No Change in Radiation Oncologists' Interaction With Industry

Roxanne Nelson, RN, BSN

September 24, 2019

CHICAGO — Most (83%) radiation oncologists queried in a recent study said that they receive industry payments, and this number has not changed significantly during the period from 2014–2018.

"However, we did see a shift when we looked at the data for 2018 — there was about a 4% to 5% drop in physicians engaging with industry in that year," said lead author Deborah C. Marshall, MD, a radiation oncology resident at the Icahn School of Medicine at Mount Sinai in New York City.

The study was presented here at the 61st Annual Meeting of the American Society for Radiation Oncology (ASTRO).

Investigators evaluated trends in physician-level payments to see if the implementation of Open Payments has decreased interactions with industry and shifted the nature of interactions toward those that would be considered more appropriate.

The results show that payments from industry for consulting, accredited education, and honoraria increased, and that overall, there have not been significant shifts away from inappropriate relationships. The value of payments for non-continuing medical education (CME) speaker's fees, food/beverage, gifts, travel, and royalty/licensing fees remained high. 

"Overall, because we haven't seen any changes in radiation oncology, it may mean that they aren't in tune with open payments, for whatever reason, or they don't see these relationships as problematic," Marshall commented.

"Or most likely, there hasn't been enough of a translation of the open payments concept into practice by different organizations or as a group," she added.

"Our interpretation is that transparency alone isn't going to change behavior," Marshall told Medscape Medical News. "It needs to be translated through other mechanisms, such as professional organizations or media attention, but that has only happened in the past 2 or 3 years."

Tracking Payments

The Physician Payments Sunshine Act, which was included in the Affordable Care Act of 2010, mandated the creation of the publicly accessible Open Payments (OP) database, which is maintained by the Centers for Medicare & Medicaid Services (CMS).

This database tracks payments, ownership stakes, and other transfers of value to physicians, dentists, and teaching hospitals as they relate to medical device firms and pharmaceutical companies. Open Payments also tracks food and beverage and travel costs that are paid by these companies.

Earlier this year, Marshall and her colleagues presented similar research that looked at the effect of the OP database on medical oncologists. Overall, those findings showed that fewer American medical oncologists appeared to be engaging with industry, as reported by Medscape Medical News at the time.

"There has been huge change in organizations such as ASCO and ASTRO with the open payments policy, but that has only happened in the last couple of years," Marshall explained. "So we are expecting any shift on the physician level to occur within the next few years."

No Real Changes

For this study, Marshall and colleagues included over 4000 radiation oncologists practicing in 2014 as per the National Plan and Provider Enumeration System. They matched Open Payments data for general (nonresearch) payments between 2014 and 2018 with individual physicians, and then calculated the percentage of physicians receiving payments, annual value and number of payments, and annual trends.

The categories of payments included accredited education; charity; consulting; entertainment, meals, travel/lodging, or gifts; investment interest, royalty or licensing fees; and nonaccredited education.

All dollar amounts were adjusted for inflation, shown in 2014 US dollars.

During the period 2014–2018, the researchers found that 4028 radiation oncologists received 115,545 payments totaling $43.8 million. 

The median per physician payment was $130 and the median received by each physician was three payments annually.

Overall, the value and number of payments have not significantly changed among radiation oncologists; the value and number of payments in most of the selected payments categories also has not changed.

The authors note that the number of consulting payments increased significantly (P =.01) as did the value for honoraria (P = .01). The value of payments also remained high for categories that include non-CME speaker's fees, food/beverage, gifts, travel, and royalty/licensing fees.

Steps Needed for Improvement

Commenting on the study, Sue Yom, MD, PhD, radiation oncologist at the University of California San Francisco, emphasized that disclosure of conflicts of interest is a very complex issue.

"There are many different facets here that I think are pertinently highlighted, but the study can't correct for the many areas of uncertainty that still exist around this," she told Medscape Medical News.

One important aspect of this report is that the Sunshine Act was passed in 2010, with Open Payments beginning a few years afterward. However, the data in this abstract only goes back to 2014. "But as far as the cumulative effect, I would say that it is stable, although it does bounce around a little and you wonder if there are outlier factors that may be affecting these numbers," commented Yom, who was not involved with the study.

The second aspect is the definition of inappropriateness. "This can be very complicated, as there has to be some interaction between clinical investigators and a variety of funded sources," she said. "I think it's clear that the peer-reviewed, traditional funding sources are not going to be adequate to sustain the burgeoning research portfolio that we aim for in radiation oncology and the multidisciplinary nature of trials."

How to conduct these relationships, however, is a newer issue in radiation oncology, she noted.

"I think the omission in some cases isn't deliberate, and for some, it may be a product of ignorance, in that people may not really know what a relevant or meaningful disclosure is," Yom noted. "My advice is that in this current state of affairs, 'overdisclosure' is the way to go, as I'm not seeing that many physicians know about Open Payments or that this information is tracked."

As an example, physicians may be unaware that this cup of coffee is tracked or that the "little gift" that was picked up is also tracked. "There is just a lack of awareness around this and it does seem a little unfair to me to judge this behavior when people are unaware of how this works," she said.

There are several steps that can be taken to improve the situation, she suggested.

The first one, Yom explained, is to educate the radiation oncology community about Open Payments, about disclosure, and about what it all actually means — and to engage in a responsible manner with funding entities.

"The second is to make the guidelines clear on all levels on how to disclose those relationships and how to manage those relationships, not only in a technically ethical manner but a meaningfully ethical manner," she said.

Finally, on an organizational level, the role of disclosures needs to be strengthened. "There may a lack of value, consciousness around it, knowledge and education surrounding it," Yom said, "But these are larger issues and go beyond this paper."

Marshall has disclosed no relevant financial relationships. Yom has disclosed clinical trial funding from Genentech, Merck, Bristol-Myers Squibb, BioMimetix; consulting for Galera; and royalties from UpToDate and Springer.

American Society for Radiation Oncology (ASTRO) 2019 Annual Meeting: Abstract 3064. Presented September 17, 2019.

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