Over $20 Million Paid to a Select Group of Top U.S. Oncologists

A small proportion of medical oncologists, many in leadership roles, received millions of dollars in payments from pharmacuetical companies, according to a retrospective cohort study.

In 2018, 139 medical oncologists — representing 1% of all U.S. oncologists — received over $100,000 in general payments, with a median payment of $154,613 (interquartile range $117,436-$207,046) and a total payment of $24.2 million, which included consulting fees, speaking fees, honoraria, and travel expenses, reported Christopher Booth, MD, of Queen’s University in Kingston, Canada, and colleagues in JCO Oncology Practice.

“These physicians hold important leadership positions, draft treatment guidelines, and are often on journal editorial boards,” Booth told MedPage Today in an email. “The findings identify a risk for perceived and real conflict of interest. Because of the leadership positions they hold, the potential impact of this small group of physicians on oncology practice and policy may be substantial.”

Booth and co-authors noted that revenue from pharmaceutical oncology drugs has increased by 70% over the past decade, and that the number and value of those payments to oncologists has also increased. While this small number of physicians received a disproportionate amount of industry payments, the team also identified a total of 52,441 physicians who received modest payments (median $109) related to oncology drugs from 2016 to 2018.

Since even small payments have been found to influence prescribing practices, the higher value payments to the selected group of physicians with leadership roles were “worrisome,” Booth said.

For this study, the researchers used the Open Payments dataset from CMS to identify all U.S. oncologists and hematologists who received more than $100,000 from pharmaceutical companies in 2018. They narrowed their search to payments made for oncology-based drugs, and only counted payments that were tied to drugs specifically used for cancer treatment. They excluded any payments made for devices or medical supplies, or any payments related to research, business ownership, or investment interests.

Based on that criteria, they identified 139 physicians who received at least six figures in payments in 2018. Among those physicians, 132 (95%) were active in clinical work, and 78 (56%) worked in an academic setting.

Furthermore, 43 (31%) of those physicians worked at National Cancer Institute-designated cancer centers, and 32 (23%) worked in National Comprehensive Cancer Network centers.

Additionally, 84 of these physicians (60%) currently hold or previously held leadership positions in their hospitals, 33 (24%) had served on journal editorial boards, and 29 (21%) had held leadership positions in specialty associations over the last 5 years.

“What happens next will require some soul searching within the oncology community,” Booth said. “Oncology specialty associations, guideline panels, and journal editorial boards should re-consider if it is appropriate for physicians with such large payments to hold these high-profile positions. It is unlikely that patients and the general public would look favorably upon industry relationships that involve hundreds of thousands of dollars.”