Importance

The terms "personalized oncology" and "precision oncology" have increased in usage and have generated considerable traction in terms of public attention and research funding. To our knowledge, no prior study has as thoroughly documented the use of the "precision oncology" terminology over the last decade.

Objective

To determine how the use of the terms "personalized oncology" and "precision oncology" have changed over time.

Design

A retrospective literature analysis using two databases (PubMed and Scopus) over 10 years was performed. Manuscripts using either term "personalized oncology" or "precision oncology" were collected. Manuscripts published in 2011, 2013, 2015, 2017 and through 30 June 2019 were pulled for text analysis. Common reasons for exclusion were if the search term appeared in the institution name only, the search term appeared only in keyword or publication title, or the search term was used to justify the relevance or application of research with no clear definition.

Setting

Manuscripts published and catalogued in PubMed or Scopus.

Results

In our study, we analysed 399 unique manuscripts published over the last decade. Over time, the terminology has shifted from "personalized oncology" to "precision oncology". Targeted therapy, molecular biomarker-guided tumour profiling and next generation sequencing (ie, "omics-guided tumor profiling") are the three most common definitions of the term. While these definitions are somewhat overlapping in concept, over the decade we observed an increase in the number of distinct interpretations of "precision oncology", ranging from structural biology to clinical practice.

Conclusions and relevance

We have observed that the phrase "precision oncology" is shifting, overlapping and expanding in definition. This all-encompassing approach to defining "precision oncology" ironically renders the term imprecise. Our analysis highlights the inherent challenges in defining novel movements in medicine.

This study uses public employee salary data from 14 US public medical schools and the Open Payments database from the US Centers for Medicare & Medicaid Services to examine the ratio of academic oncologists’ reported salaries to their general payments from the medical industry.

Background

Public perception of whom to blame for health care costs varies. Whether there is a mismatch between the causes of rising health care costs and the blame attributed to potential culprits has emerged as a topic of debate. We sought to compare the allocation of blame for rising health care costs in lay media articles and academic literature with actual health care spending in the United States.

Methods

We performed a cross-sectional systematic analysis of published lay media and academic articles. On April 10, 2018, 200 PubMed (academic) and 200 Google News (lay media) articles were collected through searches using the terms "healthcare costs" and "health care costs." Articles were included if they criticized high cost of health care in the US. We calculated descriptive statistics for area(s) of health care blamed for high costs, publication type, and primary author affiliation.

Results

PubMed articles named 47 potential drivers of high cost and Google News articles named 225. Among PubMed articles, environment, lifestyle, and medical problems (n = 15/47; 32%) were the most commonly cited source of high cost of health care, followed by 'no group singled out' (n = 14/47; 30%), and drugs or devices (n = 8/47; 17%). Among Google News articles, insurers (n = 63/225; 28%) were most commonly cited as possible sources of high cost of health care, followed by 'no group singled out' (n = 46/225; 21%) and hospitals (n = 37/225; 17%).

Conclusions

Allocation of blame for high health care costs is not always in proportion with true health care spending, and certain health care drivers are under- and overrepresented by academic and lay media publications.

Background

Identifying ineffective practices that have been used in oncology is important in reducing wasted resources and harm. We sought to examine the prevalence of practices that are being used but have been shown in RCTs to be ineffective (medical reversals) in published oncology studies.

Methods

We cross-sectionally analyzed studies published in three high-impact oncology medical journals (2009-2018). We abstracted data relating to the frequency and characterization of medical reversals.

Results

Of the 64 oncology reversals, medications (44%) represented the most common intervention type (39% were targeted). Fourteen (22%) were funded by pharmaceutical/industry only and 56% were funded by an organization other than pharmaceutical/industry. The median number of years that the practice had been in use prior to the reversal study was 9 years (range 1-50 years).

Conclusion

Here we show that oncology reversals most often involve the administration of medications, have been practiced for years, and are often identified through studies funded by non-industry organizations.

The ability to identify medical reversals and other low-value medical practices is an essential prerequisite for efforts to reduce spending on such practices. Through an analysis of more than 3000 randomized controlled trials (RCTs) published in three leading medical journals (the Journal of the American Medical Association, the Lancet, and the New England Journal of Medicine), we have identified 396 medical reversals. Most of the studies (92%) were conducted on populations in high-income counties, cardiovascular disease was the most common medical category (20%), and medication was the most common type of intervention (33%).