Department of Medicine, University of Calgary, Calgary, Canada.
Division of Cancer Care and Epidemiology, Queen's University Cancer Research Institute, Kingston, Canada.
J Cancer Policy. 2021 Jun;28:100283. doi: 10.1016/j.jcpo.2021.100283. Epub 2021 Apr 5.
Many oncologists who lead guidelines and clinical trials have financial conflicts of interest (fCOI) with industry. However, the extent to which fCOI reaches all cancer care providers is not known. Here we describe industry payments across all cancer care specialties by specific drug.
This observational, retrospective cohort study used Open Payments to describe general payments (i.e. consulting fees, meals, travel) to all US physicians for any cancer medicine during 2016-2018. Endpoints included number and value of payments by specialty, drug, and year.
During 2016-2018, industry made general payments to 52 441 physicians for 137 unique cancer drugs. Annual number of payments (465 655 in 2018) and total value ($98.5 million in 2018) increased over the study period (20 % and 31 % increase since 2016). Medical/hematologic oncologists, surgical oncologists and radiologists received the highest total value of payments, accounting for $65.7 million (67 % of total), $13.4 million (14 % of total) and $10.8 million (11 % of total) in 2018. In 2018, 5 % of physicians (n = 1660) received >$10 000 in annual payments and 0.6 % (n = 209) received >$100 000. Pembrolizumab and Nivolumab, were associated with the highest total payment in each year, accounting for 12 % and 6 % (2018) of total value, respectively.
While prior work has identified fCOIs among oncology leaders, these data suggest that payments extend across the cancer system.
Pre-existing data suggest a strong relationship between industry payments and physician prescribing. The current study demonstrates that fCOIs among oncology prescribers are pervasive. The oncology community must consider the extent to which these relationships influence clinical practice and regulatory policies.
许多领导指南和临床试验的肿瘤学家与行业存在财务利益冲突（fCOI）。然而，fCOI 延伸到所有癌症护理提供者的程度尚不清楚。在这里，我们通过特定药物描述了所有癌症护理专业的行业支付情况。
本观察性、回顾性队列研究使用 Open Payments 描述了 2016-2018 年期间所有美国医生使用任何癌症药物的一般支付（即咨询费、餐费、差旅费）。终点包括按专业、药物和年份划分的支付数量和价值。
在 2016-2018 年期间，行业向 52441 名医生支付了 137 种独特的癌症药物的一般款项。付款的年数（2018 年的 465655 笔）和总价值（2018 年的 9850 万美元）在研究期间有所增加（自 2016 年以来增长了 20%和 31%）。医学/血液肿瘤学家、外科肿瘤学家和放射科医生收到的总付款最高，2018 年分别为 6570 万美元（占总数的 67%）、1340 万美元（占总数的 14%）和 1080 万美元（占总数的 11%）。2018 年，5%的医生（n=1660）每年收到超过 10000 美元的款项，0.6%（n=209）每年收到超过 100000 美元的款项。帕博利珠单抗和纳武利尤单抗在每年的总支付中分别占比最高，分别为 12%和 6%（2018 年）。
虽然之前的工作已经确定了肿瘤学领导者之间的 fCOI，但这些数据表明，付款延伸到整个癌症系统。
现有数据表明，行业支付与医生处方之间存在密切关系。本研究表明，肿瘤学开处方者之间存在利益冲突。肿瘤学界必须考虑这些关系在多大程度上影响临床实践和监管政策。
