Collaboration between physicians and industry is vital in developing effective cancer treatments; however, the oncology community is challenged to address the potential for bias in the guidelines as a significant percentage of guideline authors list financial conflicts of interest (FCOIs).1

Researchers from the University of North Carolina at Chapel Hill conducted a cross-sectional study of the data on FCOIs for National Comprehensive Cancer Network (NCCN) guideline authors, as reported in the Center for Medicare and Medicaid Services (CMS) Open Payments database to quantify the proportion of NCCN guideline authors with FCOIs and the amount authors received from industry sources.

For this study, the researchers reviewed 2014 FCOIs of 125 authors of treatment guidelines for the 4 cancers with the highest incidence in the United States: breast, colon, prostate, and lung.

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The study findings reveal that 86% (108) of guideline authors reported at least one financial conflict of interest, with a total value of $30,287,549. Approximately 84% of authors received general payments and 47% received research payments. More than half of the authors (70 [56%]) received $1000 or more in general payments.

General payments averaged $10,011 (range, $0-$106,859) and included payments for consulting, meals, and lodging. Industry research payments averaged $236,066 (range, $0-$2,756,713); payments included funding associated with clinical trials.

The NCCN requires its guideline panelists to adhere to annual limits of $20,000 from an individual corporation or $50,000 in total FCOIs, and most authors adhere to those limits. However, in this study, 6% (8) of authors received amounts that exceeded those limits.

The prevalence and monetary value of FCOIs among oncology guideline authors is significant, but the researchers point out some findings of note. Most payments were associated with research and therefore not paid directly to the physician. Considering that most research funding comes from industry, clinical trialists are almost mandated to accept these funds.

The researchers noted limitations to their study in that Open Payments only collects data on US physicians; therefore, information on payments to nonphysician guideline authors is not included and results are not generalizable to outside of the United States. In addition, some reported payments may have been in the form of grants from charitable organizations, payments for participating in NIH or cooperative group trials using donated drugs, or coauthoring manuscripts.

Given the prevalence of FCOIs among physician field experts, finding potential guideline authors without an FCOI is difficult. The researchers conclude that more studies are needed on which relationships are more likely to result in undue influence among guideline authors.


1. Mitchell AP, Basch EM, Dusetzina SB. Financial relationships with industry among National Comprehensive Cancer Network Guideline authors. JAMA Oncol. 2016 Aug 25. doi: 10.1001/jamaoncol.2016.2710. [Epub ahead of print]