Characteristics of NCCN Committee Members: Opportunities for Change

Abstract

The National Comprehensive Cancer Network (NCCN) guidelines are an authoritative resource in cancer management. NCCN guideline committees are composed of multi-specialty teams, representing 30 cancer institutions in the US. In spite of the critical impact of these committees, little is known about its actual members. Our study evaluates the characteristics of NCCN committee members (CMs) and assesses gender and specialty-specific variance.All NCCN management guidelines were evaluated in September 2020. Characteristics of individual CMs were obtained including specialty, gender, academic rank, disease treatment site, h-index, academic degrees, and represented institutions. Chi-square test was utilized for statistical comparisons.A total of 54 NCCN guidelines were identified, along with 1768 panel members. Median committee size was 33 (range 22-38). Medical Oncologists (MO; 47.6%), Surgical Oncologists (SO; 20.9%), and Radiation Oncologists (RO; 8.9%) comprised the largest proportion of CMs. Women accounted for 37.6% of MO, 34.2% of RO, and 22.8% of SO CMs. While women accounted for 39.3% of all CMs, among committee leaders, women constituted only 23% of chairs, and 38.1% of vice-chairs (P < 0.05). Female RO held 1 chair position (compared to 1 male RO), and 9 vice chair positions (compared to 1 male RO). Assistant and Associate professors represented 22.4% and 28.7% of CMs respectively. Full professors accounted for 40.8% of all CMs, and had a higher representation among RO (53.1%) and SO (56.3%), relative to MO (35.3%), P < 0.05. The minority of SO (0.27%) and MO (0.83%) were Instructors; there were no RO Instructors. CMs with H-index > 31 were similarly represented across oncological specialties (RO: 39.2%; MO: 40.8%; SO: 43.3%), but there was a higher prevalence of MO (17.7%) with an H-index between 0-10, in comparison to RO (7.6 %) and SO (8.4), P < 0.05. CMs held MD/MD-equivalent degrees (68.5%), MD-Master's degrees (9.9%), and non-physician degrees (7.1%). MD-PhDs accounted for 15.1% of all CMs, and were more represented among RO (31.0%) relative to MO (14.4%) and SO (7.6%), P < 0.05. Memorial Sloan Kettering (75) and MD Anderson (66) were the most represented institutions; 3 institutions had ≤8 representatives. Among the 158 RO NCCN CMs, many served on gastrointestinal (19.0%), genitourinary (12.7%), and gynecological (12.7%) committees, while few served on pediatric (0.63%), and breast (1.2%) committees. 16 (29.6%) committees had no RO members.NCCN committee members are more likely to be male, MO, full professors, and have high H-index scores. RO on committees generally exhibit high scholarship but have low representation, with almost one-third having no RO members at all. Leadership roles for female oncologists are also limited, although among RO there are more females in committee leadership roles. Increasing specialty and gender diversity on committees may allow for more balanced management perspectives.