The Cost of a Word: Radiation Therapy vs Radiotherapy and Public Treatment Preferences

Patient perceptions of radiation treatment may influence acceptance of this therapy, yet the impact of treatment terminology on these perceptions has not been experimentally tested. We aimed to determine whether labeling the treatment as "radiotherapy" versus "radiation therapy" affects treatment choice and psychological perceptions.

We conducted a pre-registered, parallel-group randomized survey experiment on a demographically representative sample of US adults. Participants were randomized to a standardized clinical vignette describing early-stage cancer with two equivalent treatment options: radiation treatment versus surgery. Scenarios were identical except for the terminology used for the radiation treatment option: "radiotherapy" (control) versus "radiation therapy" (experimental). The primary outcome was treatment preference, compared using a chi-square test. Secondary outcomes included anticipated anxiety, safety, and aggressiveness, analyzed using linear mixed models with Holm-Bonferroni adjustment. Robustness of the framing effect was tested using multivariable logistic regression.

Among 1531 participants (mean [SD] age, 46.4 [16.3] years; 51.2% female; 63.0% White), exposure to "radiation therapy" reduced selection of radiation treatment compared with "radiotherapy" (62.6% vs 70.9%; difference, -8.3 percentage points [95% CI, -13.0 to -3.6]; P < .001). This effect persisted after adjustment (adjusted OR, 0.68 [95% CI, 0.54-0.84]; P < .001). "Radiation therapy" was associated with higher anticipated anxiety, lower perceived safety, and greater perceived aggressiveness of the radiation option, with no differences in perceptions of surgery.

In this randomized experiment, a single-word difference in terminology significantly altered stated treatment preference and perceptions of radiation treatment. Terminology may represent a modifiable factor shaping public perceptions of curative therapy.