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Figure.
Trends in Cancer Center Advertising Spending by Media Channel Between 2005 and 2014
Trends in Cancer Center Advertising Spending by Media Channel Between 2005 and 2014

Data are from Kantar Media (http://www.kantarmedia.com/us). All data were adjusted to 2014 US dollars using the Consumer Price Index of the US Bureau of Labor Statistics.

aPrint media includes magazines and newspapers.

bKantar Media did not report Internet search advertising data until 2010.

Table.  
Cancer Centers in the United States With the Highest Advertising Spending in 2014a
Cancer Centers in the United States With the Highest Advertising Spending in 2014a
1.
Abel  GA, Burstein  HJ, Hevelone  ND, Weeks  JC.  Cancer-related direct-to-consumer advertising: awareness, perceptions, and reported impact among patients undergoing active cancer treatment.  J Clin Oncol. 2009;27(25):4182-4187.PubMedGoogle ScholarCrossref
2.
Abel  GA.  Public advertising by cancer centers: are more data needed?  Ann Intern Med. 2014;160(12):870-871.PubMedGoogle ScholarCrossref
3.
Schenker  Y, Arnold  RM, London  AJ.  The ethics of advertising for health care services.  Am J Bioeth. 2014;14(3):34-43.PubMedGoogle ScholarCrossref
4.
Vater  LB, Donohue  JM, Arnold  R, White  DB, Chu  E, Schenker  Y.  What are cancer centers advertising to the public?: a content analysis.  Ann Intern Med. 2014;160(12):813-820.PubMedGoogle ScholarCrossref
5.
Rosenthal  E. Ask your doctor if this ad is right for you. New York Times. February 27, 2016:SR1. http://www.nytimes.com/2016/02/28/sunday-review/ask-your-doctor-if-this-ad-is-right-for-you.html. Accessed March 8, 2016.
6.
Tomycz  ND.  A profession selling out: lamenting the paradigm shift in physician advertising.  J Med Ethics. 2006;32(1):26-28.PubMedGoogle ScholarCrossref
Research Letter
August 2016

Trends in Cancer-Center Spending on Advertising in the United States, 2005 to 2014

Author Affiliations
  • 1Indiana University School of Medicine, Indianapolis, Indiana
  • 2Department of Health Policy and Management, University of Pittsburgh Graduate School of Public Health, Pittsburgh, Pennsylvania
  • 3Division of General Internal Medicine, Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
  • 4Division of General Internal Medicine, Section of Palliative Care and Medical Ethics, University of Pittsburgh, Pittsburgh, Pennsylvania
 

Copyright 2016 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Restrictions Apply to Government Use.

JAMA Intern Med. 2016;176(8):1214-1216. doi:10.1001/jamainternmed.2016.0780

In the United States, cancer centers commonly advertise clinical services directly to the public. Potential benefits of such advertising include informing patients about available treatments and reducing the stigma of cancer.1,2 Potential risks include misleading vulnerable patients and creating false hopes, increasing demand for unnecessary tests and treatments, adversely affecting existing physician-patient relationships, and increasing health care costs.3,4 Understanding the trends in the advertising spending of cancer centers and the characteristics of the centers that spend the most can inform the debate about the effect of their advertisements. We hypothesized that advertising spending by cancer centers has increased and is concentrated among for-profit cancer centers.

Methods

A descriptive analysis of cancer-center advertising expenditures was conducted from January 1, 2005 to December 31, 2014. We obtained data from Kantar Media, an agency that tracks the content and number of advertisements across major media channels and calculates expenditures according to the type and reach of the media for which they are made. An advertiser was classified as a cancer center if its name contained the words “cancer,” “oncology,” “radiation,” or another cancer therapy (eg, proton therapy; CyberKnife Robotic Radiosurgery System, Accuray; TomoTherapy, Accuray). Medical centers advertising cancer services were not included unless their advertisements mentioned a cancer clinic, center, or institute.

Advertising expenditure data were obtained across 6 media outlets: television, magazines, radio, newspapers, billboards, and the Internet. Internet advertisements were divided into display (presented along the bottom or side of websites) and search (listed as search query results, in which an advertisement for a cancer-center service, such as breast-cancer treatment, for example, appears in response to a query by a patient or other seeker that is entered into an Internet search engine) formats. Cancer-center websites were not included as Internet advertisements. Data on spending for Internet search query results were not available until 2010.

Advertising expenditure data were adjusted to 2014 US dollars using the Consumer Price Index of the US Bureau of Labor Statistics. The highest-spending centers in 2014 were identified by summing data from centers with unique names, even if such centers had numerous locations. These centers were categorized using publicly available data consisting of the (1) National Cancer Institute (NCI) designation status; (2) Commission on Cancer accreditation status; (3) tax-exemption status; (4) metropolitan location(s); and (5) number of locations. We also compared patterns of spending among NCI-designated centers.

Results

From 2005 to 2014, 890 cancer centers in the United States advertised to the public. Their total advertising spending in 2014 was $173 million. In general, inflation-adjusted spending increased for all of the types of advertising we considered (Figure). The greatest relative growth in spending was for Internet display advertisements, which increased from less than 1% of total advertising spending ($302 030 of $54 229 849) in 2005 to 5% ($8 633 000 of $173 510 900) in 2014.

In 2014, 20 cancer centers accounted for 86% of the total advertising spending by cancer centers in the United States (Table). Cancer Treatment Centers of America, a for-profit company with a national network of 5 hospitals, had the largest advertising expenditures, accounting for 59% of total advertising spending by cancer centers. Cancer Treatment Centers of America spent $101.7 million, consisting of $58.7 million for national advertising, $24.2 million for local advertising, and $18.7 million for Internet advertising. Only 2 other cancer centers spent more than $9 million: MD Anderson Cancer Center spent $13.9 million and Memorial Sloan Kettering Cancer Center spent $9.1 million. Among the 20 cancer centers that accounted for 86% of total advertising spending, 5 (25%) were for-profit, 17 (85%) were Commission on Cancer–accredited, and 9 (45%) were NCI-designated. Seven cities had more than 1 of the centers: Chicago, Houston, New York City, Philadelphia, Phoenix, Seattle, and Tampa.

Of 60 NCI-designated cancer centers, 35 (58%) advertised in 2014, with total spending ranging from $900 to $13.9 million. Half of the NCI-designated centers that advertised spent less than $4000; one-fourth spent more than $100 000, and 5 (8%) spent more than $1 million.

Discussion

Between 2005 and 2014, cancer centers in the United States substantially increased their advertising spending directed at consumers. Our findings probably underestimate these centers’ total spending for advertising to consumers because available data did not include advertising in cancer-specific magazines, medical center advertising for cancer services unless a specific cancer center was mentioned, or charitable promotions placed by affiliated organizations. For example, City of Hope, a leading cancer center in Duarte, California, was recently highlighted in The New York Times for millions of dollars in annual health care advertising.5 According to Kantar Media, that advertising was to promote donations to City of Hope and was not placed by the cancer center. Our search strategy did not capture such promotional spending. For some patients and families, cancer-center advertising may constitute a major source of information, raising concerns in view of evidence that the content of some advertising lacks balance.4 Spending on advertising is not a measure of quality of care,6 and physicians and cancer-care organizations should help patients make informed cancer treatment decisions. The effect of cancer-center advertising on the quality and costs of cancer care should be better understood.

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Article Information

Corresponding Author: Laura B. Vater, MPH, Indiana University School of Medicine, 340 W Tenth St, #6200, Indianapolis, IN 46202 (Lvater@iupui.edu).

Published Online: July 11, 2016. doi:10.1001/jamainternmed.2016.0780.

Author Contributions: Ms Vater had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.

Study concept and design: Vater, Park, Schenker.

Acquisition, analysis, or interpretation of data: All authors.

Drafting of the manuscript: Vater, Schenker.

Critical revision of the manuscript for important intellectual content: All authors.

Statistical Analysis: Vater, Park.

Obtained funding: Schenker.

Study Supervision: Schenker.

Conflict of Interest Disclosures: None reported.

Funding/Support: This study was supported by the National Center for Advancing Translational Sciences of the National Institutes of Health under Award Number KL2TR000146. Dr Schenker also received support from the Junior Scholar Award to the Department of Medicine, University of Pittsburgh.

Role of the Funder/Sponsor: The funding sources had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.

Additional Information: The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

References
1.
Abel  GA, Burstein  HJ, Hevelone  ND, Weeks  JC.  Cancer-related direct-to-consumer advertising: awareness, perceptions, and reported impact among patients undergoing active cancer treatment.  J Clin Oncol. 2009;27(25):4182-4187.PubMedGoogle ScholarCrossref
2.
Abel  GA.  Public advertising by cancer centers: are more data needed?  Ann Intern Med. 2014;160(12):870-871.PubMedGoogle ScholarCrossref
3.
Schenker  Y, Arnold  RM, London  AJ.  The ethics of advertising for health care services.  Am J Bioeth. 2014;14(3):34-43.PubMedGoogle ScholarCrossref
4.
Vater  LB, Donohue  JM, Arnold  R, White  DB, Chu  E, Schenker  Y.  What are cancer centers advertising to the public?: a content analysis.  Ann Intern Med. 2014;160(12):813-820.PubMedGoogle ScholarCrossref
5.
Rosenthal  E. Ask your doctor if this ad is right for you. New York Times. February 27, 2016:SR1. http://www.nytimes.com/2016/02/28/sunday-review/ask-your-doctor-if-this-ad-is-right-for-you.html. Accessed March 8, 2016.
6.
Tomycz  ND.  A profession selling out: lamenting the paradigm shift in physician advertising.  J Med Ethics. 2006;32(1):26-28.PubMedGoogle ScholarCrossref
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