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Yi Y, Lam TYT. How close are we from achieving demographic diversity in clinical trials? Insights from Singapore. ANNALS OF THE ACADEMY OF MEDICINE, SINGAPORE 2024; 53:407-409. [PMID: 39132957 DOI: 10.47102/annals-acadmedsg.2024226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/13/2024]
Abstract
Clinical trials are essential for assessing the efficacy and safety of new therapies. Because different patient subgroups may respond variably to treatments, it is important to emphasise diversity among participants. This approach ensures that the trial population accurately reflects the patients who will use the medication in real-world settings and helps generate broadly applicable evidence. Over half a century after Archie L. Cochrane’s call for robust, impactful and equitable trials,1 external validity remains a significant concern for clinicians when applying clinical trial results.
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Affiliation(s)
- Yueyang Yi
- Stanley Ho Big Data Decision Analytics Research Centre, The Chinese University of Hong Kong, Hong Kong SAR
| | - Thomas Yuen Tung Lam
- Stanley Ho Big Data Decision Analytics Research Centre, The Chinese University of Hong Kong, Hong Kong SAR
- The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR
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Khalis M, Elbadisy I, Bouaddi O, Luo A, Bendriouich A, Addahri B, Charaka H, Chahboune M, Foucaud J, Badou A, Belyamani L, Huybrechts I. Cluster analysis of cancer knowledge, attitudes and behaviors in the Moroccan population. BMC Cancer 2024; 24:669. [PMID: 38824496 PMCID: PMC11143602 DOI: 10.1186/s12885-024-12226-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2023] [Accepted: 04/03/2024] [Indexed: 06/03/2024] Open
Abstract
BACKGROUND Cancer has become a major health concern due to the increasing morbidity and mortality rates, and its negative social, economic consequences and the heavy financial burden incurred by cancer patients. About 40% of cancers are preventable. The aim of this study was to assess the knowledge, attitudes, and practices regarding cancer prevention, and associated characteristics to inform the development of targeted cancer prevention campaigns and policies. METHODS We conducted a cross-sectional survey of adult patients at Mohamed Sekkat and Sidi Othmane Hospitals in Casablanca, Morocco. Data collection was conducted by two trained interviewers who administered the questionnaire in-person in the local language. An unsupervised clustering approach included 17 candidate variables for the cluster analysis. The variables covered a wide range of characteristics, including demographics, health perceptions and attitudes. Survey answers were calculated to compose qualitative ordinal categories, including a cancer attitude score and knowledge score. RESULTS The cluster-based analysis showed that participants in cluster 1 had the highest mean attitude score (13.9 ± 2.15) and percentage of individuals with a high level of knowledge (50.8%) whereas the lowest mean attitude score (9.48 ± 2.02) and knowledge level (7.5%.) were found in cluster 3. The participants with the lowest cancer attitude scores and knowledge levels were aged 34 to 47 years old (middle age group), predominantly females, living in rural settings, and were least likely to report health professionals as a source of health information. CONCLUSIONS The findings showed that female individuals living in rural settings, belonging to an older age group, who were least likely to use health professionals as an information source had the lowest levels of knowledge and attitudes. These groups are amenable to targeted and tailored interventions aiming to modify their understanding of cancer in order to enhance the outcomes of Morocco's on-going efforts in cancer prevention and control strategies.
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Affiliation(s)
- Mohamed Khalis
- Department of Public Health, Mohammed VI Center for Research and Innovation, Rabat, Morocco.
- Mohammed VI International School of Public Health, Mohammed VI University of Sciences and Health, Casablanca, Morocco.
- Higher Institute of Nursing Professions and Health Techniques, Rabat, Morocco.
- Laboratory of Biostatistics, Clinical, and Epidemiological Research, & Laboratory of Community Health (Public Health, Preventive Medicine and Hygiene), Department of Public Health, Faculty of Medicine and Pharmacy, Mohammed V University in Rabat, Rabat, Morocco.
| | - Imad Elbadisy
- Department of Public Health, Mohammed VI Center for Research and Innovation, Rabat, Morocco
- Mohammed VI International School of Public Health, Mohammed VI University of Sciences and Health, Casablanca, Morocco
| | - Oumnia Bouaddi
- Department of Public Health, Mohammed VI Center for Research and Innovation, Rabat, Morocco
- Mohammed VI International School of Public Health, Mohammed VI University of Sciences and Health, Casablanca, Morocco
| | - Amy Luo
- Department of Population, Family and Reproductive Health, Johns Hopkins School of Public Health, Baltimore, MD, USA
| | - Amina Bendriouich
- Mohammed VI Faculty of Medicine, Mohammed VI University of Sciences and Health, Casablanca, Morocco
| | - Badr Addahri
- Mohammed VI International School of Public Health, Mohammed VI University of Sciences and Health, Casablanca, Morocco
| | - Hafida Charaka
- Higher Institute of Nursing Professions and Health Techniques, Rabat, Morocco
| | - Mohamed Chahboune
- Higher Institute of Health Sciences, Laboratory of Sciences and Health Technologies, Hassan First University of Settat, Settat, Morocco
| | - Jérôme Foucaud
- Institut National du Cancer, Boulogne Billancourt, France
- Laboratory of Education and Health Practice, Sorbonne Paris Nord University, Paris, France
| | - Abdallah Badou
- Faculty of Medicine and Pharmacy, Hassan II University, Casablanca, Morocco
| | - Lahcen Belyamani
- Mohammed VI Faculty of Medicine, Mohammed VI University of Sciences and Health, Casablanca, Morocco
- Faculty of Medicine and Pharmacy, Mohammed V University in Rabat, Rabat, Morocco
| | - Inge Huybrechts
- Nutrition and Metabolism Branch, International Agency for Research On Cancer, Lyon, France
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Borysowski J, Lewis ACF, Górski A. Conflicts of interest in oncology expanded access studies. Int J Cancer 2021; 149:1809-1816. [PMID: 34233015 DOI: 10.1002/ijc.33733] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Revised: 06/10/2021] [Accepted: 06/22/2021] [Indexed: 12/14/2022]
Abstract
Expanded access is a treatment use of investigational drugs, biologicals or medical devices outside of clinical trials. The purpose of our study was to assess self-reported conflicts of interest (COIs) in oncology expanded access studies. One hundred fifty-eight oncology expanded access studies published from 2013 through 2020 were included. The pharmaceutical industry funded either completely or in part 94 studies (59.49%). The authors disclosed mostly financial COIs, while the number of the reported nonfinancial conflicts was relatively small (3528 and 57 COIs, respectively). The number of articles in which at least one author had a financial COI was 118 (74.68%). The most common financial COI types included advisory board membership/consulting (1471 COIs; 41.7%), followed by honoraria (570 COIs; 16.16%) and research funding (441 COIs; 12.5%). Logistic regression was performed to identify predictors of disclosing financial COIs and positive study's conclusions. On univariate analysis, financial COIs were more likely to occur in studies with at least one center located in the United States (odds ratio [OR], 5.62; 95% confidence interval [CI], 1.57-35.98; P = .02). We also found that positive conclusions about the studied treatments were less likely in studies without industry funding (OR, 0.26; CI, 0.08-0.77; P = .01). Most of the research on COIs in oncology performed to date focused on other types of studies, especially clinical trials. To our knowledge, our study is the first to evaluate COIs in oncology expanded access studies.
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Affiliation(s)
- Jan Borysowski
- Department of Clinical Immunology, Medical University of Warsaw, Warsaw, Poland.,Centre for Studies on Research Integrity, Institute of Law Studies, Polish Academy of Sciences, Warsaw, Poland
| | - Anna C F Lewis
- Edmond J. Safra Center for Ethics, Cambridge, Massachusetts, USA.,Center for Bioethics, Harvard Medical School, Boston, Massachusetts, USA
| | - Andrzej Górski
- Laboratory of Bacteriophages, Ludwik Hirszfeld Institute of Immunology and Experimental Therapy, Polish Academy of Sciences, Wrocław, Poland
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Ludmir EB, Mainwaring W, Lin TA, Miller AB, Jethanandani A, Espinoza AF, Mandel JJ, Lin SH, Smith BD, Smith GL, VanderWalde NA, Minsky BD, Koong AC, Stinchcombe TE, Jagsi R, Gomez DR, Thomas CR, Fuller CD. Factors Associated With Age Disparities Among Cancer Clinical Trial Participants. JAMA Oncol 2021; 5:1769-1773. [PMID: 31158272 DOI: 10.1001/jamaoncol.2019.2055] [Citation(s) in RCA: 153] [Impact Index Per Article: 51.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Importance Seminal investigation 2 decades ago alerted the oncology community to age disparities in participation in cooperative group trials; less is known about whether these disparities persist in industry-funded research. Objective To characterize the age disparities among trial enrollees on randomized clinical trials (RCTs) of common cancers in clinical oncology and identify factors associated with wider age imbalances. Data Sources Phase 3 clinical oncology RCTs were identified through ClinicalTrials.gov. Study Selection Multiarm RCTs assessing a therapeutic intervention for patients with breast, prostate, colorectal, or lung cancer (the 4 most common cancer disease sites) were included. Data Extraction and Synthesis Trial data were extracted from ClinicalTrials.gov. Trial screening and parameter identification were independently performed by 2 individuals. Data were analyzed in 2018. Main Outcomes and Measures The difference in median age (DMA) between the trial participant median age and the population-based disease-site-specific median age was determined for each trial. Results Three hundred two trials met inclusion criteria. The trials collectively enrolled 262 354 participants; 249 trials (82.5%) were industry-funded. For all trials, the trial median age of trial participants was a mean of 6.49 years younger than the population median age (95% CI, -7.17 to -5.81 years; P < .001). Age disparities were heightened among industry-funded trials compared with non-industry-funded trials (mean DMA, -6.84 vs -4.72 years; P = .002). Enrollment criteria restrictions based on performance status or age cutoffs were associated with age disparities; however, industry-funded trials were not more likely to use these enrollment restrictions than non-industry-funded trials. Age disparities were also larger among trials that evaluated a targeted systemic therapy and among lung cancer trials. Linear regression modeling revealed a widening gap between trial and population median ages over time at a rate of -0.19 years annually (95% CI, -0.37 to -0.01 years; P = .04). Conclusions and Relevance Age disparities between trial participants and the incident disease population are pervasive across trials and appear to be increasing over time. Industry sponsorship of trials is associated with heightened age imbalances among trial participants. With an increasing role of industry funding among cancer trials, efforts to understand and address age disparities are necessary to ensure generalizability of trial results as well as equity in trial access.
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Affiliation(s)
- Ethan B Ludmir
- The University of Texas MD Anderson Cancer Center, Houston
| | | | - Timothy A Lin
- The University of Texas MD Anderson Cancer Center, Houston.,Baylor College of Medicine, Houston, Texas
| | | | - Amit Jethanandani
- The University of Texas MD Anderson Cancer Center, Houston.,The University of Tennessee Health Science Center, Memphis
| | | | | | - Steven H Lin
- The University of Texas MD Anderson Cancer Center, Houston
| | | | - Grace L Smith
- The University of Texas MD Anderson Cancer Center, Houston
| | | | - Bruce D Minsky
- The University of Texas MD Anderson Cancer Center, Houston
| | - Albert C Koong
- The University of Texas MD Anderson Cancer Center, Houston
| | | | | | - Daniel R Gomez
- The University of Texas MD Anderson Cancer Center, Houston.,Memorial Sloan Kettering Cancer Center, New York, New York
| | - Charles R Thomas
- Oregon Health and Science University, Portland.,Deupty Editor, JAMA Oncology
| | - C David Fuller
- The University of Texas MD Anderson Cancer Center, Houston
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The Policies for the Disclosure of Funding and Conflict of Interest in Surgery Journals: A Cross-Sectional Survey. World J Surg 2020; 45:97-108. [PMID: 32914281 DOI: 10.1007/s00268-020-05771-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/28/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Industry through its funding of research and through its relationships with study authors can influence the results of research. Most journals have policies for reporting funding and disclosing conflict of interest (COI) to mitigate the influence of industry on research. The objective of this study is to assess the policies of surgery journals for the reporting of funding and the disclosure of COI. METHODS We described the prevalence and characteristics of funding and COI policies of journals indexed under "Surgery" in the Journal Citation Reports. We extracted data from publicly available information and through simulation of manuscript submission. RESULTS Of the 186 eligible journals, 171 (92%) had policies for reporting of funding. None of the policies described procedures to deal with non-reporting or underreporting of funding. Of the 186 journals, 183 (99%) had a policy for disclosure of COI. All journals with a COI policy required disclosure of financial interest, while 96 (52%) required the disclosure of non-financial interests. Only 24 (13%) policies described how non-disclosure of COI affects the editorial process, and none described procedures to verify COI disclosure. Of the policies that required disclosing COI, 94 (51%) also required reporting the source of financial COI. CONCLUSIONS Most journals have policies for reporting of funding and disclosure of financial COI. However, many do not have clear policies for disclosing non-financial COI. Major limitations in the policies include the lack of processes for the verification of disclosed interests and for dealing with underreporting of funding and of COI.
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Marshall DC, Tarras ES, Rosenzweig K, Yom SS, Hattangadi-Gluth J, Murphy J, Korenstein D, Chimonas S. Trends in Financial Relationships Between Industry and Radiation Oncologists Versus Other Physicians in the United States from 2014 to 2018. Int J Radiat Oncol Biol Phys 2020; 109:15-25. [PMID: 32858112 DOI: 10.1016/j.ijrobp.2020.08.043] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2020] [Revised: 08/01/2020] [Accepted: 08/18/2020] [Indexed: 11/24/2022]
Abstract
PURPOSE The Open Payments transparency program publishes data on industry-physician payments, in part to discourage relationships considered inappropriate including gifts, meals, and speaker's bureau fees. We evaluated trends in physician-level payments to test whether implementation of Open Payments resulted in fewer industry-radiation oncologist (RO) interactions or shifted interactions toward those considered more appropriate compared with medical oncologists (MOs) and other hospital-based physicians (HBPs). METHODS AND MATERIALS We performed a retrospective, population-based cohort study of practicing US ROs versus MOs and HBPs in 2014 matched to general (nonresearch) payments between 2014 and 2018. Trends in payments were analyzed and reported by nature of payment. Values of payments to ROs from the top 10 companies were identified. RESULTS From 2014 to 2018, 3379 (90.3%) ROs accepted 106,930 payments totaling $40.8 million. The per-physician number and value of payments was lower in radiation oncology than in medical oncology and higher than HBPs. The proportion of ROs accepting payments increased from 61.8% in 2014 to 64.2% in 2018; the proportion of MOs accepting payments decreased from 78.7% to 77.7%; and the proportion of HBPs decreased from 40.8% to 37.5%, respectively. The annual per-physician value and number of payments accepted by ROs and MOs increased. Payments in entertainment, meals, travel and lodging, and gifts increased among ROs and remained stable or decreased among MOs and HBPs. Consulting payments increased across all groups. Top RO payors produced novel cancer therapeutics, hydrogel spacers, radiation treatment machines, and opioids. CONCLUSIONS Industry payments to ROs have become more common since OP's inception, while becoming less common for MOs and HBPs. Payments to ROs and MOs have become more frequent and of modestly increasing value compared with other HBPs, for whom the value is decreasing. No large changes in the nature of relationships were seen in ROs. Increased engagement with financial conflicts of interest is needed in radiation oncology.
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Affiliation(s)
| | | | | | - Sue S Yom
- University of California San Francisco, San Francisco, California
| | | | - James Murphy
- University of California San Diego, San Diego, California
| | | | - Susan Chimonas
- Memorial Sloan Kettering Cancer Center, New York, New York
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Zaorsky NG, Ahmed AA, Zhu J, Yoo SK, Fuller CD, Thomas CR, Choi M, Holliday EB. Industry Funding Is Correlated With Publication Productivity of US Academic Radiation Oncologists. J Am Coll Radiol 2018; 16:244-251. [PMID: 30219342 DOI: 10.1016/j.jacr.2018.07.024] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2018] [Revised: 07/11/2018] [Accepted: 07/20/2018] [Indexed: 12/18/2022]
Abstract
PURPOSE Industry payments to physicians are financial conflicts of interest and may influence research findings and medical decisions. We aim to (1) characterize industry payments within radiation oncology; and (2) explore the potential correlation between receiving disclosed industry payments and academic productivity. MATERIALS/METHODS CMS database was used to extract 2015 industry payments. For academic radiation oncologists, research productivity was characterized by h- and m-indices, as well as receipt of National Institutes of Health (NIH) funding, which is not an industry payment. Logistic regression models were used to determine whether publication metrics (m-index, h-index) and other study characteristics such as gender, PhD status, NIH institution funding status, were associated with the endpoints, research and general payments. Associations between the amount of payments (if any) and publication metrics were further studied using linear regression models. RESULTS A total of 22,543 individual payments totaling $25,532,482 to 2,995 radiation oncologists were included. Among the 1,189 academic radiation oncologists, 75% received less than $167; on the other hand, 10 (<1%) individuals received $6,425,728 (51%) of payments. On multiple logistic regression, research payments were significantly associated with the m-index, odds ratio 2.86 (95% confidence interval, 1.84-4.45, p-value <0.0001); as well as with the h-index, odds ratio 1.03 (95% confidence interval, 1.01-1.05, p-value <0.0001). The linear regression model shows that both m-index and h-index were significantly positively associated with the amount of general payments (p-values <0.0001). CONCLUSION There is an association between disclosed payment from the industry and increased individual research productivity metrics. Further research to find the cause behind this association is warranted.
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Affiliation(s)
- Nicholas G Zaorsky
- Department of Radiation Oncology, Penn State Cancer Institute, Hershey, Pennsylvania; Department of Public Health Sciences, Penn State College of Medicine, Hershey, Pennsylvania.
| | - Awad A Ahmed
- Department of Radiation Oncology, University of Miami, Miami, Florida
| | - Junjia Zhu
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, Pennsylvania
| | - Stella K Yoo
- Department of Radiation Oncology, University of Southern California, Keck School of Medicine, Los Angeles, California
| | - Clifton D Fuller
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Charles R Thomas
- Department of Radiation Medicine, Oregon Health & Science University Knight Cancer Institute, Portland, Oregon
| | - Mehee Choi
- Department of Radiation Oncology, Loyola University Chicago, Chicago, Illinois
| | - Emma B Holliday
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
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Baadh AS, Patel M, Patel K, Ahmed O. Medical industry at tumor board: Three-years analysis of the open payments database and comparison of oncologic specialties. J Surg Oncol 2017; 117:551-557. [DOI: 10.1002/jso.24899] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2017] [Accepted: 10/10/2017] [Indexed: 11/10/2022]
Affiliation(s)
- Amanjit S. Baadh
- St. Paul Radiology; Department of Interventional Radiology; St. Paul Minnesota
| | - Mikin Patel
- Department of Interventional Radiology; Medical Center of Northwestern University; Chicago Illinois
| | - Ketan Patel
- Department of Interventional Radiology; Rush University Medical Center; Chicago Illinois
| | - Osman Ahmed
- Department of Interventional Radiology; Rush University Medical Center; Chicago Illinois
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McFarland DC, Blackler E, Banerjee S, Holland J. Communicating About Precision Oncology. JCO Precis Oncol 2017; 1:1700066. [PMID: 32913976 DOI: 10.1200/po.17.00066] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
Communication in oncology has always been challenging. The new era of precision medicine complicates communication even further as a result of our increasing reliance on genomic data and the varying psychological responses to genomic-based treatments and their expected outcomes. The crux of the matter hinges on understanding communication. The informed consent process may require more attention in the precision medicine era. However, many of the communication issues are actually similar to perennial long-standing communication issues in oncology, which center on providing hope when breaking bad news and ensuring that adequate informed consent to treatments is obtained. This piece presents several common patient reactions to different precision medicine scenarios in oncology practice. We highlight these new communication issues that focus on clinical and ethical questions (ie, informed consent, shared decision making, patient autonomy, and uncertainty in oncologic treatments) and provide guidance on working with each scenario. In this article, we address common reactions of patients to genomic information and provide thoughtful communication suggestions using a Shared Decision Making framework to help patients cope with the inherent distress-provoking uncertainties in oncology practice.
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Affiliation(s)
- Daniel C McFarland
- , Memorial Sloan Kettering Cancer Center, West Harrison; and , , and , Memorial Sloan Kettering Cancer Center, New York, NY
| | - Elizabeth Blackler
- , Memorial Sloan Kettering Cancer Center, West Harrison; and , , and , Memorial Sloan Kettering Cancer Center, New York, NY
| | - Smita Banerjee
- , Memorial Sloan Kettering Cancer Center, West Harrison; and , , and , Memorial Sloan Kettering Cancer Center, New York, NY
| | - Jimmie Holland
- , Memorial Sloan Kettering Cancer Center, West Harrison; and , , and , Memorial Sloan Kettering Cancer Center, New York, NY
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Trial sponsorship and self-reported conflicts of interest in breast cancer radiation therapy: An analysis of prospective clinical trials. Breast 2017; 33:29-33. [DOI: 10.1016/j.breast.2017.02.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2016] [Revised: 02/01/2017] [Accepted: 02/26/2017] [Indexed: 11/23/2022] Open
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Linker A, Yang A, Roper N, Whitaker E, Korenstein D. Impact of industry collaboration on randomised controlled trials in oncology. Eur J Cancer 2016; 72:71-77. [PMID: 28027518 DOI: 10.1016/j.ejca.2016.11.005] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2016] [Accepted: 11/11/2016] [Indexed: 12/19/2022]
Abstract
BACKGROUND Industry funders can simply provide money or collaborate in trial design, analysis or reporting of clinical trials. Our aim was to assess the impact of industry collaboration on trial methodology and results of randomised controlled trials (RCT). METHODS We searched PubMed for oncology RCTs published May 2013 to December 2015 in peer-reviewed journals with impact factor > 5 requiring reporting of funder role. Two authors extracted methodologic (primary end-point; blinding of the patient, clinician and outcomes assessor; and analysis) and outcome data. We used descriptive statistics and two-sided Fisher exact tests to compare characteristics of trials with collaboration, with industry funding only, and without industry funding. RESULTS We included 224 trials. Compared to those without industry funding, trials with collaboration used more placebo control (RR 3·59, 95% CI [1·88-6·83], p < 0001), intention-to-treat analysis (RR 1·32, 95% CI [1·04-1·67], p = 02), and blinding of patients (RR 3·05, 95% CI [1·71-5·44], p < 0001), clinicians (RR 3·36, 95% CI [1·83-6·16], p≤·001) and outcomes assessors (RR 3·03, 95% CI [1·57-5·83], p = 0002). They did not differ in use of overall survival as a primary end-point (RR 1·27 95% CI [0·72-2·24]) and were similarly likely to report positive results (RR 1·11 95% CI [0·85-1·46], p = 0.45). Studies with funding only did not differ from those without funding. CONCLUSIONS Oncology RCTs with industry collaboration were more likely to use some high-quality methods than those without industry funding, with similar rates of positive results. Our findings suggest that collaboration is not associated with trial outcomes and that mandatory disclosure of funder roles may mitigate bias.
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Affiliation(s)
- Anne Linker
- University of California San Francisco, 631 Diamond Street, San Francisco, CA 94114, USA.
| | - Annie Yang
- Center for Health Policy and Outcomes, Memorial Sloan Kettering Cancer Center, 485 Lexington Avenue, 2nd Floor, New York, NY 10017, USA.
| | - Nitin Roper
- National Institutes of Health/National Cancer Institute, 10 Center Drive, Bethesda, MD 20892, USA.
| | - Evans Whitaker
- Library and Center for Knowledge Management, University of California San Francisco, 530 Parnassus Avenue, San Francisco, CA 94143, USA.
| | - Deborah Korenstein
- Department of Medicine, Memorial Sloan Kettering Cancer Center, 485 Lexington Avenue, 2nd Floor, New York, NY 10017, USA.
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Marshall DC, Moy B, Jackson ME, Mackey TK, Hattangadi-Gluth JA. Distribution and Patterns of Industry-Related Payments to Oncologists in 2014. J Natl Cancer Inst 2016; 108:djw163. [PMID: 27389914 PMCID: PMC5241893 DOI: 10.1093/jnci/djw163] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2015] [Revised: 04/29/2016] [Accepted: 05/25/2016] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Industry-physician collaboration is critical for anticancer therapeutic development, but financial relationships introduce conflicts of interest. We examined the specialty variation and context of physician payments and ownership interest among oncologists. METHODS We performed a population-based multivariable analysis of 2014 Open Payments reports of industry payments to US physicians matched to physician and practice data, including sex, specialty, practice location, and sole proprietor status. Payment data were aggregated per physician and compared by specialty (medical, radiation, surgical, and nononcology), and practice location linked with spending level (low, average, and high). Primary outcomes included likelihood, mean annual amount, and number of general payments. Secondary outcomes included likelihood of holding ownership interests and receipt of royalty/license payments. Estimates for each outcome were determined using multivariable models, including logistic regression for likelihood and linear regression with gamma distribution and log-link for value, adjusted for physician specialty, sex, sole proprietor status, and practice spending. All statistical tests were two-sided. RESULTS In 2014, there were 883 438 physicians, including 22 712 oncologists, licensed to practice in the United States. Among oncology specialties, 52.4% to 63.0% of physicians received a general payment in 2014, totaling $76 million, $4 million, and $5 million to medical, radiation, and surgical oncology, respectively. The median annual per-physician payment to medical oncologists was $632 (IQR = 136-2500), compared with $124 (IQR = 39-323) in radiation oncology and $250 (IQR = 84-1369) in surgical oncology. After controlling for physician and practice characteristics, oncologists were 1.09 to 1.75 times as likely to receive a general payment compared with nononcologists (overall P < 001). There was a 67.6% difference (95% confidence interval [CI] = 63.6 to 71.5, P < .001) in the mean annual value of payments between medical oncology and nononcology specialties (vs -92.7%, 95%CI = -100.2 to -85.0, P < .001] for radiation oncology). Medical and radiation oncologists were more likely to hold ownership interest (adjusted OR = 3.72, 95% CI = 3.22 to 4.27, and 2.27, 95% CI = 1.65 to 3.03, respectively, P < .001 both comparisons). CONCLUSIONS In 2014, industry-oncologist financial relationships were common, and their impact on oncology practice should be further explored.
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Affiliation(s)
- Deborah C Marshall
- Department of Radiation Medicine and Applied Sciences (DCM, JAHG) and Department of Anesthesiology (TKM), School of Medicine (DCM, MEJ), University of California, San Diego, La Jolla, CA; Massachusetts General Hospital Cancer Center, Boston, MA, (BM)
| | - Beverly Moy
- Department of Radiation Medicine and Applied Sciences (DCM, JAHG) and Department of Anesthesiology (TKM), School of Medicine (DCM, MEJ), University of California, San Diego, La Jolla, CA; Massachusetts General Hospital Cancer Center, Boston, MA, (BM)
| | - Madeleine E Jackson
- Department of Radiation Medicine and Applied Sciences (DCM, JAHG) and Department of Anesthesiology (TKM), School of Medicine (DCM, MEJ), University of California, San Diego, La Jolla, CA; Massachusetts General Hospital Cancer Center, Boston, MA, (BM)
| | - Tim K Mackey
- Department of Radiation Medicine and Applied Sciences (DCM, JAHG) and Department of Anesthesiology (TKM), School of Medicine (DCM, MEJ), University of California, San Diego, La Jolla, CA; Massachusetts General Hospital Cancer Center, Boston, MA, (BM)
| | - Jona A Hattangadi-Gluth
- Department of Radiation Medicine and Applied Sciences (DCM, JAHG) and Department of Anesthesiology (TKM), School of Medicine (DCM, MEJ), University of California, San Diego, La Jolla, CA; Massachusetts General Hospital Cancer Center, Boston, MA, (BM)
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Mahr MA, Hodge DO, Erie JC. Association between Industry Payments and Anti-vascular Endothelial Growth Factor Use in Medicare Beneficiaries. Ophthalmol Retina 2016; 1:19-24. [PMID: 31047391 DOI: 10.1016/j.oret.2016.08.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2016] [Revised: 08/15/2016] [Accepted: 08/23/2016] [Indexed: 11/18/2022]
Abstract
PURPOSE To test for associations between anti-vascular endothelial growth factor (VEGF) industry payments to ophthalmologists who provide intravitreal injections and specific anti-VEGF agent use. DESIGN Cross-sectional Medicare database study. PARTICIPANTS US fee-for-service Medicare beneficiaries and all ophthalmologists who submitted intravitreal injection claims for >10 Medicare beneficiaries between August 1, 2013, and December 31, 2013. METHODS The Sunshine Act Open Payments database was searched for all industry financial relationships in ophthalmology. The Medicare Provider Utilization and Payment Database was searched for all intravitreal injection claims and anti-VEGF drug claims among fee-for-service Medicare beneficiaries. A novel algorithm was used to merge the 2 datasets to identify physician-specific associations between industry payments and specific anti-VEGF agent use. Odds ratios (ORs) and corresponding confidence intervals (CIs) were estimated by using logistic regression models. MAIN OUTCOME MEASURES Ophthalmologists providing intravitreal injections (Current Procedural Terminology 67028); ophthalmologists with reported nonresearch payment from anti-VEGF industry; physician-specific anti-VEGF agent use (treatment specific J-codes J0178 and J2778). RESULTS Of 3391 ophthalmologists who performed intravitreal injections, 1187 (35%) received nonresearch payments from anti-VEGF industry. Of these 1187 ophthalmologists, 422 (35%) received payments from Regeneron Pharmaceuticals, 363 (31%) received payments from Genentech, and 402 (34%) received payments from both industries. When compared with ophthalmologists who perform intravitreal injections and who do not receive anti-VEGF industry payments, ophthalmologists receiving Genentech payments (median, $90; interquartile range, $22-$149) were more likely to use ranibizumab (OR, 2.14; 95% CI, 2.12-2.16), those receiving Regeneron payments (median, $55; interquartile range, $22-$131) were more likely to use ranibizumab (OR, 1.55; 95% CI, 1.54-1.56) and aflibercept (OR, 1.23; 95% CI, 1.22-1.24), those with payments from both manufacturers were more likely to use ranibizumab (OR, 2.69; 95% CI, 2.67-2.71) and aflibercept (OR, 1.53; 95% CI, 1.52-1.54), and all were less likely to use bevacizumab (OR, 0.33-0.64; P < 0.001 for all comparisons). CONCLUSIONS Industry payments to ophthalmologists who perform intravitreal injections were associated with higher odds of ranibizumab and aflibercept use, and lower odds of bevacizumab use. These findings reflect an association, not a cause-and-effect relationship.
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Affiliation(s)
- Michael A Mahr
- Department of Ophthalmology, The Mayo Clinic, Rochester, Minnesota
| | - David O Hodge
- Department of Health Science Research, The Mayo Clinic, Rochester, Minnesota
| | - Jay C Erie
- Department of Ophthalmology, The Mayo Clinic, Rochester, Minnesota.
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Fleischman W, Ross JS, Melnick ER, Newman DH, Venkatesh AK. Financial Ties Between Emergency Physicians and Industry: Insights From Open Payments Data. Ann Emerg Med 2016; 68:153-158.e4. [DOI: 10.1016/j.annemergmed.2016.01.014] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2015] [Revised: 12/04/2015] [Accepted: 01/13/2016] [Indexed: 11/27/2022]
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Marshall DC, Jackson ME, Hattangadi-Gluth JA. Disclosure of Industry Payments to Physicians: An Epidemiologic Analysis of Early Data From the Open Payments Program. Mayo Clin Proc 2016; 91:84-96. [PMID: 26763512 PMCID: PMC4739814 DOI: 10.1016/j.mayocp.2015.10.016] [Citation(s) in RCA: 76] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2015] [Revised: 09/18/2015] [Accepted: 10/20/2015] [Indexed: 11/27/2022]
Abstract
The Centers for Medicare and Medicaid Services' Open Payments program implements Section 6002 of the Affordable Care Act requiring medical product manufacturers to report payments made to physicians or teaching hospitals as well as ownership or investment interests held by physicians in the manufacturer. To determine the characteristics and distribution of these industry payments by specialty, we analyzed physician payments made between August 1, 2013, and December 31, 2013, that were publicly disclosed by Open Payments. We compared payments between specialty types (medical, surgical, and other) and across specialties within each type using the Pearson χ(2) test and the Kruskal-Wallis test. The number of physicians receiving payments was compared with the total number of active physicians in each specialty in 2012. We also analyzed physician ownership interests. Allopathic and osteopathic physicians received 2.43 million payments totaling $475 million. General payments represented 90% of payments by total value ($430 million) (per-physician median, $100; interquartile range [IQR], $31-$273; mean ± SD, $1407±$23,766), with the remaining 10% ($45 million) as research payments (median, $2365; IQR, $592-$8550; mean ± SD, $12,880±$66,743). Physicians most likely to receive general payments were cardiovascular specialists (78%) and neurosurgeons (77%); those least likely were pathologists (9%). Reports of ownership interest in reporting entities included $310 million in dollar amount invested and $447 million in value of interest held by 2093 physicians. In conclusion, the distribution and characteristics of industry payments to physicians varied widely by specialty during the first half-year of Open Payments reporting.
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Affiliation(s)
- Deborah C Marshall
- Department of Radiation Medicine and Applied Sciences, University of California, San Diego, La Jolla, CA; University of California, San Diego School of Medicine, La Jolla, CA
| | | | - Jona A Hattangadi-Gluth
- Department of Radiation Medicine and Applied Sciences, University of California, San Diego, La Jolla, CA.
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Jairam V, Yu JB. Examination of Industry Payments to Radiation Oncologists in 2014 Using the Centers for Medicare and Medicaid Services Open Payments Database. Int J Radiat Oncol Biol Phys 2015; 94:19-26. [PMID: 26547386 DOI: 10.1016/j.ijrobp.2015.09.004] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2015] [Revised: 09/02/2015] [Accepted: 09/08/2015] [Indexed: 11/28/2022]
Abstract
PURPOSE To use the Centers for Medicare and Medicaid Services Open Payments database to characterize payments made to radiation oncologists and compare their payment profile with that of medical and surgical oncologists. METHODS AND MATERIALS The June 2015 release of the Open Payments database was accessed, containing all payments made to physicians in 2014. The general payments dataset was used for analysis. Data on payments made to medical, surgical, and radiation oncologists was obtained and compared. Within radiation oncology, data regarding payment category, sponsorship, and geographic distribution were identified. Basic statistics including mean, median, range, and sum were calculated by provider and by transaction. RESULTS Among the 3 oncologic specialties, radiation oncology had the smallest proportion (58%) of compensated physicians and the lowest mean ($1620) and median ($112) payment per provider. Surgical oncology had the highest proportion (84%) of compensated physicians, whereas medical oncology had the highest mean ($6371) and median ($448) payment per physician. Within radiation oncology, nonconsulting services accounted for the most money to physicians ($1,042,556), whereas the majority of the sponsors were medical device companies (52%). Radiation oncologists in the West accepted the most money ($2,041,603) of any US Census region. CONCLUSIONS Radiation oncologists in 2014 received a large number of payments from industry, although less than their medical or surgical counterparts. As the Open Payments database continues to be improved, it remains to be seen whether this information will be used by patients to inform choice of providers or by lawmakers to enact policy regulating physician-industry relationships.
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Affiliation(s)
| | - James B Yu
- Department of Therapeutic Radiology, Yale School of Medicine, New Haven, Connecticut.
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