Marketing cancer care: A content analysis of ethical compliance in television advertising by top-ranked US cancer centers.

e23169 Background: Direct-to-consumer advertising (DTCA) in cancer care targets vulnerable patient populations and has been shown to influence treatment decisions. While multiple organizations have published ethical guidelines for cancer care advertising, compliance with these guidelines remains understudied. This study evaluates how well top cancer centers adhere to established ethical standards in their television advertisements. Methods: We analyzed television advertisements from 2019-2024 by the top 20 U.S. cancer centers as ranked by U.S. News & World Report. We reviewed published ethical guidelines for cancer care advertising from the American Medical Association, American Society of Clinical Oncology, and other professional organizations to identify common standards. Two reviewers independently evaluated advertisements against these standards, categorizing them as compliant, borderline, or transgressive. Advertisements were considered transgressive if they explicitly violated guidelines, and borderline if they contained claims subject to multiple interpretations where at least one interpretation would violate guidelines. Results: Of 31 advertisements from 12 institutions that met inclusion criteria, 16 (52%) either transgressed ethical guidelines or were deemed borderline cases. Only 4 of 12 (33%) institutions produced exclusively compliant advertisements. Common transgressions (and near transgressions) included: creating unrealistic expectations 11 (36%), implying a treatment is exclusively available at a particular hospital 4 (13%), failing to provide clear eligibility criteria for a treatment 4 (13%). Notably, institutions ranked in the top 10 produced 22 of 31 ads (71%) and were responsible for 8 of 9 transgressive advertisements. Conclusions: Despite established ethical guidelines, over half of cancer center television advertisements either violated or bordered on violating ethical standards. Top-ranked institutions were responsible for the majority of transgressive advertisements. While we observed some improvement in specific areas, such as reduced inappropriate use of patient testimonials compared to previous studies, significant ethical challenges persist. The prevalence of these issues, particularly among prestigious institutions, suggests that the mere existence of ethical guidelines is insufficient. Several interventions merit consideration, including better promulgation of existing guidelines among marketing leadership and exploring mechanisms for enforcing adherence, potentially including making compliance a requirement for hospital accreditation. As cancer care continues to advance and treatment options become more complex, ensuring ethical advertising practices is crucial for supporting informed patient decision-making and maintaining public trust in healthcare institutions.