Study examines drug industry payments to physicians who establish cancer guidelines.

Abstract

Nine of 10 physicians and researchers who helped to develop leading US cancer care guidelines reported fi nancial ties to the pharmaceutical and medical device industries, according to a study from investigators at the University of North Carolina (UNC) Lineberger Comprehensive Cancer Center in Chapel Hill.1 The study, published in JAMA Oncology, found that of the 125 panelists who worked on setting the National Comprehensive Cancer Network (NCCN) guidelines for lung, breast, prostate, and colorectal cancer, a total of 108 received some form of industry funding. Such funds could include general payments for food, lodging, or speaker fees as well as research funding. The majority of funds were within the limits set by the NCCN to prevent fi nancial confl icts of interest; however, 8 guideline authors' funding exceeded them. Researchers say the fi nding lays the foundation for future studies concerning whether the payments infl uenced the physicians' clinical practices or recommendations made in the guidelines. Because the prevalence of fi nancial relationships was fairly high among physicians who authored these guidelines, it is important to question whether such relationships infl uence their recommendations, says Aaron Mitchell, MD, the study's lead author and a clinical fellow in the division of hematology/oncology at the UNC School of Medicine. Researchers analyzed payments made in 2014 to physicians who helped write the NCCN guidelines, which can infl uence physician practice as well as the recommendations of the Centers for Medicare and Medicaid Services to help determine reimbursement for the off -label use of prescription drugs. The fi nancial limits established by the NCCN for a physician include not more than $20,000 from a single company or $50,000 or more in total. The study found that 8 physicians (6%) exceeded that limit. Coauthor Stacie Dusetzina, PhD, an assistant professor at the UNC Lineberger Comprehensive Cancer Center, says that although it is not a given that industry funding can involve undue in- fl uence, it is important to analyze whether such relationships could aff ect care guidelines. She adds that as more is learned regarding the role of industry payments in shaping prescribing and practice, it is best to encourage transparency. The authors reviewed publicly available data reported through Open Payments, a federal program required by the Patient Protection and Aff ordable Care Act that requires US drug and device manufacturers to disclose fi nancial transfers of more than $10 to physicians and teaching hospitals. They then identifi ed payments to authors who were active on the NCCN guideline panels. The majority of funding (more than 95%) was for research. In 2014, approximately $29 million in research funds were paid to guideline authors versus $1.25 million in general payments such as fees for consulting, meals, and travel. At the same time, approximately 84% of the physicians received general payments whereas 47% received research payments. The authors add that with only 1 year of data available, they may not have the full story.