Cancer drug choices tied to drugmaker payouts to doctors

(Reuters Health) - Some oncologists may be more likely to prescribe certain cancer medicines when they receive payments from the companies that make these drugs, a U.S. study suggests.

Researchers examined data on payments drug companies made to doctors in 2013 for research funding as well general payments such as gifts, fees for speaking or consulting work, meals or travel. Then, researchers looked at how often doctors prescribed different drugs for two types of cancers with multiple treatment options: kidney cancer and a rare blood cell cancer known as chronic myeloid leukemia.

Compared to physicians who didn’t receive any payments from the manufacturers of those drugs, those who did were 84 percent more likely to prescribe a kidney medication from those companies, the study found.

Payments from manufacturers were also associated with 31 percent greater likelihood that doctors would choose one of their drugs for chronic myeloid leukemia.

“While others have studied industry payments in relation (to) prescribing of other kinds of drugs, like blood pressure and cholesterol medications, ours is the first study examining oncology drugs,” said senior study author Stacie Dusetzina, a researcher at Vanderbilt University Medical Center and the Vanderbilt-Ingram Cancer Center in Nashville, Tennessee.

“Because oncology is a high-risk disease area and the drugs are very expensive, decisions about prescribing should ideally be determined by a doctor-patient discussion that is free from outside influences,” Dusetzina said by email.

Physicians and teaching hospitals receive approximately $7 billion each year from the pharmaceutical industry. While these payments have long been associated with prescriptions for more expensive brand-name drugs, the extent of this link for cancer drugs in particular has been unclear, researchers note in JAMA Internal Medicine.

Data for the current study came from the U.S. Centers for Medicare and Medicaid.

The researchers focused on three drugs used to treat kidney cancer: sorafenib (Nexavar), sunitinib malate (Sutent), and pazopanib hydrochloride (Votrient). They also looked at three drugs for chronic myeloid leukemia: dasatinib (Sprycel), imatinib mesylate (Gleevec), and nilotinib hydrochloride monohydrate (Tasigna).

Among the 354 physicians prescribing kidney cancer drugs, 32, or 9 percent, received research funding and 89, or 25 percent, received general payments for things like meals, travel or speaking or consulting gigs.

For the 2,225 doctors prescribing leukemia drugs, 38, or 4 percent, received research funding and 879, or 40 percent, received general payments.

Receipt of research payments was associated with increased prescribing for kidney cancer but not leukemia.

Results varied for individual medicines in the study.

The study wasn’t a controlled experiment designed to prove whether or how research funding or other payments from drug companies directly influences the medicines doctors prescribe for cancer.

Another limitation is that researchers lacked data on the exact diagnoses that prompted prescriptions, the authors note. They also had limited data on research funding.

Still, the results highlight the potential for company payments to influence doctors’ treatment decisions, said Dr. Yoram Unguru of the Johns Hopkins Berman Institute of Bioethics in Baltimore, who wasn’t involved in the study.

“Patients trust that their physicians will make objective and evidence-based decisions on their behalf, which reflect their interests and that these decisions will also limit harms,” Unguru said by email.

“Gifts (payment) cloud our ability to remain objective and as such, (negatively) influence the patient-provider relationship, in particular trust that physicians will place patients’ needs primary,” Unguru added.

While it’s possible physicians might not deliberately change treatment decisions based on drugmaker payments, the potential is still troubling, said Dr. Reshma Jagsi, director of the Center for Bioethics and Social Sciences in Medicine at the University of Michigan in Ann Arbor.

“Each drug has a unique risks and benefit profile, even when considering two drugs from the same class, and often costs to the patient and society vary as well,” Jagsi, who wasn’t involved in the study, said by email.

SOURCE: JAMA Internal Medicine, online April 9, 2018.