Over three quarters of Australian cancer specialists interact with a drug company rep at least monthly and two thirds have received some form of pharma funding in their career, researchers have found.

But only a minority believe there is anything problematic in the relationship between the medical oncology and haematology specialties and the pharmaceutical industry.

The findings were based on a survey answered by 116 Australian cancer physicians and trainees two years ago on their interactions with industry.

Some 19% of respondents said interaction with sales reps had influenced their patient management, most frequently by informing them of drug funding changes or access to compassionate access programs.

Around the same number (18%), said their patient care was influenced by industry-sponsored educational events, although this was mostly in response to literature presented or information received from speakers at the events.

Writing in JCO Oncology Practice, researchers led by medical oncologist Dr Adrian Pokorny noted that 70% respondents believed that drug company interactions could influence prescribing, while simultaneously denying any impact on their own decisions.

“Although most study participants accepted and acknowledged the influence of industry over practice, few saw this as a potential detriment to patient care,” they wrote.

“Indeed … the overwhelming majority saw drug access programs as beneficial, appearing not to consider the possibility that such medications may not be available on funded schedules because of poor risk-benefit profiles, high cost, or lack of cost-effectiveness.”

“We also found that a majority of respondents reported having received nonresearch payments from industry, suggesting that financial conflicts, historical or current, are widespread among medical oncologists and haematologists.”

Cause for concern

With revenue from the sale of cancer drugs nearly doubling in the past decade, the authors said there was reason for concern over the impact of doctors’ drug company ties on patient care.

“We also found that physicians who reported that their prescribing was influenced were more likely to receive payments,” they added.

“This relationship was surprising and may be due to reversed causality, with known prescribers of a company’s drug being targeted by that company, for example, to reinforce this behaviour.”

“Alternatively, this may simply be representative of sponsorship working as intended, but, if so, this suggests that sponsored Australian cancer physicians do acknowledge that their prescribing is affected. In that case, their acceptance of sponsorship is perplexing, given the ramifications for patient care.”

The study was authored by a team comprising three medical oncologists – including MOGA Chair Dr Deme Karikios – and the transparency activist and academic Ray Moynihan, as well as other researchers.

Noting that less than half of all respondents demonstrated awareness of AMA, RACP or institutional guidelines on managing interactions with the pharmaceutical industry, they said the findings were troubling and suggested close relationships had become “seemingly normalised” between cancer physicians and industry.

“Ideally, patients could receive benefits such as access to new, safe, and effective drugs and participate in clinical trials without the risk of their treating practitioners being influenced by industry,” they wrote.

“For this to occur, major regulatory and cultural changes need to take place in cancer medicine.”