Financial conflicts in cancer care top 50% across US oncology, review finds

A Yale-led review of financial conflicts in cancer care found industry ties at most major points in U.S. oncology, from clinical trials to treatment recommendations. The findings matter because cancer care costs more than $200 billion a year in the United States, according to Yale University, and financial relationships can affect how evidence is produced and used.

The systematic review, published in JNCI: Journal of the National Cancer Institute, was led by Cary Gross, MD, a professor of medicine at Yale School of Medicine, with Colin J. Kim of Yale College and Lily Wadel of Yale School of Medicine. Gross has studied financial conflicts in U.S. medicine for more than two decades, according to Yale.

What are financial conflicts in cancer care?

Financial conflicts of interest occur when a doctor, researcher or institution has a financial relationship that could influence research, medical advice or reporting, according to Gross. Examples cited by Yale include consulting payments, industry-funded trials and royalties tied to a product being studied.

Gross said such ties can weaken public confidence and may affect patient care. Yale cited studies finding that doctors with financial relationships involving a drug are more likely to prescribe that drug, and Gross said recent data indicate U.S. physicians receive about $1 billion a year from industry.

What the review found

The Yale team reviewed 36 studies covering six parts of the cancer system: clinical trials, U.S. Food and Drug Administration advisory meetings, academic medical leaders, patient advocacy groups, clinical guideline writers and practicing oncologists. The review found that financial conflicts were above 50% in nearly every area examined, according to Yale.

• Industry sponsorship appeared in 69% of cancer clinical trials, the review found.
• Industry payments went to 61% of practicing oncologists, according to the study.
• Some studies found financial ties among academic medical leaders and guideline authors reaching 100%.

Gross said commercial funding is now woven into cancer research and treatment. Pharmaceutical, device, diagnostics and health technology companies help develop treatments, support trials and fund professional education, but those relationships can also influence what gets studied, how studies are designed and how results are presented, according to Yale.

The issue is especially sensitive in oncology, Gross said, because many cancer drugs are costly, treatment choices can be complicated and the evidence available to doctors is sometimes limited. Small shifts in judgment can affect which treatments clinicians recommend and which options patients receive, he said.

How financial ties may affect cancer evidence

Gross said studies in medicine, including oncology research, have linked financial conflicts to research findings and later clinical behavior. A previous study by his team found industry-connected studies were more likely to report results favorable to industry, according to Yale.

Other research cited by Gross has associated financial ties with biased study design, differences in publication and reporting, greater use of brand-name drugs, quicker adoption of new products and, in some cases, treatment choices that do not align as closely with guidelines. Gross said those patterns can raise costs without improving quality.

Gross said the goal is not to cut off collaboration with companies, because cancer research depends in part on industry work. He called for stronger safeguards against undue influence, visible management of competing interests and continued federal support for medical research, including National Institutes of Health funding.

The study is titled “Prevalence of industry ties in the US cancer ecosystem: a systematic review and meta-analysis.” Its DOI is 10.1093/jnci/djag175.

This story draws on original reporting from Medical Xpress.