9034 Background: Following the hypothesis-generating ONCOTRUST-1 study, ONCOlogy TRansparency Under Scrutiny and Tracking 2 (ONCOTRUST-2) aimed to compare perceptions, understanding, and behaviors related to conflicts of interest (COI) in oncology between high-income countries (HICs) and low- and middle-income countries. This secondary analysis focuses on African countries versus HICs to explore regional differences in interactions with the pharmaceutical industry. Methods: We conducted a cross-sectional, survey-based study over two years (January 2024–January 2026). Participants were oncologists practicing in Africa or HICs. Outcomes included perceptions of industry-oncologists’ interactions, recognition of COI scenarios requiring disclosure, and self-reported behaviors. Comparisons used Chi-squared or Fisher’s exact tests as appropriate. Results: A total of 331 oncologists were included (Africa n=133; HIC n=188; 52% women). Most respondents were specialists (61.3%), followed by professors (22.1%) and trainees (15.1%). HIC oncologists reported better understanding of evidence-based medicine (EBM) than African oncologists (p=0.002). Overall ability to identify all COI scenarios requiring declaration did not differ (p=0.45), but HIC oncologists more frequently recognized consulting/advisory roles, direct payments/honoraria, expert testimony, personal funding, and travel/conference support as declarable COI (all p0.05). Self-reported COI disclosure prevalence was similar between groups (p=0.67), and travel/conference support from pharmaceutical industry did not differ (p=0.14). African oncologists reported fewer consulting honoraria (p=0.001) and lower amounts (p<0.001) and less research funding (p=0.02), but more receipt of drug samples (p=0.001). Compared with HIC peers, African oncologists reported poorer disclosure practices (less reporting in publications when COI existed, p=0.001; less disclosure before presentations, p<0.0001). Moreover, African oncologists reported more prescription pressure from industry (p=0.013) and lower perceived objectivity in trial appraisal when COI exist (p=0.056). Interestingly, HIC oncologists more often endorsed adopting new drugs despite weak clinical-trial evidence (p=0.003). Knowledge of COI regulations/policies was lower in Africa (p<0.0001). Across both groups, support was strong for clearer COI policies, education, and online COI databases. Conclusions: African and HIC oncologists showed difference in recognition of specific COI types, disclosure behavior, and policy awareness. Strengthening COI education and implementing clear enforceable policies are therefore needed.
Hadji et al. (2026) studied this question.