Evidence Underlying Recommendations and Payments from Industry to Authors of the National Comprehensive Cancer Network Guidelines

• Published in: The oncologist (Dayton, Ohio) Vol. 24; no. 4; pp. 498 - 504
• Main Authors: Liu, Xu, Tang, Ling‐Long, Mao, Yan‐Ping, Liu, Qing, Sun, Ying, Chen, Lei, Lin, Jin‐Ching, Ma, Jun
• Format: Journal Article
• Language: English
• Published: Hoboken, USA John Wiley & Sons, Inc 01.04.2019
• Subjects: Authorship; Cancer chemotherapy; Cancer treatment; Clinical practice guidelines; Conflict of interest; Conflict of Interest - economics; Drug Industry - economics; Financial Support; Global Health and Cancer; Guideline Adherence; Guidelines as Topic - standards; Humans; Medical Oncology; National Comprehensive Cancer Network; Neoplasms - drug therapy; Neoplasms - economics; Open Payments database; Organizations, Nonprofit; Physicians - statistics & numerical data; Remuneration; United States; United States; Clinical practice guidelines; National Comprehensive Cancer Network; Cancer chemotherapy; Cancer treatment; Conflict of interest; Open Payments database
• ISSN: 1083-7159; 1549-490X; 1549-490X
• DOI: 10.1634/theoncologist.2017-0655

Background The National Comprehensive Cancer Network (NCCN) guidelines are among the most widely used guidance in oncology. It is critical to understand the extent to which the recommendations in these guidelines are supported by evidence and to investigate whether these recommendations have been influenced by payments from industry to authors. Materials and Methods We examined the quality and consistency of evidence, as scored by guidelines authors, for systemic treatment incorporated in the NCCN guidelines. Payments data in 2015 were manually ed using the Open Payments database, which discloses all payments between the industry and American physicians. Correlations between the percentage of authors who received payments and the proportion of recommendations developed from low‐level evidence per guideline were calculated using Spearman rank correlation. Results In total, 1,782 recommendations were identified in 29 guidelines, of which 1,282 (71.9%) were based on low‐quality or low‐consistency evidence (low‐level evidence), including “case reports or clinical experience only” (18.9%). A substantial proportion (31/143, 21.7%) of category 1 (the highest level) recommendations were based on low‐level evidence. The majority of authors (87.1%) received payments from industry. However, no association was found between the prevalence of payments among authors and the percentage of recommendations developed from low‐level evidence per guideline. Conclusion The majority of systemic treatment recommendations in the NCCN guidelines are based on low‐level evidence, including more than one in five category 1 recommendations. Payments from industry were prevalent among authors. However, industrial payments among authors were not associated with inclusion of regimen/agent for which there is no conclusive evidence in the guidelines. Implications for Practice The authors found that the majority (71.9%) of systemic treatment recommendations issued in the current National Comprehensive Cancer Network guidelines were based on low‐level evidence. Physicians should remain cautious when using current guidelines as the sole source guiding patient care decisions. 摘要 背景。国家综合癌症网络 (NCCN) 指南是肿瘤学领域使用最广泛的指南之一。了解此指南中的建议得到证据支持的程度并调查这些建议是否受到行业给作者付款的影响，这一点至关重要。 材料和方法。按照指南作者的评分，我们针对 NCCN 指南中的系统治疗检查了证据的质量和一致性。我们使用开放付款数据库手动提取 2015 年的付款数据，该数据库披露了制药行业和美国医生之间的所有付款。我们使用Spearman 等级相关来计算收到付款的作者的百分比与根据每个指南的低级证据提出的建议的百分比之间的相关性。 结果。我们在 29 个指南中找到 1 782 条建议，其中的 1 282 条建议 (71.9%) 以低质量或低一致性的证据(低级证据)为依据，包括“仅有病例报告或临床经验” (18.9%)。相当大比例(31/143，21.7%)的 1 类(最高级)建议以低级证据为依据。大部分作者 (87.1%) 会收到来自制药行业的付款。不过，我们未发现作者间付款的普及程度与根据每个指南的低级证据提出的建议的百分比之间存在关联。 结论。NCCN 指南中的大多数系统治疗建议以低级证据为依据，包括五分之一以上的 1 类建议。制药行业付款在作者间较为普遍。但是，作者间的制药行业付款与指南中包含没有决定性证据的疗法/药剂之情况无关。 实践意义:作者发现，现行国家综合癌症网络指南中发布的大多数系统治疗建议 (71.9%) 以低级证据为依据。医生在将现行指南作为指导患者医疗决策的唯一来源时，应该保持谨慎的态度。 In the field of oncology, the National Comprehensive Cancer Network (NCCN) guidelines are among the most comprehensive and widely used guidelines in clinical practice. This article reports on evidence supporting NCCN treatment recommendations, as well as potential financial conflicts of interest, which might influence treatment recommendations, among authors of the guidelines.