More than 85% of 125 authors of guidelines published by the National Comprehensive Cancer Network reported financial conflicts of interest (FCOI) at the end of 2014, according to newly published research.
Using information in the Centers for Medicare & Medicaid Services’ Open Payments database, researchers found that authors received on average $10,011 in general payments for consulting, meals, lodging, and similar transfers of value. Authors also received on average $236,066 in industry research payments, including funding associated with clinical trials. Approximately 84% of authors received general payments, while 47% received research payments.
“Our study demonstrates the high prevalence and significant monetary value of FCOIs among oncologist guideline authors,” Aaron Mitchell, MD, of the University of North Carolina at Chapel Hill, and colleagues, said in a study published online in JAMA Oncology (2016 Aug. 25. doi: 10.1001/jamaoncol.2016.2710).
However, study authors note that, in regards to research funding, “accepting research funding is all but mandatory for an academic clinical trialist.”
The overall impact of the financial conflicts of interest is not known, though. “More research is needed to determine which kinds of relationships are more likely to produce the unwanted consequences of physician bias to create rational, evidence-based policies that allow for the participation of key clinical experts while managing real or perceived conflicts,” Dr. Mitchell and his colleagues said. “Given the prevalence of FCOIs reported here, finding the answer to this question is critical.”
The need for more research was echoed in a separate commentary published the same day in JAMA Oncology.
“While these relationships are often necessary to bring advancements to the field, further research is needed to better understand the consequences of FCOIs (both positive and negative) and how best to manage and report FCOIs in both research and clinical practice,” Ryan Nipp, MD, and Beverly Moy, MD, both of Massachusetts General Hospital Cancer Center, Boston, write in their commentary (2016 Aug. 25. doi: 10.1001/jamaoncol.2016.2726).
“Clearly, FCOI policies should include accessible and transparent rules for management and enforcement of FCOIs, and this creates an urgent need for evidence to inform these policies,” they continue, suggesting the oncology community is more concerned with stock ownership and participation in speaker bureaus than with meals or uncompensated consulting.
“Therefore, policies regarding FCOI disclosure may need to go beyond just disclosing every industry relationship and should consider the relative harm or importance of the FCOI.”
The authors reported no relevant conflicts of interest.
Too much disclosure information at ASCO
A change in disclosure policy at the American Society of Clinical Oncology from relevant to all financial conflicts of interest has resulted in an increased amount of disclosed FCOIs and information overload.
Researchers examining 469 presentations given by 458 speakers in 2014 and 2015 ASCO annual meetings saw an increase in the number of speakers with at least one conflict of interest from 124 of 242 in 2014 to 151 of 216 in 2015. The median number of disclosures increased from one to three during that same time. The amount of disclosures that was considered “information overload” measured as the amount of words on a presentation slide without enough time to read/comprehend the information grew from 37 of 248 presentations (14.9%) to 83 of 221 (37.6%).
“Our findings raise concern about whether current disclosure protocols constitute meaningful disclosure,” Aaron Boothby of the Oregon Health & Science University, Portland, and colleagues wrote in a research letter published Aug. 25 in JAMA Oncology (2016 Aug. 25. doi: 10.1001/jamaoncol.2016.2706).
“The solution would be to extend the time of the disclosure slide so that no slide exceeds established limits of reading speed,” the authors recommend. “Further investigation is needed on audience ability to process COI slides at professional meetings if disclosure is the major objective,” they said.
The authors reported no conflicts of interest.