their” to“our” in the middle of that sentence. I’mno disinterested observer. Not only have Ibeen working the health beat for morethan two decades, but I have been person-ally involved in the development of thenew survey and the broader work ofAHCJ. I was a Kaiser Media Fellow inHealth for a year. Gary Schwitzer broughtme into the CNN Medical Unit andhelped me figure out the beat.

Those declarations made, let me go intomore detail about the highlights of what Ithink is the most comprehensive snapshotof health journalism to date. The report isbased on survey responses from 256 AHCJmembers out of 813 sent e-mail requests(all are working journalists, not healthcommunicators or media/PR), as well asmore than 50 interviews Schwitzer didwith fellow health journalists and a litera-ture review of more than 100 published re-

search articles by graduate student AmySnow Landa.

First, the Dark SideFirst, the dark side: three out of four re-spondents said journalism is going in thewrong direction. Almost all (94%) agreethat “bottom line pressure in media organi-zations [is] seriously hurting the quality ofnews coverage of health care issues.” Thoseinterviewed gushed tales of frustration andloss. “It was much darker, much more pes-simistic, than what the survey reported,”Schwitzer says.

Things are tough all over in the newsbusiness. Newspapers in particular are hem-orrhaging jobs. But health journalists pointout that even in good times, reporters onour beat confront enormous challenges.

In his report, Schwitzer quotes a post-ing from the AHCJ listserv that he sayscaptured the essence of many comments heheard in interviews: “[E]verything health-related is my territory—the business andscience of health care (hospital battles,growth and politics of our local medicalschool), public policy issues involvingMedicaid and health insurance (we’re inthe state capital), kids-with-rare-diseasesstories, infectious diseases (flu, WestNile, etc.), nursing-home problems, evenpoverty-related issues that affect healthcare, and of course, investigative stories. Iam supervised by two different section ed-itors and write for the Health Page, theMetro Page, the Front Page, our weeklymagazine, and the Business Page.”

And as you try to cover the health carewaterfront, your coworker gets laid off . . .and your editor hands you a shiny newcamera and an editing software manual, soyou can shoot video for the newspaper’sWeb site.

Meanwhile at TV stations, reporterswho are already familiar with the chal-lenges of video production get blog assign-ments for the station Web site that are due before editing the package for the

6 o’clock news.Imagine being asked to devise a

chemotherapy plan for one patient andthen help the next decide whether to gowith CABG, PCI, or medical therapy forcardiac issues, and then explain to thenext patient how to pick a Medicare PartD plan—all while dealing with picking upthe slack after a 30% staff cut in yourmedical group.

Fewer bodies in newsrooms, alongwith consultants urging news outlets topander to short attention spans, is a trou-bling mix.

In his interviews, Schwitzer heard a“wave of comments that almost soundedlike they were coming from the samescript, people using the same terms, of‘cutesy, fluffy, news-you-can-use.’ ‘Newsyou can use’ was thrown at me so manytimes,” he said. “It is such a bad termamong health journalists now. And thequick hits, and the push for stories on stud-ies, not because anyone feels they are im-portant, but because decision-makers feelthat they are easier to do.”

Temptation to Cut CornersThe temptation to cut corners is also high-lighted by Kaiser Family Foundation Vice-President Vicky Rideout, MA, who oversawthis project.

“Greater demand plus fewer resourcesand reporters equals shorter stories, quick-hit stories. It equals more likelihood ofwriting off of a press release without ex-ploring it more, potentially more influ-ence from PR firms, more of a tendencyto want to take a video news release orhave a sponsored news segment, becauseyou have economic problems at a sta-tion,” she said.

While the overwhelming majority ofsurvey respondents said their news organi-zations rarely or never “allow sponsors,other outsiders or advertising/business staffto influence story selection or content,”11% said yes, it does happen sometimes.Like writing prescriptions because of a TVad or pharmaceutical sales call, it’s some-thing that should never, ever be allowed.

“That data point should be a strong cau-tionary note to everyone in journalism andto our audiences, raising questions aboutthe veracity and integrity of what’s beingreported,” Schwitzer said.

Despite these and other problems, de-spite the leaden mood in many newsroomsand the stereotype of the sour and cynicalreporter, the report also notes a passionatecore of optimism and determination onthe health beat. Almost half of the surveyrespondents said the quality of health beatreporting at their news organization actu-ally has been improving in recent yearsand another third say quality is at least

The State of Health JournalismBY ANDREW HOLTZ, MPH

46on

colo

gy ti

mes

•m

arch

25,

200

9

ANDREW HOLTZ, MPH,is a former CNN MedicalCorrespondent and theauthor of The MedicalScience of House, M.D.Send questions to himabout how the mediatreat medical topics orsuggestions for futurecolumns toOT@lwwny.com

ScriptDoctor | Medicine in the Media

continued on page 48

Almost 40% of survey respondents said it is at least somewhat

likely that their jobs willbe eliminated in the next three years.”

Increasing ProfessionalizationRideout said she sees a real sense of in-creasing professionalization of the beat.Indeed, earlier generations of health andmedical journalists had few mentors andno real professional standards to guidetheir reporting; they had to stumble andlearn mostly on their own. Now theAssociation of Health Care Journalists hasalmost reached its teenage years. ItsWeb site displays a Statement of Princi-ples, examples of good work, and guidesto covering tough topics. The active list-serv provides quick feedback and assis-tance for members. At annual and regional

48on

colo

gy ti

mes

•m

arch

25

holding steady.The survey responses tend to paint

a cheerier picture than Schwitzer’s in-terviews. “I do think it’s importantthat we get out of our circle and takea bigger picture look,” Rideout said.That broader view is a key accom-plishment of the report. It goes be-yond a few individual perspectives orthe chitchat among friends at meet-ings or over beers.

➞ S C R I P T D O C T O Rcontinued from page 46 “Despite all the problems, the report also notes a

passionate core of optimism and determination onthe health beat. Almost half of the survey

respondents said the quality of health beat reportingat their news organization actually has been

improving in recent years and another third sayquality is at least holding steady.”

meetings, members connect with col-leagues who can often provide better guid-ance than editors (relatively few of whomever worked the heat beat.)

Of course, as an early member andlong-time board member of AHCJ, I’m bi-ased; yet I think the survey and report of-fer some objective evidence that theorganization is doing the things for whichit was created.

Rideout also mentions HealthNewsReview.org. Inspired by MediaDoctor.or.au in Australia, the site produces reviewsof medical stories. Related to the com-plaints about quick-hit stories, reviews

of the reviews indicate that it is almostimpossible to give readers meaningful con-text and caveats about medical interven-tions in less than 500 words. HealthNewsReview.org is funded by the Foun-dation for Informed Medical DecisionMaking and the publisher is Gary Schwitzer.Small world, eh?

For health care professionals and thepublic, the value of that professionaliza-tion will be tested during coverage of re-newed efforts to restructure health carefinancing and delivery in the US. Wewill see how much of the coverage pro-vides thoughtful insight, and how many

stories merely fan flames set by interestgroups.

I was heartened by responses to surveyquestions about the mix of stories reachingreaders and audiences. Overall, these healthjournalists said there are too many lifestylefeatures. And most said there is aboutthe right amount of coverage of medicalresearch.

Want More Stories about Policy IssuesWhat really caught my eye is that morethan two-thirds of the respondents said weneed more stories about the business and

49oncology tim

es•

march 25

politics of health care; more coverageof health care quality and perfor-mance; and more stories about dis-parities, policy, and global health.

Instead of seeing those responsesas merely documenting dissatisfac-tion with our performance, I seethis thirst for more coverage ofpolicy issues as a welcome recogni-tion by health beat reporters of theimportance of these issues. More of us are no longer satisfied with re-gurgitating lead articles from theNew England Journal of Medicine or

continued on page 50

the Journal of the American MedicalAssociation. That’s a welcome sign ofprogress.

But right now, the overriding concernof health beat journalists is survival.

“No question, the news business is goingto go through some kind of really monu-mental transformation, my guess is, overthe next two to five or six years,” Rideoutsaid. “How do we protect health journal-ism through that period, so that people stillhave access to good quality health policyand other types of health reporting? Andhow do we protect the integrity of it inwhatever the new news environment is that emerges at the end of this transitionprocess?”

In future columns, I’ll write more aboutsome of the attempts to preserve and pro-tect good quality journalism in general andhealth reporting in particular.

I’ll close with a bit of rabble rousing.As the survey and report document,health journalists are being pressed bytight budgets to do more stories withless research. Marketing consultants aretelling managers that the public wantsshorter and shorter news briefs with an emphasis on light lifestyle features.Business owners want to provide whatcustomers want to buy. They will sup-port health journalists only as long asthey think their customers care. If you,like many health journalists, want to seemore stories with context and back-ground and a recognition of the largerpolicy and financing environment ofhealth care: speak up. O

T

50on

colo

gy ti

mes

•m

arch

25

➞ S C R I P T D O C T O Rcontinued from page 49

“Right now, theoverriding concern

of health beat journalists is

survival.”

OTBroadcast

NewsListen at oncology-times.com

Subscribe on iTunes

✽ In Brief | New Web Site for MelanomaPatients & Caregivers

The Aim at Melanoma Foundation

has created AimatMelanoma.org,

for melanoma patients and their

caregivers. The site is designed as

a “one-stop resource center,” offering

breaking news on melanoma re-

search; prevention and early detec-

tion guides; a free on-call oncology

nurse who can be contacted by email

or phone; a virtual support network of

melanoma patients, survivors, and

caregivers; resource links for patient

and caregiver support; and a clinical

trial matching and referral service.

The site also has links to opportuni-

ties for volunteering and advocacy, and

a memorial wall to remember those

who have lost loved ones to the disease.

www.oncology-times.com

➚