Look Here: 20 US Cancer Centers Tally 86% of Ad Dollars

Nick Mulcahy

July 11, 2016

In the United States, a minority of cancer centers spend the vast majority of the total advertising dollars by all such centers, according to a new study published online July 11 in JAMA Internal Medicine.

Researchers looked at spending over the last 10 years and found that it more than tripled from 2005 ($54 million total) to 2014 ($173 million total). During that time, 890 cancer centers in the United States advertised to the public via television, magazines, radio, newspapers, billboards, and the Internet.

However, a small group of big spenders dominates the ads.

In 2014, 20 cancer centers accounted for 86% of the total advertising spending, report the authors, led by Laura B. Vater, MPH, from the Indiana University School of Medicine in Indianapolis.

"We were surprised that cancer center advertising more than tripled since 2005 and that spending was so highly concentrated among a small proportion of cancer centers," Vater told Medscape Medical News.

Top of the list in 2014 was the Cancer Treatment Centers of America (CTCA), a network of five hospitals, which spent $101.7 million (59% of total US cancer center spending for the year).

MD Anderson Cancer Center, which has four locations, including Houston, was number two and spent $13.9 million.

Memorial Sloan Kettering Cancer Center in New York City was third, at $9.1 million.

The fourth largest spender was Fox Chase Cancer Center in Philadelphia at $3.5 million. Texas Oncology, which has four locations, was fifth at $3.4 million. (See table below for full list.)

An ongoing problem is that some ads are misleading or potentially misleading, say Lisa M. Schwartz, MD, MS, and Steven Woloshin, MD, MS, from the Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, New Hampshire, in an accompanying editorial.

They criticize multiple ads, including one from Winthrop NYCyberKnife Center in New York City, which was number 10 on the 2014 ad expenditure list, with a total of $1.3 million in spending.

In the Winthrop ad, the prostate cancer radiotherapy Cyberknife is described as the "biggest advance in prostate cancer treatment in a decade…no cutting, no pain, no incontinence." But as the editorialists point out, Accuray, the maker of CyberKnife, indicates on their company website that urinary retention, incontinence, and erectile dysfunction are potential early or late adverse effects.

Ads that describe exceptional patient outcomes are also common and troubling for an obvious reason — they unrealistically heighten hope, Dr Schwartz and Dr Woloshin say.

Cancer center ads that use emotional appeals and highlight atypical outcomes were the subject of a Medscape Business of Medicine special feature in 2014.

Study author Vater says that some experts believe the ads could stimulate increased healthcare costs.

"There is a concern that cancer center advertising may mislead patients about available treatment options, increase the demand for unnecessary tests or treatment, and increase healthcare costs," she explained.

The editorialists also suggest that there should be more efforts to police "problematic" advertising. They say that the Federal Trade Commission (FTC) could issue more ad guidelines and state attorneys general could prosecute more deceptive ads.

However, Dr Schwartz and Dr Woloshin found little evidence of active intervention. The pair searched the websites of the attorneys general in all 50 states and of the FTC and uncovered only one major action by the latter.

In 1996, the FTC took action against CTCA for making "misleading and unsubstantiated claims that their patients had among the highest recorded 5-year survival rates," according to the editorialists.

Nevertheless, CTCA still advertises their survival rates in a way that a 2014 report from Reuters described as "rosy."

The editorialists explain that online CTCA statistics are compared to national averages (from the National Cancer Institute data) but have "substantial selection bias" because their patients have high socioeconomic status, among other reasons.

Both the editorialists and study author Vater believe that patients with cancer are "vulnerable" and therefore especially open to manipulation from ads.

In conclusion, the editorialists make an appeal about cancer center ads to their fellow healthcare providers: "Expenditures on cancer center advertising are likely to continue to increase. Why can't the advertisements get better?"

But Vater explained that current business concerns, such as increasing healthcare costs and decreasing reimbursement rates, can be pressing.

"Healthcare organizations may strive to increase patient volume for cancer care (a highly profitable clinical service) to offset declining revenue. Advertising may be one strategy used to improve cancer center recognition and attract patients in an increasingly competitive environment," she said.

Table. US Cancer Centers: 2014 Total Ad Spending

Rank Cancer Center Location Millions of Dollars
1 Cancer Treatment Centers of America Multiple 101.7
2 MD Anderson Cancer Center Multiple 13.9
3 Memorial Sloan Kettering Cancer Center New York City 9.1
4 Fox Chase Cancer Center Philadelphia 3.5
5 Texas Oncology Multiple 3.4
6 Huntsman Cancer Institute Salt Lake City, Utah 2.2
7 Sutter Cancer Center Multiple 2.1
8 Dana-Faber Cancer Institute Boston 1.8
9 CCS Oncology Buffalo, New York 1.5
10 Winthrop NYCyberKnife Center New York City 1.3
11 CDH Proton Center Chicago 1.3
12 Seattle Cancer Care Alliance Clinic Seattle 1.0
13 H. Lee Moffitt Cancer Center Tampa, Florida 0.9
14 Edward Cancer Center Chicago 0.9
15 Florida Cancer Specialists Multiple 0.9
16 Fred Hutchison Cancer Research Center Seattle 0.8
17 University of Florida Proton Therapy Institute Multiple 0.8
18 Kennedy Cancer Center Philadelphia 0.8
19 Swedish Cancer Institute Seattle 0.7
20 James Cancer Hospital Columbus Columbus, Ohio 0.6


The authors and editorialists have disclosed no relevant financial relationships.

JAMA Intern Med. Published online July 11, 2016. Abstract Editorial

Follow Medscape senior journalist Nick Mulcahy on Twitter: @MulcahyNick.

Follow Medscape Oncology on Twitter: @MedscapeOnc


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