The frequency of medical reversals in a cross-sectional analysis of high-impact oncology journals, 2009\u20132018

Alyson Haslam,Jennifer Gill,Talal Hilal,Vinay Prasad,Diana Herrera-Perez,Emerson Y. Chen,Myung S. Kim,Tyler Crain

doi:10.1186/s12885-021-08632-8

Abstract

BackgroundIdentifying ineffective practices that have been used in oncology is important in reducing wasted resources and harm. We sought to examine the prevalence of practices that are being used but have been shown in RCTs to be ineffective (medical reversals) in published oncology studies.MethodsWe cross-sectionally analyzed studies published in three high-impact oncology medical journals (2009–2018). We abstracted data relating to the frequency and characterization of medical reversals.ResultsOf the 64 oncology reversals, medications (44%) represented the most common intervention type (39% were targeted). Fourteen (22%) were funded by pharmaceutical/industry only and 56% were funded by an organization other than pharmaceutical/industry. The median number of years that the practice had been in use prior to the reversal study was 9 years (range 1–50 years).ConclusionHere we show that oncology reversals most often involve the administration of medications, have been practiced for years, and are often identified through studies funded by non-industry organizations.

Highlights

Medical reversals, which are practices employed outside of clinical trials that are later found to be no better than a prior or lesser standard of care in a randomized controlled trial (RCT), are present in all medical disciplines [1]
Oncology is an important field to study the phenomenon of medical reversals, because it often includes the care of lethal and feared diseases, where patients and physicians may be willing to engage in treatments without support from prior RCTs, especially for individuals with advanced, metastatic or incurable cancers with few or no satisfactory treatment options [2]
Article inclusion We reviewed all articles published in high impact factor oncology journals during a 10-year period – Lancet Oncology, Journal of Clinical Oncology (JCO), and Journal of the American Medical Association (JAMA) Oncology

Summary

Introduction

Medical reversals, which are practices employed outside of clinical trials that are later found to be no better than a prior or lesser standard of care in a randomized controlled trial (RCT), are present in all medical disciplines [1]. Oncology is an important field to study the phenomenon of medical reversals, because it often includes the care of lethal and feared diseases, where patients and physicians may be willing to engage in treatments without support from prior RCTs, especially for individuals with advanced, metastatic or incurable cancers with few or no satisfactory treatment options [2]. If such practices are later validated, patients have benefit from early access to a promising intervention. We abstracted data relating to the frequency and characterization of medical reversals

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Discussion

Conclusion