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

To the Editor

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 clinician-patient relationships, and increasing healthcare costs.^{3, 4} Understanding trends in the advertising spending of cancer centers and the characteristics of the centers that spend the most can inform the debate about the impact of these advertisements. Our hypothesis was that advertising spending has increased and that spending is concentrated among for-profit cancer centers.

Methods

We conducted a descriptive analysis of cancer center advertising expenditures from January, 2005 to December, 2014. We obtained data from Kantar Media, an agency that tracks the content and number of advertisements across major media channels and calculates expenditures based on media type and reach. An advertiser was classified as a “cancer center” if its name contained the words “cancer,” “oncology,” “radiation,” or another cancer therapy, e.g., CyberKnife. Medical centers advertising cancer services were not included unless advertisements mentioned a cancer clinic, center, or institute.

We obtained expenditure data across six media outlets: television, magazines, radio, newspapers, billboards, and the Internet. Online advertisements were divided into display (presented along the bottom or side of websites) and search (listed as search query results). Cancer center websites were not included as Internet advertisements. Data on spending for Internet search advertisements were not available until 2010.

We adjusted expenditure data to 2014 U.S. dollars using the Consumer Price Index. We identified the highest-spending centers in 2014 by summing data from centers with unique names, even if centers had numerous locations. We categorized these centers using publicly available data: (1) National Cancer Institute (NCI) designation status, (2) Commission on Cancer (CoC) 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. Total advertising spending was $173 million in 2014. 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 ads, increasing from less than 1% of spending in 2005 ($300,000) to 8% in 2014 ($9 million).

Figure 1. Trends in cancer center advertising spending by media channel between 2005 and 2014.

Data are from Kantar Media (www.kantarmedia.com). All data were adjusted to 2014 U.S. dollars using the Consumer Price Index.

* Print media includes magazines and newspapers.

** Kantar Media did not report Internet search advertising data until 2010.

In 2014, 20 cancer centers accounted for 86% of total advertising spending (Table). Cancer Treatment Centers of America, a for-profit company with a national network of five hospitals, had the largest advertising expenditures, accounting for 59% of total spending. Cancer Treatment Centers of America spent $101.7 million: $58.7 million for national advertising, $24.2 million for local advertising, and $18.7 million for Internet advertising. Only two 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 centers, 5 (25%) were for-profit, 17 (85%) were CoC-accredited, and 9 (45%) were NCI-designated. Seven cities had more than one of the centers: Chicago, Houston, New York City, Philadelphia, Phoenix, Seattle, and Tampa.

Table.

Cancer centers in the United States with the highest advertising spending in 2014^*

							Advertising expenditure, % of total spending
Rank	Cancer Center	U.S. Location(s)**	National Cancer Institute Designated	Commission on Cancer Accredited	Non- profit	Total 2014 Advertising Spending (millions of dollars)	National	Local	Internet
1	Cancer Treatment Centers of America	Atlanta, GA Chicago, IL Philadelphia, PA Phoenix, AZ Tulsa, OK	No	Yes	No	101.7	57.8	23.8	18.4
2	MD Anderson Cancer Center	Houston, TX Albuquerque, NM Camden, NJ Gilbert, AZ	Yes	Yes	Yes	13.9	47.4	27.5	25.1
3	Memorial Sloan- Kettering Cancer Center	New York, NY	Yes	Yes	Yes	9.1	32.7	44.2	23.0
4	Fox Chase Cancer Center	Philadelphia, PA	Yes	Yes	Yes	3.5	0	66.0	34.0
5	Texas Oncology***	Austin, TX Dallas, TX Fort Worth, TX Houston, TX	No	No	No	3.4	28.7	59.3	12.1
6	Huntsman Cancer Institute	Salt Lake City, UT	Yes	Yes	Yes	2.2	10.3	83.2	6.4
7	Sutter Cancer Center	Sacramento, CA Roseville, CA	No	Yes	Yes	2.1	0	100	0
8	Dana-Farber Cancer Institute	Boston, MA	Yes	Yes	Yes	1.8	46.3	50.1	3.6
9	CCS Oncology	Buffalo, NY	No	No	No	1.5	0	100	0
10	Winthrop NYCyberKnife Center	New York, NY	No	Yes	Yes	1.3	100	0	0
11	CDH Proton Center	Chicago, IL	No	Yes	No	1.3	0	21.5	78.5
12	Seattle Cancer Care Alliance Clinic	Seattle, WA	Yes	Yes	Yes	1.0	0	74.2	25.8
13	H. Lee Moffitt Cancer Center	Tampa, FL	Yes	Yes	Yes	0.9	26.0	59.9	14.1
14	Edward Cancer Center	Chicago, IL	No	Yes	Yes	0.9	0	0	100
15	Florida Cancer Specialists & Research Institute****	Gainesville, FL Orlando, FL Tallahassee, FL Tampa, FL	No	No	No	0.9	0	92.1	7.9
16	Fred Hutchinson Cancer Research Center	Seattle, WA	Yes	Yes	Yes	0.8	5.1	43.3	51.6
17	University Of Florida Proton Therapy Institute	Jacksonville, FL	No	Yes	Yes	0.8	0	70.3	29.7
18	Kennedy Cancer Center	Philadelphia, PA	No	Yes	Yes	0.8	0	0	100
19	Swedish Cancer Institute	Seattle, WA	No	Yes	Yes	0.7	0	100	0
20	James Cancer Hospital	Columbus, OH	Yes	Yes	Yes	0.6	0	100	0

^*Data on advertising spending and frequency are from Kantar Media (www.kantarmedia.com).

^**5 of 20 cancer centers have locations in more than one metropolitan area. Spending and frequency data for centers with multiple locations or multiple centers in the same location was summed.

^***Texas Oncology has more than 150 locations across Texas and southeastern Oklahoma. This table lists metropolitan locations only. Data for advertising spending are for all locations.

^****Florida Cancer Specialists & Research Institute has more than 50 locations across Florida. This table lists metropolitan locations only. Data for advertising spending are for all locations.

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 $4,000; one-fourth spent more than $100,000, and five (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. These findings likely underestimate total spending, as 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.

If current trends continue, cancer center advertising may constitute a major source of patient information, raising concerns given evidence of imbalanced advertising content.⁴ Spending on advertising is not a measure of quality of care,⁶ and physicians and cancer organizations should help patients make informed cancer treatment decisions. Further work is needed to understand the effect of cancer center advertising on the quality and costs of cancer care.