From the Journals

Conflicts of interest common among authors of ASCO guidelines

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Disclosures system needs improvement

The study by Saleh et al. illustrates the need for a better disclosure system that is more consistent and allows for potential conflicts of interest to be more easily identified and managed, says Clifford A. Hudis, MD, of The American Society of Clinical Oncology.

In an editorial accompanying Dr. Saleh’s study in the July 29 issue of Cancer, Dr. Hudis and coauthor Robert W. Carlson, MD, of the National Comprehensive Cancer Network, write that while disclosure compliance is important, they do not believe the lack of disclosures reported in the analysis “represent malintent or malfeasance on the part of authors or a lack of diligence by the involved institutions.

“Instead, this represents one more in a potentially endless number of illustrative specific examples of all that is wrong — and must be fixed—with disclosure as currently practiced in the United States,” the authors wrote.

Dr. Hudis and Dr. Carlson outlined several possible solutions for a better disclosure system, including making the definitions of research funding, consultancy, honoraria, and travel support standardized and applied consistently. In addition, one source of universal disclosure should be developed within the house of medicine that provides a simple, easy-to-use, easily vetted, shared, and accessible resource that allows for the easy documentation, confirmation, and sharing of potential conflicts, according to the authors. Finally, companies that are subject to sunshine reporting should be required to notify covered individuals, in nearly real time, “when and what they are reporting so that there is no disconnect or time lag,” the doctors wrote.

Clifford A. Hudis is CEO for the American Society of Clinical Oncology and Robert W. Carlson is CEO for the National Comprehensive Cancer Network. Dr. Carlson reports being issued US patent D848,448S for Evidence Blocks (part of National Comprehensive Cancer Network guidelines).


 

A significant number of physicians who author practice guidelines are not reporting financial conflicts of interest, a study finds.

Lead author Ramy R. Saleh, MD, of the University of Toronto, and colleagues searched The American Society of Clinical Oncology (ASCO) website to identify all clinical practice guidelines (CPGs) for systemic therapy published between August 2013 and June 2018. Investigators analyzed self-reported author financial conflicts of interest and funding sources and also reviewed The Open Payments database to identify compensation to guideline authors. Researchers categorized conflicts of interest into two groups: research funding (which could include departmental and/or hospital funding) and nonresearch payments (including travel expenses, honoraria, employment, and stock ownership to the individual author).

The initial search identified 121 CPGs published by ASCO between August 2013 and August 2018 of which 26 guidelines were selected because of their focus on systemic treatment. Findings showed that 239 guideline authors who were not exempt from reporting received industry payments, but only 184 (77%) disclosed these payments, according to the study in Cancer. The mean total of all undisclosed payments from 2013 to 2017 received by CPG authors was $187,503 and the median was $30,500. Of the 55 authors with undisclosed conflicts of interest, 34 authors (62%) received more than $1,000 of nonresearch funding, and 19 authors (35%) received more than $5,000 per calendar year.

The majority of the authors with undisclosed conflicts were medical oncologists, the investigators found. Radiation oncologists and surgeons had similar proportions of undisclosed financial conflicts.

The researchers concluded that financial conflicts of interest among authors of ASCO guidelines are common and are not disclosed in a substantial number of cases. The findings indicate that current self-disclosure practices are not adequate for accurately reporting conflicts, they noted.

“Improved transparency of [financial conflicts of interest should become standard practice among CPG authors,” the investigators wrote. “Professional societies and journal editors need to create a mechanism to verify self-reported [financial conflicts of interest].”

Source: Saleh et. al. 2019 July 29 doi: 10.1002/cncr.32408.

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