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KentuckyOne rebuffs ethics panel on cancer ad

Andrew Wolfson
@adwolfson

The giant banner across Jackson Street in the heart of Louisville's medical center offers hope for victims of a dreaded disease.

"FIGHT CANCER with 5 or fewer TREATMENTS," it proclaims.

In much smaller type, it adds that the treatment is through the James Graham Brown Center's "CyberKnife," a procedure that delivers large doses of radiation very accurately to tumors.

The CyberKnife, one of several brands of stereotactic radiosurgery, does allow treatment in five visits or less, according to the National Institutes of Health — but only for small, isolated tumors.

And for that reason, the University of Louisville Hospital's ethics committee May 20 voted unanimously to ask KentuckyOne Health, which runs the cancer center and the hospital, to take the banner down or revise it to provide more context.

"It is false and misleading advertising," said Dr. Larry Florman, a plastic and reconstructive surgeon who sits on the committee, whose members include doctors, nurses and clergy.

In an email to KentuckyOne Health "strongly advising" that the banner be removed or altered, the committee said cancer patients receiving conventional therapy had questioned why their treatment required more than five sessions, or why they could not receive CyberKnife treatments.

Florman said a friend's mother, being driven to her 34th conventional radiation treatment, went "ballistic" on seeing the banner and demanded to see "the CyberKnife doctor," only to be told her cancer couldn't be treated with it.

"It's almost like a scam," Florman said.

But KentuckyOne, which began managing most of U of L Hospital in 2012, has refused to budge.

Spokesman David McArthur said that after consulting with the chairman of the U of L department of radiation oncology and examining clinical results, "We decided that keeping the banner in place is appropriate."

He said CyberKnife can fight cancer with five or fewer treatments, and that in nearly three years, all patients treated with it at the cancer center have received one to five treatments. More than half were treated for metastatic cancer — cancer that had spread.

"We share the committee's desire to ensure patients are able to make informed choices about where to seek treatment and we are proud of the success of CyberKnife for our patients," McArthur said in an email, adding that the radiation oncology team will provide more details about the "proven benefits of CyberKnife" at the ethics committee's meeting Wednesday. From October 2012 through April 2015, 522 patients have been treated with it, McArthur said.

He said that "in the spirit of collaboration, we are looking for additional ways to ensure potential patients have the appropriate information to understand if CyberKnife is the right treatment for them."

But leading medical ethicist Arthur Caplan, to whom the American Society of Radiation Oncology referred questions about the ad, said that the committee has got it right.

"The notion of five treatments is false and even cruel to those with other cancers," said Caplan, a bioethics professor and director of the Division of Medical Ethics at New York University Medical School.

Dr. Anthony Zietman, associate director of the Harvard Radiation Oncology residence program at Boston's Massachusetts General Hospital, said the banner is accurate but misleading as well.

"For the right person, it is great treatment, but the banner implies it is for everyone," said Zietman, who adds that fewer than 20 percent of cancer patients are eligible for treatment with stereotactic radiosurgery at his hospital.

He also said the banner falsely implies that CyberKnife can cure cancer.

"Ethically, this is quite fascinating," Zietman said. "Their motive is to suck people in."

KentuckyOne Health is a unit of Catholic Health Initiatives, a Denver-based not-for-profit hospital chain that says its mission is to "nurture the healing ministry of the Church," emphasizing "human dignity and social justice as we create healthier communities."

Accuray, a Sunnyvale, Calif., company that makes the CyberKnife, says the therapy is non-invasive and painless, allowing patients to spend less time and stress on cancer treatment and "more time living your life to the fullest." It also says the CyberKnife system has a strong record of proven clinical effectiveness.

By minimizing the dose of radiation to organs adjacent to the target tumor, the technology allows a high dose to be delivered to the tumor, thus potentially increasing the efficacy of radiation treatment, according to the American Cancer Society.

The U.S. Food and Drug Administration in 2001 approved the CyberKnife system for use in any organ, including the prostate, lung, brain, spine, liver, pancreas and kidney.

But NIH says on its website that stereotactic radiosurgery can be used in the brain only to treat "small tumors with well-defined edges," and in other organs to treat only small, isolated tumors.

The U of L Hospital ethics committee traditionally has reviewed issues of patient care, but its chairman, Dr. Mark Boswell, the head of U of L's anesthesiology department, said KentuckyOne Health has supported expanding its scope to include advising the company on organizational ethics.

In its May 20 email, a copy of which was provided to The Courier-Journal, the committee says that "although CyberKnife treatments appear quite effective for certain types of cancer, it is not appropriate for all types of cancer."

The committee said the ad — which hangs from a pedestrian bridge connecting the hospital to the U of L ambulatory care building — is of "particular and immediate concern in terms of its effects on patients, family members and clinicians."

"The Ethics Committee strongly advises that the sign be removed or revised as soon as possible," its email said.

Reporter Andrew Wolfson can be reached at (502) 582-7189