By Paul Harari, MD, FASTRO, ASTRO Board Chair
In the seven years that I have served on the ASTRO Board in various capacities, our leadership has heard from key stakeholders and discussed and debated many important issues. We’ve discussed the future of brachytherapy and the emerging promise of theranostics and artificial intelligence along with the variability of radiation and cancer biology faculty and the need for common curriculum across residency training programs.
Given the attention this year to residency and training issues, I want to continue the discussion about matters that impact our field. Earlier this year we learned that the ACGME residency training requirements would be updated and that part of the deliberation process included public comments. Given the impact that ACGME rules have within our departments and practices, ASTRO did provide comments on a range of topics.
While we think that by and large the current radiation oncology training requirements are good, we feel there are areas that could be adjusted. Knowing that any changes in ACGME’s residency requirements will impact future residents and the field, I want to give some context to ASTRO’s position on ACGME’s proposed changes to the radiation oncology residency program requirements.
Does Program Size Matter?
ASTRO appreciates the difficulty of identifying the right mix between faculty and residents, particularly when some programs are quite large and others small. The three factors that impact this balance are minimum number of faculty, minimum number of residents, and the faculty-to-resident ratio. We recognize that numeric rules do not guarantee success when it comes to education and training, and that minimum requirements are simply an attempt to strike the best balance.
At one point in time, ASTRO thought the idea of increasing both the minimum number of faculty and the minimum number of residents might be a worthy approach. But after further analysis and discussion, we concluded that there is insufficient data at this time to support an increase in the minimum number of residents. If ACGME elects to share anonymized data about key factors such as ABR pass/fail rates or case logs with information about program size, that may shed further light on the question of whether program size matters. In the absence of such clear data, ASTRO believes four residents is an acceptable minimum.
We do have concerns, however, about the current faculty to resident ratio. We fully support that both the cancer biologist (or radiobiologist) and the medical physicist be considered core faculty. We think that given the increasing complexity of multidisciplinary cancer care, at least four different clinical faculty are needed to provide guidance and knowledge transfer for residents to develop the depth of understanding required for practice. Thus, we recommend that the faculty:resident ratio be increased from 0.67:1 to 1:1 and that it be further clarified that this ratio applies to clinical physician faculty. We think that this size-agnostic metric would help improve quality across all programs.
As I stated in my March blog post, ASTRO has an eye toward the future health and growth of the specialty. From this perspective, we are supportive of many of the proposals to update residency program’s case minimums and curriculum.
- ASTRO supports the proposal to require disease-specific clinical rotations. As multidisciplinary, multimodality treatments and increased sophistication of radiation delivery continue to expand and define the standard of care for many cancer patients, we believe this training is imperative.
- As we look to the future, we anticipate the need for radiation oncologists to be prepared to manage patients who are receiving theranostics and other radiopharmaceuticals. The ongoing use of Xofigo®, the recent approval of Lutethera® and the imminent approval of a PSMA-targeted radioligand and other novel radiolabeled agents in the pipeline lead us to believe that the current requirements are likely insufficient. We are supportive of this update to increase the minimum number of cases.
- We have significant concerns about the levels of brachytherapy training, particularly in light of recent reports showing underutilization of brachytherapy for patients with cervical cancer and an associated decline in cure rates. We are concerned that the current intracavitary requirements could be met with vaginal cylinders only and without exposure to tandem-based insertions for cervix or endometrial cancer. We wholeheartedly support this proposed change.
- We agree with the update for resident scholarly activity to require that the results of investigative projects be submitted for publication. We are hopeful that if residents must submit a manuscript during their residency training, faculty at the institution will provide mentorship guidance to help further residents’ scholarly skills.
While ASTRO heard concerns about many of these topics, we had not heard concerns that the current resident training requirements are insufficient for external beam cases. After discussion, ASTRO leadership agreed that the focus in the current requirements related to a maximum of 250 treated patients per year is an appropriate upper limit. We have several concerns with changing the definition of the upper limit to 350 simulations per year. First, this could be ambiguous (e.g., is this initial simulation only or does it include adaptive simulation or verification simulation or boost simulation or even simple/block check simulation)? Second, we are concerned that more than 250 initial simulations (i.e., more than 250 treated patients as per the current definition) will not afford residents ample time to read and learn from each simulated case. In many academic practices, full-time attending physician workload does not exceed 250 initial simulations per year, and thus we think this is a reasonable benchmark for the upper limit of patients treated by a resident.
Looking Towards the Future
Radiation oncology has attracted many hundreds of truly outstanding residents to the field over the last several decades. Despite the most recent match challenges, I strongly believe that the discipline remains vibrant, dynamic, intellectually and emotionally rewarding, and a wonderful blend of cancer biology, technology and compassionate cancer care for cure and/or palliation. The more we engage the voice of our trainees and early career practitioners in the dialogue, the stronger our field can become for future generations of providers and cancer patients.
Posted: May 28, 2019
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By Theodore DeWeese, MD, FASTRO
As president of ASTRO and chair of the Annual Meeting Planning Committee, I am thrilled to share with you the exciting, innovative changes coming to the 2019 Annual Meeting and the totally redesigned Presidential Symposium! ASTRO recognizes that as a Society, we must evolve to match the pace of change in this modern world we live in and we take that seriously — in order to provide our members with innovative, thought-provoking, problem-solving tools and events, the Annual Meeting is undergoing a transformation. The Annual Meeting’s theme, Innovate, Collaborate: Transform, speaks to not only the changes taking place in our field as new technology and research expand our capabilities, but also the changes taking place within the format of the meeting itself.
The Annual Meeting is a must attend for all those working in radiation oncology and the changes planned over the next three years ensure this meeting remains an indispensable event and experiential learning opportunity. Most importantly, these changes incorporate your feedback and we will continue to ask for your participation in shaping the program (more on that below!). You can preview the exciting innovations in our previous post, but for now, I want to give you a sneak peek into the reengineered Presidential Symposium.
A whole new experience
In the past, the Presidential Symposium was a didactic lecture focused on a “deep dive” of a topic. This year, we are unveiling a whole new format centered around this thought-provoking question: “Curing metastatic disease with radiotherapy: Myth or reality?” I am inviting attendees to join me in discussing this provocative, and perhaps polarizing topic using a new concept design for the symposium.
General Session: The first part of the Presidential Symposium will be comprised of three, level-setting talks and an Oxford-style debate, taking place in the general session room. I like to think of this session as your large university lecture hall. The presentations will ensure that all attendees are on the same page as to the state-of the-state when thinking about metastatic cancer. The Oxford-style debate will be a fun and educational dialogue to help unveil and explore where the controversies lie.
Expanded Learning Sessions: Next, attendees will select one of 12 facilitated sessions. I liken these to a smaller university course with much more interaction and discussion during class. Each of the 12 topics will focus on one aspect of the overall debate topic to give attendees an opportunity to “pick a side” they feel most passionate about and get more involved in the debate! Start conversing with your peers and colleagues now and be sure to let us know your feedback on the topics selected thus far, including if we have left out something important!
Table Talks: Following the expanded learning sessions, you will have the opportunity to continue the discussions with informal table talks in the Innovation Hub. These sessions will be more akin to a five to 10-person study group, with high interaction and engagement. And, this is where the real fun begins!
For the first time ever, we are opening a community on ASTRO’s forum, ROhub, for members and industry to start the discussion and shape the topics ahead of the Annual Meeting!
All ASTRO members are invited to opt-in:
- Join the PS: Innovate Together community. You’ll need to log in with your ASTRO credentials.
- Click the latest discussion post or start your own.
- Discuss the expanded learning session topics and start the conversation with your colleagues now. Provide feedback on the various topics and let us know if we’ve missed something important!
- Post suggestions for the Table Talk topics and let us know if you are interested in leading a Table Talk.
Members of the community will receive a daily digest of the previous day’s conversations to keep up to date with the latest information. You can change your digest subscription at any time by simply adjusting the “Community Notifications” under the “My Account” tab.
The Presidential Symposium is just one example of how we’re increasing engagement and collaboration as we raise the profile of radiation oncology and continue to support innovation within our field. You will experience a customized learning event, where you can determine your path and have a unique opportunity to shape the discussion topics. On behalf of the ASTRO Annual Meeting planning committee, I invite you to join us in Chicago for these exciting, ground-breaking changes!
View the video to learn more about the Presidential Symposium.
Learn more about what’s new for the 2019 Annual Meeting from ASTRO CEO Laura Thevenot.
Posted: May 22, 2019
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By Laura Thevenot, ASTRO Chief Executive Officer
You might have heard some rumors over the past few months that ASTRO is making some changes to our Annual Meeting. You may even have been contacted to give your feedback on the meeting, whether it was to participate in a focus group or take a survey. We’ve taken an in-depth look at our Annual Meeting with a goal of transforming it into an indispensable experience not only for our members, but for anyone involved in cancer treatment.
While the ASTRO Annual Meeting is a successful, well-attended event, we need to evolve to keep pace with newer learning styles and a changing audience. In addition, the pace of change in radiation oncology and cancer treatment overall has greatly accelerated, and we felt it was time to reengineer the Annual Meeting to meet the needs of our audience. Here is a sampling of suggestions we received from attendees:
- Provide more innovative, forward-thinking information, with session formats to match.
- Offer a less packed schedule – with more time to connect with the content and colleagues.
- Allow for opportunities to solve problems collaboratively.
- Provide wrap up sessions with key points for attendees to take back to their practices.
- Present a more comprehensive look at cancer care, incorporating interdisciplinary approaches.
- Make the Exhibit Hall more of an educational hub, with interactive experiences.
What’s new in 2019? Innovate, Collaborate: Transform!
ASTRO 2019 will be the beginning of a three-year transformation of our Annual Meeting. Here are some of the exciting changes we have planned this year:
- An all-new format for the Presidential Symposium, based around the provocative question: “Curing Metastatic Disease with Radiotherapy — Myth or Reality?”, with an Oxford-style debate, followed by facilitated break-out sessions, and the opportunity to continue the discussion on various subtopics in the Innovation Hub with “Table Talks.” We will be asking for your input on this — stay tuned for more information on how to provide feedback, as well as more details on the Symposium coming from our president, Dr. Ted DeWeese, in next week’s blog post.
- A new focus on wellness throughout the meeting, with a special luncheon, more healthy food options available throughout the day, Sunrise Yoga and more free time in the schedule, giving you a chance to relax, reflect and connect with old and new friends.
- An inspirational closing session on Wednesday, “Cancer Breakthroughs: Takeaways from the Major 2019 Oncology Meetings,” that will highlight the big takeaways from the meeting along with an overview of the advances from the past year in multidisciplinary cancer treatment.
What’s on tap for 2020 and beyond?
In the past we have positioned the ASTRO Annual Meeting as “the premier radiation oncology scientific event in the world.” We are still that event, but we have the potential to be so much more. With curated content, a warmer, more inviting environment, a focus on debate, discussion and collaboration, along with the top practice-changing science, we can provide a cohesive and unifying experience for the entire cancer care community. We are working on plans to move the meeting in this new direction over the coming years, and we welcome your feedback and suggestions as these plans take shape.
Radiation oncology is at the intersection of humanity and technology. ASTRO’s Annual Meeting can be the place where the best of the oncology community connects to advance cancer care, improve patient outcomes, and inspire and renew providers.
Posted: May 15, 2019
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New Grants Aim to Individualize Radiotherapy by Improving Patient Experiences and Outcomes
By Gita Suneja, MD, MS, ROI Research Committee Chair
The Radiation Oncology Institute is excited to announce new funding awards to four research teams who will be working to personalize radiation therapy for cancer patients. We received a record number of applications, highlighting the strong enthusiasm and ongoing work in this area of radiation oncology research. The following teams were selected for the ROI Personalized Radiation Therapy research awards.
Minimizing Cardiac Toxicity for Lung Cancer Patients Carmen Bergom, MD, PhD, and El-Sayed Ibrahim, PhD, and their team at the Medical College of Wisconsin will conduct a pilot study to determine whether cardiac MRI can be used to detect early, non-symptomatic damage to the heart in lung cancer patients treated with radiation therapy. They will measure associations between delivered cardiac dose and subclinical cardiac damage, as well as test whether biomarkers associated with cardiac dysfunction correlate with the damage to the heart. Eventually, this information could be used to prevent and manage the effects of radiation to the heart by personalizing treatment plans to minimize cardiac toxicity and improve long-term outcomes for lung cancer patients.
Enhancing Patient Experience and Reducing Anxiety Using Virtual and Augmented Reality Platforms David Byun, MD, and his team at New York University School of Medicine will take on a new project that will explore whether the application of virtual and augmented reality platforms during consultation visits could better increase patient knowledge about radiation therapy, reduce anxiety, and improve the quality of their overall treatment experience. Dr. Byun’s CurieUx (Curie User eXperience) mixed reality patient education software is designed to include a novel virtual reality 360° tour of simulation and treatment rooms for patients to explore, as well as interactive virtual disease-specific anatomy models to help physicians personalize their verbal explanation of each patient’s diagnosis and treatment. To measure the efficacy of the intervention, Dr. Byun and his team will conduct a feasibility study, followed by a prospective trial, to determine whether using the CurieUx platform would help reduce patient anxiety and improve their overall treatment experience.
Customizing Patient-Physician Communication Daniel Golden, MD, MHPE, and Ritu Arya, MD, at the University of Chicago are focused on improving communication between patients with cancer and their physicians by developing a personalized discussion guide that explains external beam radiotherapy in an easy-to-digest format. With the grant from the ROI, Dr. Golden, Dr. Arya and their partners at the Institute of Design at the Illinois Institute of Technology will build upon their existing collaboration to create three new guides in the “Communicating the External Beam Radiotherapy Experience” (CEBRE) series that are tailored for patients with breast, lung and prostate cancer. The guides will be written at the sixth-grade level and provide understandable information unique to the patient’s disease site and treatment process in a graphic narrative format. Patients, caregivers, medical and non-medical staff will be involved in the development of the site-specific CEBRE guides to ensure a human-centered design process with key stakeholder input.
Individualizing Radiation Treatments for Pancreatic Cancer Patients Adam Wolfe, MD, PhD, and Terence Williams, MD, PhD, at The Ohio State University have discovered a molecular signature made up of microRNAs that could predict which patients with pancreatic cancer are at high-risk for local-regional recurrence following surgery. One of these microRNAs shows promise to help identify the pancreatic cancer patients who might benefit most from radiation therapy. With the ROI grant, Dr. Wolfe and his team will validate whether the molecular signature can predict for local-regional recurrence in an independent dataset using samples from two other institutions. They will also use cell and mouse models to examine if microRNA-296 increases cell death following radiation. Together, these two aims will improve patient selection for radiotherapeutic management of pancreatic cancer.
The future of the field is bright! We look forward to sharing more about each of these projects with you this month in honor of May being National Cancer Research Month. Be sure to follow us on Twitter, Facebook or LinkedIn to get all of the latest news on these and other research projects in our portfolio.
Posted: May 7, 2019
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