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Does Cancer Literature Reflect Multidisciplinary Practice? A Systematic Review of Oncology Studies in the Medical Literature Over a 20-Year Period

This work was presented in abstract form at the 96th Annual Meeting of the American Radium Society, April 27, 2014, St Thomas, US Virgin Islands.
https://doi.org/10.1016/j.ijrobp.2015.03.011Get rights and content

Purpose

Quality cancer care is best delivered through a multidisciplinary approach requiring awareness of current evidence for all oncologic specialties. The highest impact journals often disseminate such information, so the distribution and characteristics of oncology studies by primary intervention (local therapies, systemic therapies, and targeted agents) were evaluated in 10 high-impact journals over a 20-year period.

Methods and Materials

Articles published in 1994, 2004, and 2014 in New England Journal of Medicine, Lancet, Journal of the American Medical Association, Lancet Oncology, Journal of Clinical Oncology, Annals of Oncology, Radiotherapy and Oncology, International Journal of Radiation Oncology, Biology, Physics, Annals of Surgical Oncology, and European Journal of Surgical Oncology were identified. Included studies were prospectively conducted and evaluated a therapeutic intervention.

Results

A total of 960 studies were included: 240 (25%) investigated local therapies, 551 (57.4%) investigated systemic therapies, and 169 (17.6%) investigated targeted therapies. More local therapy trials (n=185 [77.1%]) evaluated definitive, primary treatment than systemic (n=178 [32.3%]) or targeted therapy trials (n=38 [22.5%]; P<.001). Local therapy trials (n=16 [6.7%]) also had significantly lower rates of industry funding than systemic (n=207 [37.6%]) and targeted therapy trials (n=129 [76.3%]; P<.001). Targeted therapy trials represented 5 (2%), 38 (10.2%), and 126 (38%) of those published in 1994, 2004, and 2014, respectively (P<.001), and industry-funded 48 (18.9%), 122 (32.6%), and 182 (54.8%) trials, respectively (P<.001). Compared to publication of systemic therapy trial articles, articles investigating local therapy (odds ratio: 0.025 [95% confidence interval: 0.012-0.048]; P<.001) were less likely to be found in high-impact general medical journals.

Conclusions

Fewer studies evaluating local therapies, such as surgery and radiation, are published in high-impact oncology and medicine literature. Further research and attention are necessary to guide efforts promoting appropriate representation of all oncology studies in high-impact, broad-readership journals.

Introduction

Cancer is best treated by a multidisciplinary team consisting of surgeons, medical oncologists, and radiation oncologists (1). Although each oncologic specialist brings her or his own expertise and experience to the tumor board discussion, articles published in high-impact general oncology and medicine journals often become the common language spoken by the members of a patient's oncologic team. As such, studies published in high-impact general oncology and medicine journals have the potential to significantly alter practice and referral patterns and inform multidisciplinary discussions. In keeping, patterns of referral for radiation therapy have been shown to be influenced by the referring medical oncologists' familiarity of the indications for and logistics of radiation therapy regimens 2, 3.

Although it has been shown that cancer studies enjoy disproportionately high representation in high-impact journals (4), limited information is available regarding the relative representation of different cancer treatment modalities. One study did evaluate trends in the publication of pharmacotherapy, radiation therapy, and surgery studies in head and neck cancer research (5). The authors found that because US government sponsorship of oncology research has declined, industry has become the predominant funding source for prospective trials, and industry largely supports studies evaluating pharmacotherapy (5). We hypothesized that fewer prospective trials evaluating local therapies are being published in high-impact general medicine and general oncology journals and that part of the reason for this discrepancy may be disproportionate industry and commercial sponsorship. Other factors that may contribute to decreased numbers of surgery and radiation studies could include differences in perceived study “quality” as defined by factors such as randomized trial design, primary endpoint, number of patients, and length of follow-up.

This study evaluated the distribution of oncology publications that assessed a therapeutic intervention (local, systemic, or targeted therapies) across 3 general medicine, 3 general oncology, 2 radiation oncology, and 2 surgical oncology journals over 3 time points: 1994, 2004, and 2014. In addition, we assessed study characteristics such as disease setting, trial design, primary endpoint, study outcome, number of patients, duration of follow-up, receipt of industry funding and number of citations.

Section snippets

Methods and Materials

The Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) was followed in the planning, implementation, and reporting of this systematic review (6). Ten journals (general medicine, general oncology, radiation oncology, and surgical oncology) were chosen for analysis based on their impact factor, broad readership, and potential to impact practice. Included were 3 general medicine journals: New England Journal of Medicine (NEJM), Lancet (Lancet), and Journal of the American

Results

A total of 8460 articles were published in the included journals during the study period of interest. A total of 7500 articles were excluded (Fig. 1), and 960 prospective studies (11.3%) were included for analysis. Of the 960 studies included, 68 studies (7.1%) were published in general medicine journals, 692 studies (72.1%) were published in general oncology journals, 164 studies (17.1%) were published in radiation oncology journals, and 36 studies (3.8%) were published in surgical oncology

Discussion

This descriptive, bibliometric study of prospective clinical trials assessing a therapeutic intervention found local therapy trials comprised only a minority of publications. Additionally, targeted and systemic therapy trials had higher rates of industry funding than local therapy trials. Targeted therapy trials comprised 2%, 10%, and nearly 40% of the total included publications in 1994, 2004, and 2014, respectively. The number of industry-funded trials likewise increased over time. On

Conclusions

Therapeutic clinical trials evaluating local cancer therapies such as radiation and surgery are less frequently published in the highly visible, broad-impact, general medical and oncologic journals. Because the care of cancer patients is a “team sport,” the visibility and accessibility of radiation and surgery literature is important when it comes to educating referring and co-managing physicians in the role of local therapy in multidisciplinary care. We hope these data will prove useful to all

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    Conflict of interest: none.

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