By Lisa Braverman, PhD, Senior Managing Editor, ASTRO Journals
This past summer, I had the opportunity to spend a week in Finland. While the trip was mostly a vacation, I was inspired to visit a cancer treatment facility by the recent ASTROnews issue, “Personalizing the Patient Experience.” The articles about Danish and Australian centers made me wonder: What decisions were made in the design of a Finnish treatment facility, and why?
Shortly before my travels, I contacted Docrates Cancer Hospital in Helsinki and was graciously invited to visit. My time there revealed beauty, efficiency and an exceptionally well-curated cultivation of calmness.
I was first struck by how separate the patient waiting areas were from the administrative centers of the hospital. Nearly every waiting room I have visited in the United States is open concept to a fault: dozens of chairs comingle with stations to check in, check out, provide information and pay. Waiting areas were abundant in Docrates, all of which were small and intimate. The ones near windows were flooded with light; others outside infusion rooms were designed to look like living rooms. For patients seeking more privacy, cubbies with desks were provided. Walls of greenery were ubiquitous, promoting calm and obvious references to the world outside. As with nearly everywhere I visited in Finland, Docrates was noticeably quiet. Juha Kononen, MD, PhD, Chief Clinical Director of Personalized Oncology, said a quiet soundscape was intentional and “very Finnish”; having a low sound burden was meant to enhance healing and lessen the hardships of treatment.
Dr. Kononen showed me his office and vacant infusion beds. All faced the same direction: outward toward the Baltic Sea. Doctors sat with their backs to the sea, so patients could look at the water. He explained that this was done on purpose, so patients would have something nice to look at while they were undergoing treatment. The floors were wood to evoke feelings of home; stunningly detailed paintings of wildlife adorned patient room doorways in an effort to keep the mood light.
In terms of radiation therapy treatment, Dr. Kononen confirmed that the center mostly sees prostate cancer and breast cancer patients and occasionally head and neck cancer patients.
One goal of cancer treatment at Docrates is to offer highly personalized care to each individual’s disease. Dr. Kononen noted that Docrates’ approach to prostate cancer treatment, for example, is more aggressive than most. Strong emphases are placed upon understanding the tumor microenvironment and using radiopharmaceutical therapies. The center offers an in-house cyclotron in order to be able to deliver nucleotides in the most efficient way possible.
When speaking with members of the Docrates team, I was struck by everyone’s unwavering commitment to ensuring a positive patient experience. A patient’s doctor and nursing staff remain with them throughout the entirety of treatment. Schedulers empathize with patients’ time pressures and proactively work to have them seen as quickly as possible; administrative staff have medical training so they are able to answer treatment-related questions during off-hours. All of Docrates’ actions, Dr. Kononen said, are done “with the best interest of the patients at the center.”
Visiting a cancer treatment center was an extremely informative way not just to learn about RT practice outside the United States, but to learn more about Finnish culture. I hope to make such visits part of my vacation routine in the future!
Lisa Braverman assists with the publication of ASTRO's three scientific journals. She holds a PhD in Communication and Culture, and she enjoys interfacing with ASTRO members from all over the world.
By Cindy Tomlinson, Senior Patient Safety and Regulatory Affairs Manager
In 2022, the American Board of Radiology announced that it was terminating the Nuclear Regulatory Commission recognition of all ABR certification processes after December 31, 2023. This change is important for radiation oncologists that want to begin offering radiopharmaceuticals but have not previously offered treatments regulated by the NRC, such as brachytherapy or radiopharmaceutical therapy.
What does this change mean? Starting on January 1, 2024, any radiation oncologist who is interested in becoming an Authorized User (AU) under 10 CFR 35, Medical Use of Byproduct Material, must obtain AU status via the “alternate pathway.”
What is the “alternate pathway”? The “alternate pathway” is how radiation oncologists become AUs without using board certification to prove compliance with training and experience requirements.
Simply put, if you are not already an AU, are within seven years of completion of training, and you want to become an AU, you must have all the proper paperwork, signatures and attestations as required by either the NRC or Agreement State. Note: if you are more than seven years after completion of training, there may be additional training and experience requirements needed to obtain AU status, but the process will be the same. You will need to contact your state radiation control program (for agreement states) or the NRC (for all others).
What can I do? Current trainees should ensure that your training program maintains meticulous records, complete with preceptor attestations, and fills out both NRC form 313A (AUT) and form 313A (AUS) and provides those to you upon graduation. This information must also be accessible to you indefinitely. Also, current trainees should ask their training programs to make them an AU under their training program’s license. This will be dependent on what type of license your facility has and the structure of your training program. The first step is to discuss this with your program director, your radiation safety officer (RSO) and your radiation safety committee.
ABR’s change puts greater onus on radiation oncologists, trainees and training programs to obtain AU status, particularly those that wish to deliver brachytherapy and radiopharmaceuticals.
More information, including links to state-specific radiation control programs and forms (where available), can be found on ASTRO’s How to Obtain AU Status webpage.
If you have any questions, please contact Cindy Tomlinson.
Learn more about radiopharmaceutical therapies in the Winter 2023 ASTROnews.