By Rosalyn Morrell, MD, Committee on Health Equity, Diversity and Inclusion
More than 100 years after it debuted as a mainstream cancer treatment, radiation oncology is still somewhat of an unknown specialty to the general public, and even to other medical specialties. Even over the course of my own career (14 years), I have been consistently surprised at the high number of misconceptions and general lack of awareness about radiation therapy and its benefits and effectiveness in treating cancer.
When patients hear the word “oncologists,” they typically think of our medical oncology colleagues. Or, when they hear “radiation oncologist,” they confuse us with radiologists. Many patients have presented to my clinic with an inaccurate understanding about the treatments and side effects. Oftentimes, their primary source of information has been anecdotal evidence passed on by family and friends or information gleaned from the internet. In fact, it has been reported that approximately 72 percent of people research health-related information on the internet.1
However, we all know the internet can be a notoriously unreliable source of health data.
As for our internal medicine resident colleagues, in a recent article published in the Red Journal, 93 percent of polled internal medicine residents stated that they did not receive radiation oncology training during their medical school training. Furthermore, only 26 percent reported knowing when to consult radiation oncology for a patient with a new cancer diagnosis.2
Additionally, we know that lack of awareness among other medical specialties, especially primary care physicians, can have an impact on patient care.2
More frequently than ever before, primary-care providers are taking a more active role in the care of the cancer patient, referring them to oncology specialists and participating in survivorship care. Yet many of them report uncertainty about the benefits of radiation therapy and a lack of understanding regarding when patients should be seen by a radiation oncologist.2,3
This lack of awareness about radiation oncology can lead to or exacerbate disparities in the quality of patient care and survival rates across many segments (e.g., racial/ethnic, geographic or socio-economic) and even the economic bottom line for radiation oncology practices.4,5
Patients may not be referred to a radiation oncologist at all, or may be referred in later stages of their disease or only for palliative treatment.6
Since 2003, ASTRO has been actively conducting research assessing patient perception of our field. Over the years, that perception has not changed much.7
Now, work is underway at ASTRO to raise positive awareness and the profile of radiation oncology in treating cancer. Most recently, ASTRO’s Board of Directors has made raising the profile of radiation oncology a part of their strategic plan
On an organizational level, this will be impactful, but we should also be asking what each of us can do in our day-to day activities to raise awareness of radiation oncology. Three areas that we as practitioners could be addressing in our own practices are:
1. How do we educate our primary-care physician colleagues and other specialists about our field?
2. How can we raise the level of knowledge and awareness of radiation therapy in our patient populations?
3. How can we get more positive stories and awareness about radiation oncology into mainstream media and the general public?
So, how might we do that? Below are a few activities and best practices that have been employed by myself and others in their own practices to help raise positive awareness of radiation oncology.
- For primary-care physicians and other medical specialties:
- Arrange face-to-face visits with primary-care physicians and other specialists.
- Provide their offices with educational literature about radiation therapy for referring physicians and to give to their patients (browse ASTRO’s patient education resources).
- Participate in physician networking groups.
- Host open houses at your practice.
- Start a radiation oncology journal club or tumor board.
- Partner with other specialists for disease-specific community events.
- For our local community patient populations:
- Give talks or seminars to community groups, churches and other organizations.
- Promote or sponsor cancer awareness and education seminars.
- Attend or sponsor support groups.
- Promote or sponsor cancer screenings.
- Sponsor and participate in cancer-related community outreach events.
- For the general population:
- Offer to give interviews on local radio or television.
- Create an informative and educational website.
- Post testimonials on a blog or website.
- Promote cancer prevention on social media.
- Start a blog.
- Write a book.
These are just a few ideas to initiate the conversation regarding awareness of our field. I urge you to sponsor or support activities in your own communities to raise positive awareness of radiation oncology. Your patients will be healthier, happier and have a brighter future.
Please tell us in the comments what you are doing that can help raise the profile.
1. Bibault JE, Katz MS, Motwani S et al. Social Media for Radiation Oncologists: A Practical Primer. Advances in Radiation Oncology. 2017;2: 277-280.
2. Shaverdian N, Yoo SM, Cook, R et al. Gaps in Radiotherapy Awareness: Results from an Educational Multi-institutional Survey of US Internal Medicine Residents. Int J Radiat Oncol Biol Phys. 2017; 98:1153-1161
3. Samant R, Malette M, Tucker T. Radiotherapy Education Among Family Physicians and Residents. Journal of Cancer Education. 2001;16:134-138.
4. Park H, Decker RH. Disparities in Radiation Therapy Delivery: Current Evidence and Future Directions in Head and Neck Cancer. Cancers of the Head and Neck. 2016;1:1-5
5. Rueth NM, Lin HY, Bedrosian I, et al. Underuse of Trimodality Treatment Affects Survival for Patients With Inflammatory Breast Cancer: An Analysis of Treatment and Survival Trends From the National Cancer Database. J Clin Oncol. 2014;32: 2018-2024
6. Zaorsky NG, Shaikh TA, Handorf EA. A National Assessment of Medical School Knowledge in Radiation Oncology and Comparison to Primary Care and Radiation Oncology Attending Physicians. Int J Radiat Oncol Biol Phys 2014;90:S601-602.
7. ASTROnews, Spring 2014; p14-20
By Randi Kudner, Senior Quality Improvement Manager
It’s difficult to keep track of all the administrative deadlines within a radiation oncology practice. This is especially true for those practices reporting to Medicare’s Merit-based Incentive Payment System (MIPS). As we near the end of the second year of the MIPS program, there are several requirements to consider and a few items to check off the end-of-year “to do” list.
In 2018, physicians or practices must achieve 15 points to avoid the 5 percent penalty in 2020. Small practices ( less than 16 eligible clinicians) can achieve this by choosing two medium-weight Improvement Activities
, or one high-weight activity. Large practices (16 or more eligible clinicians) need four medium-weight or two high-weight activities.
In 2017, the Cost performance category was not included in MIPS; however, it was scored. ASTRO recommends that all practices review their 2017 Feedback Report
in the Quality Payment Program Portal
to see whether a Cost score was provided. If a practice received a score in 2017, it is likely they will also meet the required thresholds for 2018, when the category will be 10 percent of the final MIPS score.
All practices can learn more on the ASTRO website
or contact ASTRO directly