Financial conflicts of interest among National Comprehensive Cancer Network clinical practice guideline panelists in 2019

Abstract

BACKGROUND: Clinical practice guidelines (CPGs) are evidence-based guidelines that serve as a standard of care in oncology practice, reimbursements, and quality improvement initiatives. To our knowledge, the extent of financial conflicts of interest (FCOIs) in National Comprehensive Cancer Network (NCCN) guidelines have not been systemically evaluated. The current study evaluated the extent of FCOIs in the NCCN CPGs for the most common malignancies in the United States. METHODS: The authors examined the latest 2019 versions of the NCCN CPGs for the 10 most common cancers by incidence in the United States. Using disclosure lists, they catalogued the FCOIs for the panelists under various categories outlined in the CPG. The authors also tabulated the companies and institutions involved in each panel disclosure. An "episode" describes 1 instance of participation of a panelist in 1 company in 1 category of each guideline. "Affiliation" describes an industrial, commercial, or institutional affiliation reported by a panelist in each episode. RESULTS: Of the 491 panelists on the CPG panel, 483 (98.3%) completed FCOI disclosures. A total of 224 (46.4%) reported at least 1 FCOI episode. A total of 1103 episodes were disclosed with an average of 4.9 episodes reported per panelist with FCOIs. Acting as part of scientific advisory boards, as a consultant, or as an expert witness was the most common FCOI category (19.9%). A total of 191 companies were associated with 1103 episodes of FCOI. The top companies were Bristol-Myers Squibb, Merck, Genentech, and AstraZeneca. Among cancers, the prevalence of FCOIs was highest for lung cancer (56%), bladder cancer (52%), pancreatic cancer (52%), non-Hodgkin lymphoma (50%), kidney cancer (49%), colorectal cancer (43%), breast cancer (42%), melanoma (40%), prostate cancer (38%), and uterine cancer (32%). Among the panelists with FCOIs, 26%, 17%, and 57%, respectively, reported 1, 2, and >3 episodes. There were 127 episodes noted among the CPG chairs and/or vice chairs who reported FCOIs (mean, 6.4 episodes). The chairs and/or vice chairs of CPGs for uterine cancer, pancreatic cancer, melanoma, and prostate cancer were not found to have any FCOIs. CONCLUSIONS: FCOIs are very prevalent among NCCN CPG panelists. In nearly one-half of the CPGs, the majority of the panelists had at least 1 FCOI. Greater than one-half of the CPG chairs and/or vice chairs reported multiple FCOIs. Further research studies are necessary to determine the impact of these FCOIs.

No interest, no conflict

“…Commentaries exist as to the value of disclosures published in 6‐point font in journals for which one‐half the weight is drug advertising and slide flashes with durations shorter than reading speed in meetings for which the most ostentatious displays are not scientific. The fact that the current research article by Desai et al 1 describing FCOIs is of sufficient interest to be published suggests that superficial disclosure processes apply to guideline committees as well. Whether enhanced transparency can reduce bias is not known (at least to this author), but it is important to note that Desai et al point out that disclosure can have the unintended consequence of creating a moral license for biases 1 …”

“…The fact that the current research article by Desai et al 1 describing FCOIs is of sufficient interest to be published suggests that superficial disclosure processes apply to guideline committees as well. Whether enhanced transparency can reduce bias is not known (at least to this author), but it is important to note that Desai et al point out that disclosure can have the unintended consequence of creating a moral license for biases 1 …”

“…In this issue of Cancer , Desai et al have described the financial conflict of interest (FCOI) disclosures among panelists on the National Comprehensive Cancer Network (NCCN) clinical practice guidelines committees 1 . Not surprisingly, they documented that the vast majority of panelists complete their FCOI disclosures as required, but that nearly one‐half, including chairs, have declared FCOIs.…”

“…Not surprisingly, they documented that the vast majority of panelists complete their FCOI disclosures as required, but that nearly one‐half, including chairs, have declared FCOIs. The authors also clearly demonstrated how NCCN processes are not fully compliant with recommendations regarding FCOI management for guideline committees as promulgated by the Institute of Medicine (IOM) 1 …”

“…More specifically, Desai et al suggested that chairs and vice chairs should be free of all FCOIs, that committee members with FCOIs play a limited role in the rating process and be restricted from any formal voting on guidelines, and that the guidelines be rated according to standardized criteria (see for example https://www.leitlinienwatch.de/english-criteria/). 1 …”