Compensated industry relationships common in oncology

More than one-half of U.S. oncologists received an industry-related payment in the year 2014, according to the results of a population-based study.

Oncologists appeared more likely to receive industry payments than physicians in other specialties, results showed.

“Collaboration between oncologists, researchers and biomedical industries is essential for the development of novel cancer therapeutics,” Jona A. Hattangadi-Gluth, MD, assistant professor of medicine at University of California, San Diego and chief of central nervous system radiation oncology at Moores Cancer Center, and colleagues wrote. “However, financial relationships between physicians and industry create conflicts of interest. Whether industry-related financial conflicts of interest introduce undue influence on physician decision-making and treatment utilization is highly controversial.”

Hattangadi-Gluth and colleagues used available data from the 2014 Open Payments report to analyze specialty variation and context of industry–physician financial payments and ownership interests. These data included information on physician specialty, sex, practice location and sole ownership status. Practice locations were linked with spending levels to account for regional differences in spending and practice settings.

The percentage of physicians receiving a general payment, as well as the total value and number of general payments, served as the primary outcome measures. Secondary outcome measures included the percentage of physicians receiving a licensing or royalty payment and the percentage of physicians holding industry ownership interests.

The researchers identified a total of 883,438 physicians licensed to practice in the United States in 2014, including 22,712 oncologists. The majority of U.S. oncologists (n = 15,494) were classified as medical oncologists; 4,934 physicians were classified as radiation oncologists and 2,284 were classified as surgical oncologists.

The majority of physicians in all specialties were men. A minority of physicians acted as sole proprietors, particularly within oncology specialties. The majority of physicians practiced in average hospital referral regions.

Sixty-three percent (n = 9,765) of U.S. medical oncologists received a general payment in 2014, as did 52.4% (n = 2,585) of radiation oncologists and 58.3% (n = 1,332) of surgical oncologists.

These represented 314,183 total general payments to medical oncologists, 17,668 general payments to radiation oncologists, and 13,380 general payments for surgical oncologists.

General payments to medical oncologists totaled $75,682,601. Payments to radiation oncologists totaled $4,442,260, and payments to surgical oncologists totaled $5,103,033.

Medical oncologists had a higher median annual per-physician payment ($632; interquartile range [IQR], 136-2,500) than radiation oncologists ($124; IQR, 39-323) or surgical oncologists ($193; IQR, 57-723; P < .001).

A total of 1.4% (n = 213) of medical oncologists held ownership interests, along with 0.9% (n = 43) of radiation oncologists and 0.3% (n = 7) of surgical oncologists.

Oncologists were 1.09 -to 1.75-times as likely to receive a general payment than nononcologists (overall P < .001). Factors associated with the likelihood of receiving a general payment included male sex, non–sole proprietor status, and practice in an average or high hospital referral region.

An adjusted estimate showed a 67.6% (95% CI, 63.6-71.5) difference in the mean value of payments between medical oncology and nononcology specialties. This difference was –92.7% (95% CI, –100.2 to –85) when researchers compared radiation oncology and nononcology specialties.

Ownership interests appeared more common among medical oncologists (adjusted OR = 3.72; 95% CI, 3.22-4.27) and radiation oncologists (adjusted OR = 2.27; 95% CI, 1.65-3.03); however, nononcologists had a higher likelihood of receiving a royalty or licensing payment.

Male physicians also had a higher likelihood of receiving a royalty or licensing payment (adjusted OR = 37.3; 95% CI, 25.2-58.7).

“As transparency of physician payments increases, it is important to understand the complexity of these relationships in oncology and to help guide interpretation by patients and stakeholders,” Hattangadi-Gluth and colleagues wrote. “Although some relationships may represent problematic financial interests, many have positive consequences for cancer care. Future policies should work toward managing these relationships appropriately and fostering fruitful collaborations with industry.” – by Cameron Kelsall

Disclosure: Hattangadi-Gluth reports research funding from Varian Medical Systems for research unrelated to the current study. The other researchers report no relevant financial disclosures.