Direct-to-consumer advertising in oncology: A content analysis of print media

Abstract

6034 Background: Direct-to-consumer advertising (DTCA) is an increasingly prevalent and contentious medium of medical communication. Content analysis of cancer-related DTCA, with a focus on how benefit and risk/side effect information is presented, is essential to understanding its potential effect on oncology outcomes. Methods: We reviewed all product-specific DTCA for oncology-related medications appearing in the patient-focused cancer magazines CURE, Coping with Cancer, and MAMM: Women, Cancer and Community during 2005. We assessed the Flesch reading ease score (FRES), calculated with the formula [206.835 - (1.015 x average sentence length) - (84.6 x average syllables per word)], for the benefit and risk/side effect information presented in each advertisement. Ranging from 0 to 100, a FRES of 65 or higher is considered understandable for the average person. We also assessed the largest type size (in mm) and the placement (first, middle or final third of text) of benefits and risks/side effects, as well as the ads’ use of appeals to clinical trial data, cost, celebrity endorsement, physician endorsement, and implied patient testimonials (visual and written). Results: Of 75 ads reviewed, many were repeated, such that 15 unique ads were analyzed. The mean FRES for benefit information was 40.64, while the mean FRES for risks/side effects was 32.30, a difference of 8.34 [95% CI: 1.16, 15.52]. The mean largest benefit type size was 7.10 mm, while the mean largest risk/side effect type size was 2.33 mm, a difference of 4.77 mm [95% CI: 2.35, 7.17]. No ads mentioned cost, and none contained a celebrity or physician endorsement. 53% referenced clinical trials, and 60% offered an implied patient testimonial. In their first third of text, 93% presented benefits; 13% presented risks/side effects. In their final third of text, 27% presented benefits; 93% presented risks/side effects. Conclusion: Oncology print DTCA is difficult to read, as assessed by a standard readability measure. Moreover, compared to risks/side effects, benefits are presented in a larger typeface, earlier in the text, and in language that is modestly easier to read. Oncology providers should be aware of such differences, as they may influence patients’ perceptions of cancer-related medications. No significant financial relationships to disclose.