Trends in enforcement of National Comprehensive Cancer Network financial conflict of interest policy.

Background: The National Comprehensive Cancer Network (NCCN) financial conflict of interest (FCOI) policy sets dollar maximums for panelists, but violations may occur.

Methods: We studied NCCN Guidelines panelists for the 20 most prevalent cancers, 2013-2022. We included panelists with at least 1 full calendar year of service ("current panelists") and those who began service during the study period ("new panelists"); NCCN FCOI policy limits ($20 000 from any single company or $50 000 across all companies) apply to both groups. Industry payments were obtained from Open Payments and mapped manually via National Provider Identifier. We calculated industry payments received, excluding the same payment categories as does NCCN (research, meals, travel and lodging). We estimated whether panelists received payments exceeding NCCN limits ("violation"). As a proxy for whether panelists were subsequently disqualified as stipulated, we measured continued service for at least 1 full calendar year ("retention") subsequent to an estimated violation. We analyzed retention before and after 2016, due to increased scrutiny on NCCN FCOI in 2016.

Results: The annual proportion of current panelists with estimated violations ranged between 0.5% (2020) and 5.8% (2016). Among panelists who did vs did not have violations, retention was 83.6% vs 88.5% during 2014-2015 (odds ratio [OR] = 0.55, 95% CI = 0.26 to 1.31) and 46.6% vs 89.4% during 2017-2020 (OR = 0.10, 95% CI = 0.06 to 0.17). Among new panelists, 2.7% (5/185) had prior-year violations during 2014-2015, as did 5.5% (18/330) during 2017-2021.

Conclusions: Each year, a small portion of panelists receive industry payments exceeding NCCN limits. Since 2016, the likelihood that such panelists will continue to serve has decreased substantially.