Many Authors of NCCN Guidelines Have Financial Conflicts of Interest

Eighty-six percent of National Comprehensive Cancer Network (NCCN) guideline authors had at least one reported financial conflict of interest, according to a study published in JAMA Oncology. The majority of the industry-related conflicts of interest were research payments for laboratory or clinical trials.

The study authors analyzed financial conflicts of interest in 2014 among 125 guideline authors of cancers with the highest incidence in the United States: breast, prostate, and lung.

Among the guideline authors analyzed, the average amount received was $10,011 in 2014 and ranged to upwards of $106,000 in payments for consulting, meals, lodging, and other general compensation. Average industry research payments in 2014 were $236,066 and reached as high as $2,756,713, which included funding of clinical trials. About 84% of the authors received general payments while 47% received research funding. Seventy guideline contributors (56%) received $1,000 or more in general payments, and eight authors (6%) had financial conflicts of interest of more than the $50,000 maximum stipulated by the NCCN.

“Although financial conflicts of interest may result from engaging in important scholarship, [they] may still influence guideline authors in counterproductive ways,” wrote study authors led by Aaron P. Mitchell, MD, of the UNC School of Medicine in Chapel Hill, North Carolina. “Research is needed to understand how best to manage author financial conflicts of interest during guideline creation.”

NCCN guidelines are widely used by oncologists, shape oncology practice in the United States, and influence the drugs that are reimbursed via Medicare.

The study authors accessed the conflict of interest payments through the Open Payments database, a publically available source from the Centers for Medicare and Medicaid Services. Since August 2013, the Physician Payments Sunshine Act requires that all drug and device manufacturers disclose transfers of anything with a financial value greater than $10 to physicians and teaching hospitals.

Mitchell and coauthors acknowledged the benefits of accepting funding for academic clinical trials as well as the societal value of clinicians who communicate with the biomedical industry on medical needs and development of cancer therapies. Still, “more investigation is needed on the relative influence of general payments and research funding on physician practice and guideline recommendations,” they wrote.

In an accompanying editorial, Ryan D. Nipp, MD, and Beverly Moy, MD, MPH, both of the Massachusetts General Hospital Cancer Center in Boston, acknowledged the benefits of relationships between the biomedical industry and academic oncologists while also cautioning against the potential influence that such relationships could have. “The integrity of scientific research and maintenance of trust in the research process require ongoing and rigorous scrutiny regarding the methods for managing and/or prohibiting financial conflicts of interest,” wrote Nipp and Moy.

The editorial authors noted that the types of conflict of interest are important in deciphering the relationships among researchers and industry. “Research suggests that the oncology community views financial conflicts of interest involving stock ownership and participation in speakers bureaus as more of a cause for concern than payment for meals or uncompensated consulting. Therefore, policies regarding financial conflict of interest disclosure may need to go beyond just disclosing every industry relationship and should consider the relative harm or importance of the financial conflict of interest.”