By Raymond Mailhot Vega, MD, MPH
In mid-December, a colleague emailed me a link to an ROhub discussion on the creation of a society for Hispanics in radiation oncology. This prospect excited me. Representation matters. As a Latino becoming a radiation oncologist, I did not see myself in the workforce. Becoming what I did not see presented unique challenges and, at times, a feeling of isolation since I struggled to find others who had shared my experiences. A silver lining is charting your own territory, but being on your own, it can be hard to know if you’re making progress heading towards your destination. How do you explain to an attending whose feedback post-consult is, “Wow, you speak Spanish so well” that while meant as a compliment, so do 15% of Americans and such an observation does not provide a meaningful critique of my patient knowledge or my memorization of the inclusion criteria of PORTEC-2. Now as an attending and full member of ASTRO, I am eager to extend a hand to the next generation as they navigate their careers.
Recently, ASTRO has been working to create different ROhub communities to provide virtual spaces for communities of radiation oncologists to gather, addressing an important need. A space for communities of radiation oncologists to gather is manifold in its benefits. Latinx physicians are drastically underrepresented in radiation oncology at only 2% of the rad-onc workforce overall,1 despite the fact that 15% of Americans identify as Hispanic. Established in education is the credo “you can’t be what you can’t see,” and medical training and employment is no different. A virtual affinity space allows for mentorship of trainees and junior faculty seeking career advice. A dedicated space also provides mental health support. Physician burnout continues to gain more visibility, and the extra stress and invisible labor that more commonly burden diverse faculty are well-documented.2 A defined space for Latinx doctors facilitates the creation of a community in which we can share our common experiences, interests, stories and struggles.
Some may feel that purposely creating communities around race or ethnicity could increase divisions between people. Divisions already exist, and the “I don’t see race” perspective from the 1990s blinds ourselves and hinders our ability to dismantle the extraordinary barriers developed over hundreds of years of systemic racism that affects both patients and doctors. A dedicated community can provide a safe space to generate ideas from lived experience and foster leaders to represent that community among the larger membership. The COVID-19 pandemic has thrust in the spotlight the disparities that communities of color have faced, and a forum representing those affected can create opportunities that successfully address such inequities in health care and oncology.
To address the need for connection among physicians, physicists and trainees, ASTRO is launching various ROhub communities. These forums will create a virtual space in which ASTRO’s underrepresented and diverse members can congregate and network along with all members who wish to participate. I am excited for ASTRO’s debut and kick-off of these ROhub communities — intentional spaces for radiation oncologists to unite and grow from shared experiences. Particularly as we face social changes with our Annual Meeting moving to a virtual experience, planned socializing and networking must adapt. The timing for this initiative could not be more appropriate. Opportunity is not a zero-sum game: we don’t have to lose power or influence when others gain it. Increased diversity will push our research forward, bring new ideas to the forefront and result in higher-quality care for all patients.
ASTRO’s initiative will provide a broader tent for all of us. I encourage you to speak out for increased equity in representation of your brown and Black radiation oncology colleagues, for bridging the health-care disparities that patients of color face, for making our system more accessible for the disabled, for improving gender parity among our workforce and for creating a safe space for those who identify as LGBT+. Our time is now.
Since the submission of this blog post, ASTRO is pleased to announce the launch of the Gender Equity Community on the ROhub, a space for members to discuss gender gaps, offer mentorship and seek or provide helpful resources. The community was created for those personally encountering gender-related concerns and for those who wish to support and promote gender equity within their workplace. Work is underway to launch additional communities in the coming months.
Raymond Mailhot Vega, MD, MPH, is a gay, Latino assistant professor at the University of Florida, where he directs the hematology radiotherapy program in addition to treating pediatric patients and patients with breast cancer. He is a recipient of a Global Oncology-Young Investigator Award to conduct educational interventions for pediatric radiotherapy treatment in Mexico to reduce disparate outcomes.
1. Fung CY, Chen E, Vapiwala N, et al. The American Society for Radiation Oncology 2017 Radiation Oncologist Workforce Study. Int J Radiat Oncol Biol Phys. 2019; 103: 547-56.
2. Matthew PA. What is Faculty Diversity Worth to a University? The Atlantic. 2016 November 23, 2016;Sect. https://www.theatlantic.com/education/archive/2016/11/what-is-faculty-diversity-worth-to-a-university/508334/. Accessed on May 11, 2020.
Posted: September 29, 2020
| 0 comments
Why the ASTRO Annual Meeting is more important, now, than ever
by Theodore DeWeese, MD, FASTRO, ASTRO Chair
ASTRO’s 2020 Annual Meeting theme, “Global Oncology: Radiation Therapy in a Changing World,” was chosen in mid-2019. Who could have imagined just how prescient the topic would be and how much the world would change since then?
This will be my 27th ASTRO Annual Meeting, and I am looking forward to it as much as I did, if not more, than my first year attending the meeting as a resident. I am especially enthusiastic about the immersive educational experiences the ASTRO staff and your professional colleagues have planned for you.
Last year in my Welcome Address article to our Chicago attendees, I wrote: “We all strive to transform science and improve care for patients on a daily basis, and the ability for our specialty to lead in these domains has never been greater. But, if we are to be highly successful, we cannot do these things in isolation.”
What a difference a year makes.
Who could have known that much of the world would be in isolation for a large portion of 2020? Yet, we have seen how reactive and responsive our field has been in this unprecedented time, which allowed us to quickly reengineer how we transform science and care for our patients. And our specialty’s ability to focus on patient health has truly never been greater, as we have seen through your unselfish and dedicated work caring for, and continuing treatment of, your patients during this public health emergency.
I went on to write that “working closely with our colleagues is important.” I would argue that this year it’s more important than ever. This year’s Annual Meeting will provide you with the opportunity to work closely, albeit virtually, with your colleagues from around the globe on the latest scientific advances. We already know that COVID-19 will have a long-term impact on cancer care for years to come, so the chance to learn from your peers in the global oncology community is especially important.
I also want to acknowledge and respond to all who have expressed your feelings about our pricing structure, both for members and residents. As Laura Thevenot shared in her blog post, the financial implications to a relatively small specialty association have been significant. Canceling the Miami meeting incurred tremendous costs. Our Annual Meeting is a primary revenue source for ASTRO and because we had to cancel the in-person meeting due to COVID-19 and the need to keep our communities safe, the organization absorbed the many monetary damages associated with canceling a city-wide annual meeting. The Board had to take extraordinary fiscal action inside ASTRO to keep our activities and member support services going. We know the Annual Meeting is the key educational activity of the year for many of our members and, thus, we as a Board decided to go “all in” on the best learning platform possible in order to keep our members engaged and educated and provide an experience that members would be willing to support. We also spoke with numerous department chairs and leaders about their support for their residents. Overwhelmingly, they noted that the savings from airfare, hotels and meals would allow them to support their resident’s attendance at our meeting. And to-date, we have seen strong registrations for our members-in-training. To ensure that as many as possible can attend, we are freezing the member-in-training and student rates at the early-bird level for the duration of the registration period. We also know that many people are still assessing their expenses for the year, so we are also extending our early-bird deadline for all attendees until September 8 to give you more time to secure your annual meeting attendance at the lowest rate.
Why register early?
- The meeting, customized for our specialty’s unique needs, includes all the educational and scientific programming you are accustomed to.
- In recognition of the financial impact our meeting cancellation will have on the Miami Beach area, ASTRO will donate a portion of all early-bird registration fees to two Florida cancer patient support organizations. We are happy to announce that the recipients are Caring Friends Cancer Support Group and Gilda's Club South Florida and we are pleased to show our support for their important work during this challenging time.
- All early-bird registrations will be recognized on our Patient Support Honor Roll, which will be unveiled during the Annual Meeting.
I am particularly excited about the internationally renowned Keynote speakers who will deliver remarks on timely topics including global health, COVID-19 and racial justice and equality. We are working on the final details of their presentations and will announce their names and the schedule soon. We also will have Storytelling, a new session that encourages you to share your experiences and interact with other attendees. The virtual poster hall offers a new feature ― author narration ― just one of this year’s virtual platform innovations designed to inspire and encourage you.
Not being able to meet in person is a disappointment, I concede. However, participating in this year’s ASTRO Annual Meeting offers you many opportunities that would not be possible in person, most notably that the content will be available to all registered attendees until November 30 to ensure access to all the presentations and materials. This year there are just as many ― if not more ― competing sessions, but you won’t have to miss any of them in this online format. There are more than 200 hours of CME credit opportunities — something that has never been possible before during a four-day meeting. We are also able to offer CAMPEP and ASRT credits. Additional new features include Master Classes on topics that include leadership, radiopharmaceuticals and the integration of medical marijuana into radiation oncology practice, and we are also bringing you more Cancer Breakthroughs sessions to showcase the top science from meetings that were postponed or held virtually, including ASCO, ESTRO and AAPM. The Cancer Breakthroughs session was added last year and was one of our highest evaluated sessions.
I truly am excited about the 2020 Annual Meeting and hope you are too. We know the importance that this meeting and the content presented provide in continuing your education and providing the latest science from the field. I invite you to check out the Meeting Highlights on the website and register now. We want you to take advantage of the best rates possible, so we’ve extended the early-bird registration through September 8 at 11:59 p.m. Eastern time. Your participation is important to creating a collaborative experience and I look forward to “seeing” you at the meeting.
Posted: August 18, 2020
| 0 comments
By Laura Thevenot, ASTRO CEO
In the wake of the COVID-19 pandemic, we know that each ASTRO member has been impacted as you continue to provide world-class cancer treatment to your patients (and manage a host of new responsibilities like homeschooling children). Likewise, ASTRO has been impacted in many ways as we continue our work to provide high quality services to our members. As we launch registration for our virtual Annual Meeting on July 9, I want to explain how this meeting is coming about and why your participation is so important.
The ASTRO Annual Meeting is the primary income source for ASTRO, which is a 501(c)6 nonprofit. Unfortunately, ASTRO is not eligible to apply for any of the financial support available to many small businesses as a result of the pandemic. While membership dues produce roughly 15% of the organization’s overall budget, the Annual Meeting and income generated by the sponsorships, exhibitors and attendees is the revenue engine for ASTRO’s overall operations. This allows ASTRO to provide members with education and training for their practice, reimbursement and health policy expertise, advocacy work on Capitol Hill, clinical practice guidelines, safety resources and so much more.
Last year in anticipation that more than 11,000 radiation oncologists, residents, physicists and other health care professionals would descend on Miami in support of the Annual Meeting, ASTRO secured contracts with numerous entities including the Miami Convention & Visitors Bureau, 54 hotel properties, transportation service providers, audio/visual firms, and much more. While the ASTRO Board acted quickly to change course to a virtual Annual Meeting due to COVID-19, there are still many contracts and significant damages that we are contractually obligated to pay. We do hold event cancellation insurance, which will offset some of these expenses, but we are in line behind more than 170 other medical meetings that canceled before us.
With the cancellation of the in-person event and other revenue generators, ASTRO proactively looked to streamline day-to-day operations and adjust budgets. Like many of you, we suspended all business travel, cut professional development and other costs and implemented pay and benefit cuts for all staff in an effort to curtail spending given the extraordinary disruption and an uncertain future. We instituted these budget cuts to avoid staff layoffs and maintain our commitment to provide you with the support and educational content you need. For ASTRO to continue to play its role in supporting members, we also need to keep the ASTRO organization healthy and fiscally sound.
In an effort to produce an immersive and interactive virtual meeting, ASTRO then invested in an online platform that is being customized for our community’s unique needs, including networking and interview opportunities and an expansive exhibit hall. I promise you this will not be a hyped up Zoom call! This virtual meeting will be immersive and unlike anything you have ever experienced before. This transition to a virtual platform required us to negotiate and secure new contracts with a range of vendors including an online platform provider, videographers and audio technicians, digital designers to create online materials, support to produce trainings and onboarding for all presenters and exhibitors, and so much more. Everything we have done to produce this Annual Meeting was done to create a world-class, unforgettable learning experience for you.
We recognize that every member of the ASTRO community has been impacted in so many ways by the pandemic, including financially. Based on our COVID-19 practice survey, we know that your patient volumes have been negatively impacted and therefore you expect revenue declines this year. At the same time, we have seen the resilience of radiation oncology during the pandemic, and we marvel with pride in your ability to provide cancer patients with needed treatments and services without disruption. We also know that cancer doesn’t wait for a COVID-19 vaccine, and the need to get the latest science out to the global oncology community is more pressing than ever.
Because we understand that both your time and financial resources are precious, we are making the content available to all registered attendees for 30 days to allow you time to view materials at a pace that works best for you. One of the top complaints we get about our meeting is that there are too many competing sessions, so key content is missed, but not this year! This format and the 30-day window allow us to provide over 200 hours of CME credits — something that has never been possible, nor ever offered before during a four-day meeting. We hope that the financial savings from airfare, hotel and meals will make it possible for more members than ever to participate and learn at our Annual Meeting. In recognition of the fiscal impact our meeting cancellation will have on the Miami Beach area, a portion of all early-bird registration fees will be donated to two local cancer patient support organizations in the greater Miami area.
While everything is different for the 2020 Annual Meeting, we hope that our community will continue to gather to learn from each other, network and show our resilience as we continue to make our way through this unprecedented time. Thank you for all that you do for ASTRO and for your care and support of cancer patients.
Posted: July 2, 2020
| 0 comments
By ASTRO Journals Team
A recent Advances in Radiation Oncology article, Nutrition in Cancer: Evidence and Equality, examines the role of nutrition in cancer through the lens of social equity. Focusing on how diet affects cancer outcomes, particularly patients living in food priority areas (FPAs), the researchers sought to collect data at the human cellular level to advance understanding of the link between poor nutrition and cancer. Their research concentrated on four areas: nutritional intervention, synergy with definitive treatments, diet and long-term effects and how a lack of nutrient-dense foods contributes to outcomes. To learn more about this research, we reached out to the corresponding author Melissa A.L. Vyfhuis, MD, PhD, to answer a few questions.
Please summarize your study.
Our article attempts to answer the question: How does diet affect cancer outcomes? We tried to answer the question with as much data as possible, including human population level epidemiology down to cellular signaling. All in all, we found over 100 years of evidence that dietary intake can affect tumor development, may enhance treatment effects and may prevent symptoms associated with muscle wasting. Despite this, there are few clinical trials to demonstrate evidence-based recommendations. The highest-risk populations — those at high risk of nutritional deficits at baseline — may have the most to gain from such dietary interventions, but there are no studies to date.
What initially prompted you to pursue this study?
Historically, the primary focus of dietary intervention in oncology was caloric density. Understandably, oncologists are focused on the prevention of weight loss. Indeed, most clinical studies in humans aim to minimize treatment interruptions from manifestations of cachexia. However, if obesity, insulin resistance and metabolic syndrome account for major risk factors in tumorigenesis — and are major causes of death following completion of curative oncologic therapies — then perhaps the individual baseline should be taken into consideration. Our research demonstrates that nuance in dietary recommendations may be beneficial.
Looking at the bigger picture, how could your findings impact patient care? What do you see as the key practice-changing implications of the research?
Approximately one third of patients ask what they should eat prior to embarking on definitive cancer therapies. We see four separate and important questions that need further research to provide patients with the best answer. First, can nutritional intervention (micronutrient or macronutrient supplementation) mitigate or prevent cachexia and therefore help patients complete definitive therapies? Second, is there a possible treatment related effect whereby nutrition can synergize with definitive treatments to increase control or survival? Third, can a healthy diet mitigate the long-term side effects of definitive cancer therapies? Finally, to what extent are patients with the highest nutritional deficiencies at baseline adversely affected from their lack of access to nutrient dense foods?
Did anything about your findings surprise you?
We were surprised to find just how far back in time the original nutritional intervention studies go. Despite 100 years of animal data suggesting a treatment effect, we are still in need of large randomized trials across many disease sites and patient populations.
You point out that many studies have been published on the effects of living within an FPA and having higher incidences of various health issues like diabetes, hypertension, etc., but few studies have focused on cancer treatment and outcomes for patients living in FPAs. You then conclude that further research is needed to characterize the nutritional needs of cancer patients residing in FPAs and strategize how best to include them in future clinical trials. Why do you think this subject has not been studied as much as others regarding equity in health care, and what can cancer researchers do to include this population in future clinical trials?
I believe that this subject has not been studied as much because the prospective characterization of nutrition and its effect on cancer care is such a complicated, difficult task to begin unraveling, especially since other confounding factors can cloud the pictures such as access to care, social support and other psychosocial factors.
The recent addition of deregulated cellular energetics as an emerging hallmark of cancer highlights that the acceptance of the role in nutrition in cancer is also recent. We now hope to see this area of research grow rapidly.
What is the link between FPA and food deserts? Food deserts and poverty cannot be solved by health care practitioners alone, but what do you see as their role in decreasing the effects of living in these areas has on patients?
Patients living in FPAs (previously called food deserts) are at high risk of nutritional deficiencies because of lack of access; however, these zip codes can be very heterogenous. While community access to food cannot be solved by a health care professional, we hope to start a dialogue between oncology practitioners and patients. The end goal would be a discussion regarding the patient’s current diet, the recommended diet during and after a definitive cancer treatment and resources that can be used to bridge the gap. Hopefully, with these specific nutritional interventions, citizens at risk for poor eating habits can live longer, healthier lives after cancer care.
What steps can health care practitioners treating underserved populations living in FPAs take to improve nutrition, and therefore potentially improve outcomes, for patients?
We believe that asking patients about their current diet and access to nutritious foods is the best start.While future studies are needed, encouraging nutrient dense foods as opposed to calorically dense foods that are within each patient’s budget will likely be prudent. Also, having information on hand about resources available in the area (i.e. virtual pantry programs, church donations) to provide to patients can be helpful.
What are your next steps? Will you be pursuing further study?
Our next step is to better characterize our own patient population’s access to nutritious foods. In a prospective manner, we will gather data about our patient’s diets and economic means to determine how to best identify patients at the highest risk of nutritional deficits. We hope to begin to bridge the gap with those in the greatest need.
Read the full article, Nutrition in Cancer: Evidence and Equality in Advances in Radiation Oncology, ASTRO’s open-access journal.
Posted: July 1, 2020
| 0 comments
By Doriann Geller, ASTRO Communications
ASTRO staff continue to monitor the worldwide effect of the novel coronavirus. During this time, several program updates have been made ― or are in progress ― to APEx - Accreditation Program for Excellence®. These changes are reflected on the program’s webpages.
Visitors to APEx's webpage will find an updated message of support during the pandemic as well as information for practices regarding current applications. Specifically, facility visits continue to be on hold and will resume only when it is safe and permissible to do so. Meanwhile, APEx is offering extensions to practices that are awaiting facility visits and those whose accreditation expires during the public health emergency.
APEx recently announced a new payment option for practices thinking about starting the accreditation process. Through the end of this calendar year, ASTRO is offering a partial payment option to assist with the upfront fee. Practices that request the partial payment option will pay half of the total amount due upon submission of the application; the balance is due before finalizing the facility visit.
In June, notice was given of changes to two Evidence Indicators affecting all facilities starting July 7, 2020. The first, Evidence Indicator 1.6.1, addresses transferring previous radiation therapy and promotes the creation of a standard process for transfer of care documents to a new provider and in emergency situations. The second, new Evidence Indicator 2.4, separates the treatment plan from the treatment prescription (EI 2.3) to allow for more detailed evaluation of both criteria.
Last, an APEx FAQs page was added in May. Divided into sections, the FAQs cover all aspects of the accreditation process, including application, the Self-Assessment, facility visits, reaccreditation, program requirements and general questions. This informative section covers questions asked over the life of the program and gives answers and examples that clarify program policies.
As a reminder, the 2019 Annual Report, “APEx in Review: Five Years of Dedication to Quality Improvement,” posted to the website in January, is available to read and download. APEx was launched in 2014 to support quality improvement in radiation therapy practices. The accreditation process evaluates essential functions and steps that contribute to the delivery of safe, high-quality care. Learn more about APEx standards and dedication to patient safety and check back frequently for program updates and news. APEx is the right choice for radiation oncology practice accreditation.
Posted: June 24, 2020
| 0 comments