Conflict of Interest and Oncology Guidelines

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“There is no greater threat to the integrity of the clinical research enterprise than the appearance or reality of a conflict of interest—be it financial, academic, or scientific.”1 This is from the American Society for Clinical Oncology (ASCO) guideline on oversight of clinical research, and it would seem to apply also for the NCCN guidelines, which are created by experts from leading academic oncology centers and built on results of research and clinical judgment.Public scrutiny of conflict of interest in medicine is at an all-time high, fueled by expanding concerns over relationships between industry and physicians and ignited by reports of abuses. Ethicists note that conflict of interest rules are designed to maintain the “integrity of professional judgment” and to “minimize conditions” that would cause others to question that judgment.2 Rules center on disclosing, managing, and, when necessary, prohibiting conflicts. Yet research studies have shown tremendously variable practices, including how conflicts are classified and reported, monetary values permitted, and the management of potential conflicts.3,4Greater transparency in conflict of interest management is important. In response to these evolving concerns, NCCN recently revised its conflict of interest practices (http://www.nccn. org/about/disclosure.asp). Instead of reporting the entire panel membership conflicts as an aggregate statement, NCCN has begun reporting individual disclosures for each panel member. Other oncology organizations, such as ASCO, are also revising conflict of interest policies for individuals on guideline committees.Furthermore, these steps are only part of a growing roster of probable changes in how potential conflicts are reported and...

Harold J. Burstein, MD, PhD, editor-in-chief of JNCCN, is an Associate Professor of Medicine at Harvard Medical School and a medical oncologist at Dana-Farber Cancer Institute and Brigham & Women's Hospital. He is a clinician and clinical investigator specializing in breast cancer.

Dr. Burstein attended Harvard College and earned his MD at Harvard Medical School, where he also earned a PhD in immunology. He trained in internal medicine at Massachusetts General Hospital and was a fellow in medical oncology at Dana-Farber before joining the staff.

Dr. Burstein's clinical research interests include novel treatments for early- and advanced-stage breast cancer and studies of quality of life and health behavior among women with breast cancer. He has written widely on breast cancer in both traditional medical journals and on the web, including New England Journal of Medicine and Journal of Clinical Oncology. International committees focusing on cancer treatments that he has or continues to participate in include the NCCN Clinical Practice Guidelines Breast Cancer Panel, St. Gallen Breast Cancer Panel, CALGB Breast Cancer Committee, ASCO Health Services Research and Clinical Research Committees, the National Quality Forum Breast Cancer Technical Panel, and other ASCO expert panels.

  • 1.

    American Society of Clinical Oncology Policy Statement: oversight of clinical research. J Clin Oncol 2003;21:23772386.

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    Emanuel EJ, Thompson DF. The concept of conflict of interest. In: Emanuel EJ, et al. eds, The Oxford Textbook of Clinical Research Ethics. New York: Oxford University Press; 2008:758766.

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  • 3.

    Lo B, Wolf LE, Berkeley A. Conflict of interest policies for investigators in clinical trials. N Engl J Med 2000;343:16161620.

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    Cho MK, Shohara R, Schissel A, Rennie D. Policies on faculty conflict of interest at US universities. JAMA 2000;284:22032208.

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    Moses H, Braunwald E, Martin JB, Their SO. Collaborating with industry: choices for the academic medical center. N Engl J Med 2002;347:13711375.

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