Placing oncology and conflicts of interest in a global context: Evidence from the large international ONCOTRUST-2 study.

Abstract

9042 Background: Conflicts of interest (COIs) arising from relationships between pharmaceutical industry and oncologists can influence clinical practice and research. Still, global patterns of COIs and disclosure practices remain unexplored. In this interim analysis of ONCOTRUST-2 study, we compared self-reported COI-related practices and financial relationships among oncologists practicing in high-income countries (HICs) versus low-/middle-income countries (LMICs). Methods: ONCOTRUST-2 is a multinational cross-sectional survey (January 2024–January 2026) targeting oncologists with at >1 year of experience from LMICs and HICs. Data were collected using snowball sampling through established professional networks and scientific societies. Multivariable logistic regression models were fitted, adjusting for years of professional experience, specialty, current position/seniority, frequency of pharmaceutical industry visits, and the presence of local COI regulations/policies. We report adjusted odds ratios (aORs) with 95% confidence intervals, using a significance threshold of p < 0.05. Findings are reported in accordance with the CROSS guidelines. Results: A total of 678 oncologists responded to the survey (LMICs: 63.9; HICs: 36.1%) mainly in medical oncology (48.7%), clinical oncology (15.9%) and radiation oncology specialties (15.5%). After adjustment for experience, specialty, position, pharma-visit frequency, and local COI policy presence, HIC oncologists reported higher prevalence of higher-profile industry relationships, including consulting/advisory roles (aOR 2.13, CI: 1.45–3.13; p < 0.001) and honoraria/consulting payments (aOR 2.77, CI: 1.29–5.98; p = 0.009). Trips/accommodation support was also more common in HICs (aOR 1.52, CI:1.07–2.17; p = 0.021). A marked gradient was observed for payment magnitude. HICs oncologists were less likely to report no money received (aOR 0.37, CI 0.25–0.54; p < 0.001) and more likely to report receiving $2,000–$5,000 (aOR 6.96, 95% CI 3.08–15.75; p < 0.001) or > $5,000 (aOR 17.23, 95% CI 4.92–60.32; p < 0.001). HICs oncologists reported better COIs disclosure in key academic settings. COIs disclosure before presentations was more common in HICs (aOR 2.72, 95% CI 1.81–4.09; p < 0.001), and disclosure in publications was also higher (aOR 1.92, CI: 1.32–2.79; p < 0.001) than in LMICs. Reporting non-disclosure was also less frequent in HICs (aOR 0.44, 95% CI 0.25–0.77; p = 0.004). Conclusions: Oncologists in HICs reported both greater engagement with and better COI disclosure compared with LMICs. These findings suggest that global COI policies and disclosure infrastructures may differ by national economic context and should be strengthened, with attention to equitable, context-appropriate implementation, regulation governance of COI in LMIC settings.