Report of the Incoming Chair

Report from Tom Eichler, MD, FASTRO

“My momma always said, ‘Life is like a box of chocolates. You never know what you’re gonna get’.”—Forrest Gump

When I traveled to Miami a year ago to see the newly-renovated convention center and the many exciting venues that Miami had to offer, the 2020 Annual Meeting took on a pulsating vibe. The broad strokes of the meeting were initially sketched out in November 2018, but planning began in earnest as soon as we left Chicago in 2019. My excitement began to build as the reality of hosting a throng of ASTRO members in South Beach began to sink in. And then…well, you know the story: a “box of chocolates” arrived. Don’t get me wrong:  I’m still thrilled to be hosting you but cannot help but be disappointed knowing that I will not be seeing my many friends and colleagues pinballing through the convention center, headed to the next session.

In April, when we began to understand the breadth and scope of the pandemic, it quickly became apparent that there was no way to safely bring people together in Miami. I think you’ll agree that putting together the Annual Meeting is an enormous task. Being forced to pivot to a virtual platform six months out, however, adds an entirely new dimension of complexity. I want to recognize the entire ASTRO Education division led by Nina Taylor and the Annual Meeting team led by Cristin Watson for their diligence, patience and creativity. The division has worked tirelessly to produce what I’m confident will be a best-in-class meeting. We learned a great deal during the planning process, experience which will help us in providing virtual content in the future. But there is nothing that can replace the sheer joy of being physically together! I look forward to that experience when we return to Chicago in 2021.

When COVID-19 began spreading across the country, ASTRO acted early to ascertain the impact on our members. We fielded the same survey1 three times between mid-April and late June so we could ascertain trends. A significant percentage of respondents said that their patient volumes had declined and practices delayed non-urgent treatments. This decline in patient volume led to many practices experiencing financial challenges, in some cases resulting in staff furloughs. Our partners at ESTRO and our Latin American colleagues reached out to us and requested to use the same survey tool, generating impact data with a more global perspective.

ASTRO published a set of coronavirus FAQ’s on March 17 (with a subsequent update) and provided additional resources for members such as webinars hosted by colleagues impacted early on, a special ROHub area where members could share information and insights, and assistance acquiring PPE. Based on our membership survey data, 74% of respondents said they used the ROHub as a resource. In addition, we joined with ESTRO to quickly survey experts in our specialty and create streamlined processes of care for head and neck cancer and lung cancer for use during the pandemic. ASTRO staff worked tirelessly with Capitol Hill to secure needed financial relief for members and petitioned CMS with recommendations for regulatory modifications, most notably the expanded use of telemedicine. Like all of you, as we move into 2021, I remain hopeful that we’ll begin to see some light at the end of the tunnel but vigilance will be demanded for the foreseeable future.

As if things couldn’t get more complicated, CMS published the Final Rule detailing the construct of the radiation oncology alternative payment model on September 18. ASTRO had been working on the Model for the past couple of years, collaborating with the staff and leadership of CMMI. Based on our good-faith interactions, we had every belief that they were open to our proposals to improve the Model and listening to our concerns. This, unfortunately, has not been the case. The model has several significant problems, the most pressing of which was the January 1, 2021 effective date. As we headed into this meeting, CMS said they heard ASTRO's concerns and is delaying the Model until July 2021. The punitive level of payment cuts continues to be a major problem and CMS seems to be holding fast on the cuts. While they reduced the level of mandatory participation by a modest 10%, we have strongly advocated for the model to be voluntary so that it could be adequately tested. ASTRO advocacy has been working closely with stakeholders and our Congressional champions to express our deep concerns and to secure their support in pressuring CMS to make much-needed modifications to the model. The climate in Washington has made this an extremely heavy lift. Please don’t be discouraged: we’ll continue to use everything in our advocacy toolbox to ultimately make this a fair deal.

In late July, numerous radiation oncology, medical physics and nuclear regulatory societies across the globe participated in a virtual 3-day meeting hosted by the IAEA, Challenges in Global Cancer Care. The purpose of the meeting was to discuss areas of mutual interest and coordinate efforts to improve access to radiation therapy in low and middle-income countries. This was an important and useful exercise to get a sense of where ASTRO might be able to leverage our resources and to work on a collaborative basis with these other organizations. This will be an ongoing effort during my Chair year as we explore the possibility of developing a global umbrella organization to reduce overlap and discover synergies while elevating ASTRO’s presence on the international stage.

Closer to home, we shall make a renewed effort to better understand manpower issues, working closely with our colleagues at ARRO—our future leaders—SCAROP and ADROP. There is nothing as important as assisting our members-in-training and attracting high-quality applicants to our field. There is clearly work to be done here.

Finally, as Dr. DeWeese mentioned, we are working as an organization to better understand why our field fails to attract Black and underrepresented minorities in medicine. We need to proactively work to enhance diversity in radiation oncology, as enunciated in our Strategic Plan, such that our physicians better represent the patients they serve and, long-term, improve outcome disparities. This will not be a quick fix: it will take years to diversify our specialty, but this will also be a prime focus of mine in the coming year. Complacency is not an option.

And so, my friends, the window is closing on my year as your President, punctuated by a memorable 2020 Annual Meeting. Thank you for attending and for taking the time to read this statement. I look forward to my upcoming year as your Chair and would like to thank my friend and colleague, Ted DeWeese, for his extraordinary leadership in this unprecedented time. All members of the Society have benefited from his calm and thoughtful approach as the Board navigated many difficult issues over the past year. And thank you to the Board of Directors for their tireless service to ASTRO. Most importantly, thank you—the membership—for entrusting me with this responsibility. I will need your strong shoulders and thoughtful counsel as we work together to build a better tomorrow for our specialty. If I may be so bold as to channel Abraham Lincoln: “With public sentiment, nothing can fail, without it nothing can succeed.” Don’t hesitate to reach out to me! Stay safe, be well

  1. Wakefield DV et al. Initial impact and operational responses to the COVID-19 pandemic by American radiation oncology practices. Int J Radiat Oncol Biol Phys. 2020 Oct 1;108(2):356-361.