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Purpose The Open Payments transparency program publishes data on industry-physician payments, in part to discourage relationships considered inappropriate including gifts, meals, and speaker’s bureau fees. We evaluated trends in physician-level payments to test whether implementation of Open Payments resulted in fewer industry–radiation oncologist (RO) interactions or shifted interactions toward those considered more appropriate compared with medical oncologists (MOs) and other hospital-based physicians (HBPs). Methods and Materials We performed a retrospective, population-based cohort study of practicing US ROs versus MOs and HBPs in 2014 matched to general (nonresearch) payments between 2014 and 2018. Trends in payments were analyzed and reported by nature of payment. Values of payments to ROs from the top 10 companies were identified. Results From 2014 to 2018, 3379 (90.3%) ROs accepted 106,930 payments totaling $40.8 million. The per-physician number and value of payments was lower in radiation oncology than in medical oncology and higher than HBPs. The proportion of ROs accepting payments increased from 61.8% in 2014 to 64.2% in 2018; the proportion of MOs accepting payments decreased from 78.7% to 77.7%; and the proportion of HBPs decreased from 40.8% to 37.5%, respectively. The annual per-physician value and number of payments accepted by ROs and MOs increased. Payments in entertainment, meals, travel and lodging, and gifts increased among ROs and remained stable or decreased among MOs and HBPs. Consulting payments increased across all groups. Top RO payors produced novel cancer therapeutics, hydrogel spacers, radiation treatment machines, and opioids. Conclusions Industry payments to ROs have become more common since OP’s inception, while becoming less common for MOs and HBPs. Payments to ROs and MOs have become more frequent and of modestly increasing value compared with other HBPs, for whom the value is decreasing. No large changes in the nature of relationships were seen in ROs. Increased engagement with financial conflicts of interest is needed in radiation oncology.

Sexual function is a vital aspect of human health and is recognized as a critical component of cancer survivorship. Understanding and evaluating the impacts of radiotherapy on female sexual function requires precise knowledge of the organs involved in sexual function and the relationship between radiotherapy exposure and sexual tissue function. Although substantial evidence exists describing the impact of radiotherapy on male erectile tissues and related clinical sexual outcomes, there is very little research in this area in females. The lack of biomedical data in female patients makes it difficult to design studies aimed at optimizing sexual function postradiotherapy for female pelvic malignancies. This scoping review identifies and categorizes current research on the impacts of radiotherapy on normal female erectile tissues, including damage to normal functioning, clinical outcomes of radiation-related female erectile tissue damage, and techniques to spare erectile tissues or therapies to treat such damage. An evaluation of the evidence was performed, and a summary of findings was generated according to Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) Extension for Scoping Reviews guidelines. Articles were included in the review that involved normal female erectile tissues and radiotherapy side effects. The results show that little scientific investigation into the impacts of radiotherapy on female erectile tissues has been performed. Collaborative scientific investigations by clinical, basic, and behavioral scientists in oncology and radiotherapy are needed to generate radiobiologic and clinical evidence to advance prospective evaluation, prevention, and mitigation strategies that may improve sexual outcomes in female patients.

IMPORTANCE: Given the potential for undue influence of industry-physician payments on oncology care, it is important to understand how a national transparency program may be associated with financial interactions between industry and medical oncologists. OBJECTIVE: To identify trends in industry payments to medical oncologists from 2014 to 2019 and determine if the implementation of the Open Payments program is associated with changes in the frequency or value of payments or any shift in the nature of industry-oncologist financial interactions. DESIGN, SETTING, AND PARTICIPANTS: This retrospective, population-based, observational cohort study analyzed Open Payments reports of industry payments made in 2014 to 2019 to a cohort of licensed medical oncologists practicing in the US in 2014, using data from the National Plan and Provider Enumeration System. EXPOSURES: Receipt of an industry payment from January 1, 2014, to December 31, 2019. MAIN OUTCOMES AND MEASURES: General industry payments to medical oncologists, including the proportion receiving payments, total annual value and number of payments, and average annual trends over time, by aggregate value and by nature-of-payment category. Trends over time were analyzed using linear regression and generalized estimating equations. RESULTS: In 2014 to 2019, there were 15 585 medical oncologists who received a total of 2.2 million industry payments with a total value of $509 million. The absolute number of oncologists receiving payments decreased from 10 498 in 2014 to 8918 in 2019 (−15.1%). The annual per-physician payment value decreased among those receiving less than $10 000 in aggregate by −3.2% yearly (95% CI, −4.1% to −2.3%; P

This study uses Medicare Open Payments data to characterize trends in the prevalence and value of physicians’ interactions with industry overall and by specialty between January 2014 and December 2018 after implementation of the federal Open Payments transparency program in 2013.

e14126 Background: The U.S. Department of Health and Human Services recently proposed to eliminate federal protections against discrimination in healthcare on the basis of gender identity. This proposal seeks to alter the Patient Protection and Affordable Care Act Section 1557 Rule, which currently prohibits sex discrimination in any health program receiving federal financial assistance. The provisional change poses imminent threats to transgender and gender diverse (TGD) communities who face discrimination in healthcare, and in cancer care specifically. If current federal protections are eliminated, enacting local non-discrimination policies may safeguard TGD individuals’ rights to access safe equitable cancer care. To determine the need for local policy change, we sought to assess the current protections based on gender identity and expression for patients at National Cancer Institute (NCI)-Designated Cancer Centers. Methods: Publicly available hospital non-discrimination policies and Patients’ Bill of Rights were examined from the main affiliated hospitals of each of the 62 NCI-Designated Cancer Centers, excluding laboratories. The policies were classified as clearly including gender identity and expression or not. McNemar’s Test calculated differences between non-discrimination policies and Patient’ Bill of Rights. Results: Of 62 institutions, 30 (48.4%) clearly included gender identity and expression in their hospital non-discrimination policies, whereas 45 (72.6%) included gender identity and expression in their Patients’ Bill of Rights ( p= 0.014). Thirty-seven (59.7%) institutions included gender identity and expression in only one of the documents (Table). Conclusions: NCI-Designated Cancer Centers do not consistently include gender identity and expression in publicly available non-discrimination documents. The discrepancy between Patients’ Bill of Rights documents and hospital non-discrimination policies suggests a difference between what institutions outwardly convey to patients and what they operationalize in their legal documents. Paired outcomes from 62 independent NCI-Designated Cancer Centers. [Table: see text]

6520 Background: Industry-physician financial relationships in medical oncology are common and introduce conflicts of interest. The Open Payments (OP) program collects and discloses data on industry payments to physicians, in part to discourage inappropriate relationships. However, the effect of OP on how oncologists engage with industry is unknown. Our aim was to evaluate trends in physician-level payments to test whether the implementation of OP has resulted in fewer physicians engaging with industry and has shifted the nature of interactions towards those considered more appropriate. Methods: We performed a retrospective cohort study of US medical oncologists in 2014 from the National Plan and Provider Enumeration System. OP data for general (non-research) payments between 2014-2017 were matched to physician to evaluate receipt of payments over time. We calculated the percentage of physicians receiving payments, annual value and number of payments, and average annual trends over time, including by nature of payment. Results: From 2014-2017, medical oncologists received 1.4 million industry payments totaling $330.6 million. The absolute number of medical oncologists receiving payments decreased 4% on average annually ( P= .006), and proportionally from 67.2% to 59.6% overall. The value and number of payments have not significantly changed. The value and number of payments increased for accredited/certified CME (+821% and +209% annually) and decreased for non-accredited/certified CME (-18% and -25% annually). The value and number of food/beverage payments remained the same. The value and number of royalty/licensing payments increased. Conclusions: Fewer oncologists are receiving payments, but spending has not decreased suggesting that physicians are less likely to engage and industry is more selective. Increased payments for accredited CME suggest that less appropriate speaker’s fees are being avoided. Food/beverage payments are not decreasing, thus these interactions may not be recognized as problematic. Increasing royalty/licensing payments require ongoing scrutiny. Changes in physician payments since the inception of OP highlight the importance of transparency in policymaking.

Background The relationship between margin distance and recurrence and survival for stage I non-small cell lung carcinoma (NSCLC) less than or equal to 2 cm is not clear. Methods Patient clinicopathologic data were reviewed from a pooled data set of stage I NSCLC lesions less than or equal to 2 cm resected by wedge resection at Brigham and Women's Hospital (BWH) between 2000 and 2005 and the International Early Lung and Cardiac Action Program (I-ELCAP) between 1999 and 2015. Multivariable models were constructed to evaluate the relationship between margin distance and recurrence and survival, adjusting for patient age, sex, tumor size, and histologic type. Optimal margin distance was determined for recurrence-free and overall survival using maximum χ 2 values among survival distributions. Results Of 182 cases, 138 tumors had margin distance reported (113 BWH and 25 I-ELCAP). The average tumor size was 13.3 mm, and margin distance was 8.3 mm. During a mean follow-up of 49.6 months, there were 33 recurrences and 59 deaths. Increased margin distance was independently associated with lower risk of recurrence (odds ratio [OR], 0.90; 95% confidence interval [CI], 0.83–0.98). Margin distance was also independently associated with longer survival (hazard ratio [HR], 0.94; 95% CI, 0.90–0.98). A margin distance greater than 9 mm was associated with longest recurrence-free survival and a margin distance greater than 11 mm was associated with longest overall survival. Conclusions Increased margin distance was independently associated with lower risk of recurrence and longer overall survival in patients undergoing wedge resection for NSCLC tumors less than or equal to 2 cm. These findings suggest that with a minimum appropriate margin distance, wedge resection may yield outcomes comparable to those of lobectomy.