Marketing Cancer Care: A Content Analysis of Ethical Compliance in Television Advertising by Top-Ranked U.S. Cancer Centers.

Direct-to-consumer advertising (DTCA) in cancer care influences patient decisions but often targets vulnerable populations. Despite established ethical guidelines, adherence remains understudied. This study evaluates how well top U.S. cancer centers comply with these standards in television advertisements. We analyzed 31 TV ads from 2019 to 2024 produced by members of the top 20 cancer centers as ranked by U.S. News & World Report, comparing them against ethical guidelines from the American Medical Association, American Society of Clinical Oncology, and others. Two independent reviewers categorized ads as compliant, borderline, or transgressive. Transgressive ads explicitly violated guidelines, while borderline cases contained ambiguous claims with at least one problematic interpretation. Of the 31 ads from 12 institutions, 16 (52%) were either transgressive or borderline. Only 4 of 12 (33%) institutions produced exclusively compliant ads. Common issues included unrealistic expectations (36%), implying exclusive treatment availability (13%), and unclear eligibility criteria (13%). Notably, institutions ranked in the top 10 produced 71% of the ads and were responsible for 8 of 9 transgressive cases. The prevalence of transgressive advertising suggests that ethical guidelines alone are insufficient. Potential solutions include increasing awareness among marketing leadership and enforcing compliance, possibly as a hospital accreditation requirement. Policy Summary: As cancer care continues to advance and treatment options become more complex, ensuring advertising practices adhere to extant ethical guidelines is crucial for supporting informed patient decision-making and maintaining public trust in healthcare institutions.