By Charlotte Raley, Quality Improvement Analyst, ASTRO

Accreditation’s importance is growing among radiation oncology practices for ensuring safety and quality of patient care. With the trend of practice consolidation and growth, ASTRO’s APEx - Accreditation Program for Excellence® has seen a surge in requests to synchronize new or acquired facilities into existing accreditation cycles. This reflects a practice’s desire to ensure continuous quality improvement and alignment of processes, especially for those with new facilities.

Previously, requests to add facilities to an existing accreditation had to wait until the next cycle, delaying the process of solidifying or aligning procedures in newly acquired or built facilities. To address this, APEx initiated a satellite synchronization process that allows practices to add new facilities to their current accreditation cycle. Any new satellite(s) will be assessed on their compliance with the APEx Standards, going through the same rigorous process as the previously accredited facilities. This process is open to APEx-accredited practices that want to add new facilities during the accreditation process or within the first three years of their four-year accreditation cycle.

The first practice to take advantage of this option was the Miami Cancer Institute. They opted to bring their new facility in Plantation, Florida, into alignment with their main facility in Miami, which received APEx accreditation in 2021 and was the first APEx-accredited proton center in south Florida. The newly added satellite at Plantation is also the first APEx-accredited facility in Broward County. We spoke with Alonso Gutierrez, PhD, MBA, Assistant Vice President, Chief Physicist at Miami Cancer Institute and Vice Chair of Medical Physics and Dosimetry at Florida International University, and Shandelle Castillo, MHA, Radiation Oncology Program Coordinator at Miami Cancer Institute, to get a firsthand account of what influenced their decision to choose APEx and their experience with the satellite synchronization process.

Gutierrez stated, “We wanted to have the same standards across all our radiation oncology centers within the Baptist Health South Florida enterprise and given that our satellite functions identically to our main site, just at a different physical location, it was something that was somewhat of a no-brainer for us to do.” Gutierrez says he expects that any future satellites within their network will also be APEx-accredited. “We didn’t really question [why APEx] because we feel it’s very RO-specific and RO-dedicated, and from a quality of standards perspective, we firmly believe in the practice standards that APEx sets forth [for patient care].”

When asked about the process itself, Castillo reported “the process was fairly easy; [ASTRO staff] gave us a timeline for everything and provided all the documentation that we needed, and then the on-site review was very well organized.” Gutierrez added, “We had a kickoff meeting to really talk about the expectations of [the process], and it was very much in sync with the main site accreditation, making it easy for us to leverage a lot of the work we had previously done.”

The process consists of a practice submitting an application for synchronization, paying an additional fee and scheduling an in-person facility visit. The visit results are sent to ASTRO’s Practice Accreditation Subcommittee and follows the normal process to determine the facility's accreditation status. If the facility receives full accreditation, it will be added and “synced” to the practice's cycle.

“Synchronization is a great word because it actually parallels the expectations of the main site, but it’s done at a level of efficiency. The process is done just as rigorously, but efficiently and streamlined, so redundancy gets minimized. You can focus on the key aspects of the program, knowing that the main site has already gone through the more demanding documentation and process development [components].”

The new APEx satellite synchronization process is intended for practices to maintain high standards of care as they grow and ensure those standards are maintained across all facilities within a practice. “We thought the process was well organized and well structured”, says Gutierrez. He notes that accreditation is important to patients as well. “They may not know what it entails, but for [us] to say [we’ve] gone through a rigorous process for high quality [care] adds credibility to the organization.”

If your practice could benefit from the APEx satellite synchronization process, contact ASTRO staff and get started today!

By Geraldine Jacobson, MD, MBA, MPH, FASTRO; Bruce Haffty, MD, FASTRO; Pranshu Mohindra, MD, MPH; and Chirag Shah, MD

On behalf of the ASTRO Board of Directors and the ASTRO Workforce Task Force, we are pleased to announce that the wait is over. The final report of the radiation oncology workforce study commissioned by ASTRO and conducted by Health Management Associates (HMA) is now out.

Let’s back up a bit for those of you who may be unfamiliar with the actions of the ASTRO Board more than a year and a half ago. In June 2021, then-ASTRO Chair Tom Eichler, MD, FASTRO, called for the formation of a Workforce Task Force to look into the concerns that many felt about a potential radiation oncologist supply and demand imbalance given a drop in interest in the specialty during the NRMP Match process. The Task Force was comprised of a diverse group of radiation oncologists, including representatives from the Society of Chairs of Radiation Oncology Programs (SCAROP), Association of Directors of Radiation Oncology Programs (ADROP), Association of Residents in Radiation Oncology (ARRO), ASTRO’s Committee (now Council) on Health, Equity, Diversity and Inclusion (CHEDI) and both community-based and academic practitioners.

Our first recommendation to the ASTRO Board was to authorize a Request for Proposal (RFP) to conduct an independent, unbiased workforce analysis. A formal RFP was issued to third-party consulting companies experienced in conducting this type of analysis. After a thorough evaluation of the proposals, the task force recommended, and the Board approved, hiring HMA, a research firm with strong expertise in this complex analysis. Specifically, HMA was tasked with evaluating the current and future supply of radiation oncologists, demand for radiation oncology services and projecting future trends through 2030. It is important to emphasize, while the study was funded by ASTRO, significant steps were taken to ensure an independent analysis, with ASTRO leadership maintaining an arm’s length from the HMA team. The task force served as representatives of the specialty who were available to HMA as resources to provide iterative feedback in the development of the model.

Meanwhile, the task force also proposed, and the Board approved, an updated ASTRO Workforce Statement in February 2022 focusing on issues impacting residency training programs, including the size, selection process and scope of training programs and published an editorial in the Red Journal that provided more context on the statement. ASTRO members also had the opportunity to learn more about the process and provide their feedback during the 2022 Annual Meeting, which resulted in meaningful changes to HMA’s methodology that reflected members’ real-world experiences.

We are pleased to announce the final HMA report, “Projected Supply and Demand for Radiation Oncologists in the U.S. in 2025 and 2030,” is now available. The analysis includes an evaluation of radiation oncologist supply (new graduates, exits from the specialty) and potential changes in demand (growth of Medicare beneficiaries, hypofractionation, loss of indications, new indications) as well as radiation oncologist productivity (measured as work RVUs produced per radiation oncologist) and demand per beneficiary. The results of the analysis and what HMA deemed the most likely scenario demonstrated a relative balance between radiation oncologist supply and demand for radiation services through 2030; the growth in radiation oncologists was balanced by the rapid growth of Medicare beneficiaries over the same time period. The primary factors driving the model were found to be growth of Medicare beneficiaries and changes in work RVU productivity, with hypofractionation and loss of indications having only a moderate impact. While the most likely scenario was a balance of workforce supply and demand, some scenarios did demonstrate the possibility of over- and undersupply.

While the analysis took into consideration multiple parameters and evaluated multiple scenarios, it is recognized that no model is perfect. Given the heterogeneity of our specialty, it is not surprising that the scenarios presented in the report lead to variable conclusions. HMA also developed a modeling tool that allows programs and practices to evaluate different scenarios. We encourage individuals to use this tool to assess the workforce using the unique variables specific to their own environment. We also recognize that continuing study will be needed as new data emerge, including Medicare beneficiary and wRVUs, to evaluate the balance of supply and demand in radiation oncology in the years beyond 2030. The ASTRO Board and Workforce Subcommittee remains vigilant in monitoring the need for future assessment.

We invite you to read the task force’s interpretation of the study, which is available online in the Red Journal as an open access Article in Press. The HMA final report is available as a supplement to the paper and the modeling tool is available for download. Please submit your questions in the comments below or on the ROhub.

Read previous posts:

A Look Ahead at the Radiation Oncology Workforce in the United States – Bruce Haffty, MD, FASTRO; Chirag Shah, MD; and Pranshu Mohindra, MD, MPH, March 1, 2022

The Future of our Field – Thomas Eichler, MD, FASTRO, January 5, 2021

A Commitment to the Field - Theodore DeWeese, MD, FASTRO, March 10, 2020

The Residency Training Landscape, Continued - Paul Harari, MD, FASTRO, May 28, 2019

The Residency Training Landscape - Paul Harari, MD, FASTRO, March 20, 2019

By Tara Kosak, MEd, RT(T)(CT) and Meghan Kearney, MS, Quality and Safety Program Managers

March 12-18 marks National Patient Safety Awareness Week (PSAW), an opportunity for health care organizations to celebrate the important work being done every day to improve patient and staff safety and a platform to promote awareness.

The Department of Radiation Oncology at Dana-Farber Brigham Cancer Center uses PSAW as a way to reinforce our strong safety culture within the department and to educate staff about current efforts and initiatives related to patient safety. Last year, Dana-Farber Brigham Cancer Center celebrated the week with a variety of activities including:

1. A daily enewsletter, featuring frontline staff messages from various members of the radiation oncology team about “what safety means to me.” The messages were accompanied by safety selfies of staff holding ASTRO's #PSAW22 sign.

   Example of a staff message [edited for length]:

   • “As we celebrate National Patient Safety Awareness Week, I want to applaud our department for creating a strong safety culture… We rely on each other to provide every patient the highest level of care and safety. I encourage each one of us to celebrate the work we have done to ensure we deliver safe and high-quality care to all our patients and identify ways to improve patient safety.”
    
   • “As medical dosimetrists, safety is always our utmost priority, for our colleagues and especially for our patients... As a group, we often collaborate to improve our efficiency and ensure that every patient receives safe, compassionate care. We are fortunate to work in a department that promotes a culture of open discourse and actively tries to improve upon that culture. These acts of quality care should be celebrated as a reflection of the diligence and conscientious staff this department has accumulated, as well as a reflection of the organization as a whole.”

2. Safety-focused quizzes and surveys were embedded within the daily newsletter and staff who completed surveys were entered into a daily gift card raffle.
   
   Examples of surveys:
   • Safety reporting survey to better understand barriers to reporting events
   • Submit a safety initiative
   • Feedback on the departmental quarterly safety newsletter  
   • Just for fun – this or that
   • Patient safety rounds quiz

3. A patient safety rounds forum was held on Equity Informed High Reliability.  
   • Dana-Farber Brigham Cancer Center has been deeply invested in learning about high reliability organizations over the last several years. Staff within quality improvement and clinical operations leadership teams completed online and interactive education through an online learning platform, with the support of Brigham and Women’s Hospital (BWH) Quality & Safety. 
   •  
   • A guest speaker presented at the department’s quarterly patient safety rounds to discuss BWH’s approach to high reliability using an equity informed approach. 

4. All staff received cupcakes in a jar adorned with the department's safety logo.

5. Staff were encouraged to use ASTRO's PSAW virtual meeting background for all virtual meetings and share selfies holding the #PSAW sign.  

6. The department recognized the year’s Great Catch award recipients.  
   • To endorse the culture of safety and continuous learning within the department, a Great Catch program was put into place nearly seven years ago to acknowledge individuals and teams that go above and beyond to prevent harm, report an issue that may lead to significant process improvement or identify an issue that is not well understood. 
   •  
   • The Great Catch nominees are voted on by the quality improvement committee on a quarterly basis and winners are awarded with a certificate, showcased in a quarterly safety newsletter and acknowledged at the standing Patient Safety & Process Improvement Rounds. 

While PSAW is a week-long opportunity for the department to showcase its pledge to safety, the journey for promoting safety is continuous and evolving. The department is actively planning for PSAW 2023, building on all of the great ideas from past celebrations. This year, the plan is to continue to share messages in a daily enewsletter from frontline staff on how safety impacts their daily work. New this year, we will encourage staff to wear purple in support of safety, host a guest speaker presentation on moral injury and facilitate a design contest. The winning design will become a pin and the official Great Catch award token for past and future Great Catch Award recipients.

Our department is strongly committed to safety reporting and understands that reports are an opportunity to learn and grow, rather than the reflection of unsafe practice. The department currently uses a commercial hospital-wide software platform for safety report submission internally. In addition, we are proud to have officially joined as members of the RO-ILS: Radiation Oncology Incident Learning System^® initiative. For years, the department has drawn from the educational resources and aggregate reporting provided by RO-ILS, and we are excited to officially be contributors to the larger radiation oncology community.

What are your plans for 2023 PSAW? Not sure? Now is the time to start planning! ASTRO has provided new fliers for your individual and group safety selfies and a virtual background for #PSAW23. Additionally, ASTRO is collecting stories about patient safety — share your passion with us and the community. We would love to hear how RO-ILS, APEx and your own initiatives have fueled positive change and quality improvement. For more information and to get involved, visit ASTRO’s PSAW webpage.

Share ideas in the comments section and join the conversation about patient safety.

By Jennifer Jang, ASTRO Communications

At the tender age of 11, sixth graders Aneesh Pirlamarla (PGY-4, far right), Rohan Katipally (PGY-5, far left) and Nishant Shah (PGY-5, middle) became friends in middle school. Fast forward 19 years, their most recent reunion took place at the 2022 ASTRO Annual Meeting, convening now as radiation oncologists. They joke, “what was in the water in South Brunswick, New Jersey?”

The trio came together at middle school under the identity of “comets,” the same cohort at school, meaning their classes and activities were often in parallel — a prescient indicator of what was to come. Their friendship thrived in fits and starts over the next two decades, and yet they landed in mystifyingly similar contexts.

Of the three, Rohan knew earliest on that he wanted to pursue medicine, attending Brown University’s combined undergraduate and medical school program, while Nishant started out with aspirations for engineering at Boston University, enjoying the process of design and science. He eventually migrated into medicine with an interest in surgery, a seemingly natural extension of his initial interest in engineering. However, as he came to the end of his surgery rotation, he recognized that the field didn’t match his personality, as he envisioned having more of a relationship with his patients. Around the same time, a family member was diagnosed with cancer, so his thought process was in a place primed to consider radiation oncology.

Among such an illustrious trio, someone has to be “last,” in which case Aneesh trailed slightly behind the other two, having taken a gap year, even though he was the one who initially prompted Nishant to think about the field of radiation oncology. While at Rutgers, Aneesh engaged in a shadowing program where he followed a breast surgeon, and during clinic with him, he met a radiation oncologist who made an impression. Fast forward a few years, at the end of his third year at Albert Einstein College of Medicine, he was compelled to survey his academic experiences and decided to revisit radiation oncology. Around this same time, Nishant was having a medical identity crisis and called Aneesh, unsure of what steps to take next and which specialty to hone in on, after having focused on surgery for so long. As Aneesh had RO on his mind, he prompted Nishant to explore the field as well. Meanwhile, as Aneesh was researching where to do his RO residency, he consulted Rohan and Nishant on where to apply, and both recommended Fox Chase Cancer Center where he is now.

The three have an ease that comes with having known each other for a long time, without pretense and with much good humor. They strike me as the type who won’t speak for months, and then call one another up late one night and pick up exactly where they left off. Rohan spoke with admiration of his friends, humbly remarking that to collaborate in the future in some capacity would be an honor. The other two were quick to point out that Rohan was class valedictorian, implying who it would really be an honor for, and poked light fun at his sincere compliment.

Prior to the interview, I had conjectured that the three had pre-medical dispositions from their youth, and that their journey to radiation oncology was linear, and I was quickly disproven. In fact, Rohan and Nishant chanced upon each other in the midst of residency interviews, oblivious that the other was engaged in the same process. The three weaved in and out of varying aspects of their medical education and landed on radiation oncology having taken different paths.

But a few common factors characterized the journey to their destination. All three tried other more common fields and found that they were ill fits for their personalities, hugely because of the lack of the opportunity to develop relationships with patients. As for radiation oncology, they were all drawn to the intellectual challenge of the science and diagnostics, the team-based treatment administration and the exciting future of evolving technologies.

When asked about the future of radiation oncology, they collectively viewed it optimistically, touching upon some endeavors necessary to grow the field. Nishant remarked the importance of having a grassroots effort at medical schools to raise awareness of this specialty. He pointed out that the influence of Neha Vapiwala, MD, FASTRO, was critical at the University of Pennsylvania Perelman School of Medicine as an Assistant Dean of Student Affairs, and that because of her, every medical student knew about radiation oncology from the get-go, something he observed while doing his internship there.

Aneesh noted that learning more about the synergies between immunotherapies and radiation held much promise, highlighting that Rohan has researched and published in this area. Aneesh commented that he was not exposed to RO in medical school, and that it needs to be better incorporated into curriculums so students know of it as an option. Rohan piggybacked on this comment, pointing out the need for broader oncologic education for medical students. Being able to impart to students that ROs work as part of a team, ranging from dosimetrists and physicists to medical oncologists and surgical oncologists, will help cultivate interest in the field. Aneesh also highlighted radiation’s growing potential to treat non-oncologic diseases as the method of delivery has improved significantly. The area is ripe for research to discover and apply novel ways to treat patients both within and outside of cancer. The three energetically conveyed wanting to be advocates for the field, broadening exposure, also touching upon payment reform, health policy, all as facets and contributors of delivering high quality care.

They concluded with a few sprinkled memories of Latin class together, group projects involving wildly involved homemade videos to depict scientific concepts, their moms’ active group chat, someone’s embarrassing AOL screenname that they respectfully kept to themselves so as not to embarrass anyone, and fantasy football leagues. Fast forward to today, Aneesh and Nishant both run podcasts with their NOT-abundant spare time and use it as a way to keep in touch with the community they’ve built over the years, extending to their college and medical school classmates. Clearly, connection is important to these three. And it’s that warmth, empathy and connection that bodes well for three meaningful careers ahead where they touch the lives of many grateful patients.

To stay apprised on the careers and observations of this dynamic trio, check them out on Twitter:
@AKPirlamarlaMD
@NishantShah8792
@RohanKatipally

Do you have a shared connection through radiation oncology? Email the Communications Department to share your story for consideration on the Blog!

By Jennifer Jang, ASTRO Communications

Two Chicago-area organizations, Cancer Support Center and LivingWell Cancer Resource Center, were selected as ASTRO’s 2021 Survivor Circle grant winners for the services they provide to cancer patients, their families and caregivers. Each organization received a $10,000 grant in late 2021 and were honored at the 63rd Annual Meeting in Chicago. Specifically, the Survivor Circle Grant Program provides financial gifts to two cancer support organizations in the state hosting ASTRO’s Annual Meeting. ASTRO followed up with both organizations to learn more about how the grants provided tangible aid in the past year.

The Cancer Support Center (CSC), located in Chicago, is a community-based non-profit organization with two facilities in Chicago’s Southland neighborhoods of Homewood and Mokena. CSC serves anyone seeking oncology care and focuses on a health equity initiative providing services to communities of color with high cancer morbidity rates. CSC uses the Five Point Model of Cancer Care, which comprises Counseling/Stress Management, Education, Nutrition, Fitness and Body Image. “Navigators,” as they call their providers, address these points at the first meeting, when the first time “participants,” as they call their clients, come in the door.

Pre-COVID-19, when a cancer patient came to CSC, they immediately met with a program navigator who began the patient support process. Since COVID however, CSC determined they could achieve a significant level of care through intentional videos. CSC thus chose to use the Survivor Circle Grant to develop a series of introductory videos focusing on how supportive care can improve their participants’ lives.

Three videos were created: “What to Expect at The Cancer Support Center,” “Why Supportive Care is so Valuable,” and “What Supportive Oncology Care is and How it Can Help.” These videos are housed on CSC’s YouTube page, as well as embedded in their website at strategic points of entry for interested participants. Opportunities are abundant as CSC continues to find new ways to share the videos and spread the message of CSC and the importance of psychosocial oncology care. Challenges included staff ease in front of the camera, ensuring that scripts encompassed the wide range of topics associated with each area and needing to be engaging and concise.

Funds were spent on staff time (Executive Director, Marketing Manager, Marketing Coordinator for development of the video content and marketing; Executive Director, Clinical Program Director, Program Manager, Program Navigator and two staff therapists to rehearse and shoot the video content) and Videographer.

This project has made it easier than ever for CSC to share who they are, what they do and why it is important. They have already utilized the video content on their website, social media platforms and in presentations with external partners. From introductory presentations about CSC to hospitals and businesses, to hospital staff sharing with patients — the reach is vast. CSC had heard that it is difficult for participants to think about coming to CSC, and the video series is helpful to bridge the gap of conveying what to expect. For example, hospital staff shares the video with patients or upper management to communicate CSC as a resource or to explain the importance of psychosocial care in general. The full potential of the videos’ reach is still being discovered, and they anticipate using them for years to come to encourage higher participation and referrals, and also to incorporate psychosocial care into the experience of all cancer patients.

Similarly, the LivingWell Cancer Resource Center, the other recipient of the 2021 Survivor Circle Grant, expanded their breadth of reach using the new funding, but in a more physical way. Upon receiving the funding, their social work team mobilized to support patients needing transportation to and from appointments. The grant removed a barrier to patient care in the most practical way, as many LivingWell participants tend to rely on rides from family, friends or caregivers. When rides are not available, patients often have no choice but to cancel their appointments, delaying much-needed care.

The Survivor Circle Grant has helped LivingWell Cancer Resource Center reinforce their efforts to provide a foundational component of their purpose, increasing access to care. From November 2021 through October 2022, LivingWell funded a total of 175 rides, totaling almost $7,000. The average ride distance was 12 miles, with the furthest distance traveled as 49 miles, to various Northwestern Medicine Cancer Centers.

Alongside the grant, LivingWell bolstered their efforts with other partnerships, including the American Cancer Society, which is piloting its Road to Recovery program, using community volunteers to provide rides in DuPage and Kane counties. However, the limited number of available drivers has been an obstacle, as the demand for rides far outpaces the availability of drivers. The program has not yet been piloted for the DeKalb community, and because of these challenges, ASTRO funding has been instrumental in providing access for patients to receive care. The social work team works with patients to determine alternative options to support visits for patients’ long-term medical needs, including investigating family, friends and community resources to provide rides along with assessing the patient’s health plan to see if transportation might be included in their coverage. If not, the team often works with the patients to change to a plan that includes this coverage without sacrificing medical coverage for care.

Through the year, LivingWell’s social work team made every effort to exhaust every other possible resource before considering Uber Health as an option. To offset the cost of inflation and increasing gas prices, LivingWell will use remaining funds to purchase $25 gas cards, which will help 130 patients through the remainder of 2022.

The Cancer Support Center and LivingWell Cancer Resource Center have used their funds to multiply their impact. Similarly, we encourage cancer support organizations in next year’s Annual Meeting state, California, to consider how they too might strengthen their support. Applications will open up in January 2023 and be due in the spring. For questions, contact Beth Bukata.

Read about the 2022 Texas-based Survivor Circle grant recipients.