May 2018


By Deborah A. Kuban, MD, FASTRO, and Colleen A.F. Lawton, MD, FASTRO

Research saves lives. Our patients and all of us working in radiation oncology are the beneficiaries of more than a century of research on how we can continuously improve the delivery of radiation therapy to treat and cure cancer. As ASTRO’s research foundation, the Radiation Oncology Institute (ROI) plays an essential role in advancing the field by investing in studies to provide practical solutions for radiation oncology professionals with the goal of improving outcomes for cancer patients now and in the future. During May, the ROI is honoring National Cancer Research Month by announcing five new award winners whose research aims to improve the lives of cancer patients undergoing radiation therapy.

The ROI’s research seeks to address some of radiation oncology’s current challenges and is designed to be responsive to the needs of patients and the professional community. Attendees of the 2017 ASTRO Annual Meeting were asked the question: “How do we improve our ability to get radiation to the patients who need it?” Each of the new research awards focus on a topic that was identified from the responses to that question. Financial toxicity, access, awareness and stereotactic body radiation therapy (SBRT) emerged as critical issues facing the field. The ROI is proud to recognize the following researchers with Innovative Projects in Radiation Oncology awards, totaling more than $200,000 in grant funding.
  • Fumiko Chino, MD, mentored by Yvonne Mowery, MD, PhD, and David Brizel, MD, FASTRO, at Duke University, will prospectively quantify and investigate the impact of high treatment costs for head and neck cancer patients receiving radiation therapy. Patient costs are often overlooked and may be associated with increased symptom burden, poor treatment compliance and increased mortality. Dr. Chino’s passion to conduct research in the emerging field of “financial toxicity” stems from personal experience when she and her late husband went into massive debt to pay for his cancer treatment. Her ground-breaking research has been covered by Forbes, National Public Radio (NPR), U.S. News and World Report and JAMA Oncology.
  • Rachel Conklin, MMS, PA-C, and her team at the Department of Radiation Oncology at Vanderbilt-Ingram Cancer Center will explore using telehealth to increase access to the cancer center’s radiation oncology survivorship program for patients who receive care at a community facility, in a rural area approximately 50 miles from the main campus. This study is an important first step in understanding whether telehealth is an effective method to provide follow-up care for the growing number of cancer survivors who were treated with radiation therapy in the United States. Additional members of the team include: Eric Shinohara, MD, MS; Debra Friedman, MD; Lisa Kachnic, MD, FASTRO; and Tatsuki Koyama, PhD.
  • Karen Hoffman, MD, and her team at the University of Texas MD Anderson Cancer Center are prospectively surveying prostate cancer patients to study how receiving counseling from a radiation oncologist in a multidisciplinary clinic increases their awareness of radiation therapy as a treatment option with a favorable side effect profile and whether it changes their treatment choice. Because a large portion of men with localized prostate cancer only meet with a urologist, they may not be aware that radiation therapy is a treatment option with less impact on sexual and urinary function than surgery. The long-term goal of this study is to inform patients, providers and policymakers about the best practice environment in which to receive counseling about prostate cancer treatment options.
  • Nima Nabavizadeh, MD, and his team at the Oregon Health & Science University’s Department of Radiation Medicine will prospectively study if stereotactic body radiation therapy (SBRT) can be safely used to help patients with hepatocellular carcinoma (HCC) and advanced cirrhosis as they await a liver transplant. The primary aim is to evaluate the ability of SBRT to successfully bridge patients to a liver transplant, particularly in patients with advanced cirrhosis at baseline. His team will also assess treatment-related toxicity and quality of life, as well as the histologic effects of SBRT in explanted livers. The multidisciplinary liver team will consist of: Kristian Enestvedt, MD; Christian Lanciault, MD, PhD; Alice Fung, MD; Khashayar Farsad, MD, PhD; Joseph Ahn, MD, MS; Yiyi Chen, PhD; and Ramtin Rahmani.
  • Chad Tang, MD, along with Benjamin Smith, MD, and Grace Li Smith, MD, PhD, MPH, at the University of Texas MD Anderson Cancer Center, will conduct an analysis to understand the barriers to access and costs associated with four treatment options for patients with prostate cancer—surgery, external beam radiation therapy, brachytherapy and active surveillance. Data from the MarketScan and Medicare databases will be used, which will provide a balanced view across private and public health insurance in both young and old prostate cancer patients on a national level. A prospective survey of patients being treated with surgery and brachytherapy will be used to evaluate financial toxicity. The results could be used to help increase access to radiation treatment options for patients with prostate cancer.

‚ÄčThese five new ROI-funded projects show great promise to help transform the practice of radiation oncology and help ensure that patients who can benefit from radiation therapy have access to this less invasive, life-saving therapy. We invite you to help ROI continue to support the best and brightest investigators conducting research on topics essential to the future of radiation oncology and our patients by making a gift to the ROI during National Cancer Research Month.

Deborah A. Kuban MD, FASTRO, is president of the ROI Board of Trustees and Deputy Division Head, division of radiation oncology at the University of Texas MD Anderson Cancer Center. Colleen A.F. Lawton, MD, FASTRO, is vice president of the ROI Board of Trustees and vice-chair, department of radiation oncology at the Medical College of Wisconsin. 

Posted: May 16, 2018 | 0 comments

Interoperability: What Technical Challenges do Radiation Oncologists Face?

by Mary Feng, MD

Interoperability is a major challenge in radiation oncology due to the technical specialization of our field. Safety and efficiency of clinical care can be compromised when information exchange across software is not seamless. To address this issue, in 2004, ASTRO created Integrating Healthcare Enterprise–Radiation Oncology (IHE-RO), an initiative that helps to ensure safe, efficient radiation treatments by improving system-to-system connections.
IHE-RO, now operated by the American Association of Medical Physicists, tests use cases to address clinical issues and helps to check interoperability between different equipment. To prioritize what technical challenges are most pressing to radiation oncologists, we are seeking user feedback.
We need to hear from you, the end users who experience these technical challenges. Where is information transfer inefficient? What do you worry about as information passes between systems? Are there situations in which many manual steps are required to guard against treatment errors? When are you manually transcribing information or sending PDFs because direct electronic transfer is not currently possible? What other workarounds has your clinic developed because direct information transfer is not currently possible?
Answers to these questions will be used to develop new use cases, which will be the basis for the technical committee to develop industry standards for vendors to improve the system integration of their products, resulting in safer and more efficient patient care.
We need to hear your input on what is important to you. Chances are, many others are experiencing the same problems, and together we can push for change. Please share your thoughts in a brief survey so that we can develop new use cases. The survey should take less than 10 minutes to complete. Your responses will be treated with confidentiality. The deadline for completion is May 31. Many thanks in advance to those who participate for your time and thoughtfulness.
IHE-RO is an AAPM/ASTRO-sponsored initiative for improving the functionality of the radiation oncology clinic.  Founded in 2004, it is comprised of physicians, physicists, programmers and others from private practice, academics and industry, working together to identify and solve connectivity issues in radiation oncology. After starting with use cases addressing specific clinical problems, technical standards are established for the field that aid product development. Vendors can meet in Connectathons to test their products’ ability to integrate with other hardware and software.
Posted: May 9, 2018 | 0 comments