By Sue Yom, MD, PhD, MAS, FASTRO, Editor-in-Chief, International Journal of Radiation Oncology · Biology ·Physics
The gift giving season has just passed, but there’s nothing to say that we can’t continue to give throughout the year. As many of you know, I’ve just become the editor-in-chief (EIC) of the International Journal of Radiation Oncology · Biology · Physics (IJROBP or the Red Journal). It’s a great privilege to be named to this position. One of my first acts as EIC is to announce that the ASTRO journals staff and editors have joined together in an effort to enhance the experience of our associate editors and reviewers. This new initiative, called the Reviewer Recognition Program (RRP), officially began January 1, 2022.
We’re aware that these days, everyone has growing pressures on their time and during COVID, many of us are running on empty. Speaking from my experience, it’s amazing to me that despite this sense of barely making it through, everyone at the Red Journal remains so energized and dedicated. Our editors and reviewers continue to find the best content and provide the best review process possible for our authors. As a result, our journal is thriving.
I hope others share my experience that the Red Journal is (already) rewarding. On those gloomy days when it’s all been too much, it is uplifting to me to see that our community of radiation oncology perseveres. I am in awe of my brilliant, articulate peers who continue to work on science, for this idealistic dream of bettering conditions for patients and our field. I love that the Red Journal is a stimulus for our community to learn, to communicate, to disagree. I am sure the other ASTRO editors-in-chief feel exactly the same. These journals are each a truly unique nexus, and the community they create is so much more than just publishing articles.
The Reviewer Recognition Program will be multifaceted, but the first component rolls out now. Reviewers and Associate Editors are eligible to receive a voucher for a free or reduced Article Processing Charge (APC) after reviewing 12 papers within three years. Here’s how it works. We will provide a Review Recognition Form that can be filled out listing the article numbers and dates of filing corresponding to 12 reviews that have been completed for any of the three ASTRO journals. Associate editors, who at times write extensive reviews of submissions themselves, are eligible to claim an especially detailed set of editorial comments for credit. The claimed reviews must have a reasonable level of quality and timeliness. Reviews of article revisions can be claimed if they demonstrate a reasonable level of additional new effort. The reviewer will submit the Review Voucher Form to the ASTRO editorial office. After verification and approval of the form, it will be redeemable for one voucher code. This voucher can be used as credit towards one-half of the APC for an IJROBP or Practical Radiation Oncology Open Access paper, or for one full APC at Advances in Radiation Oncology.
What’s an APC, you say? An APC is the cost charged to an author for the expenses of publishing an Open Access article. Therefore, at Advances, one APC credit would cover the whole cost of publishing, whereas at IJROBP or PRO it will cover half of the cost of publishing your article as Open Access (should you choose that option for your accepted paper). The voucher can be redeemed by its holder after a paper is accepted, as long as the holder is a named author on the accepted paper. Additionally, we will develop a database called the Preferred Reviewer Program, to which reviewers can subscribe so that they can signal their willingness to review often. To maintain Preferred Reviewer status, participants must accept >75% of invitations and complete their reviews within 14 days. In return, editors will preferentially invite Preferred Reviewers with the goal of completing the RRP requirements within three years.
We hope you’ll agree that the RRP satisfies a number of purposes at once. Most importantly and foremost, it gives our reviewers and associate editors a tangible recognition of their efforts. Greater recognition of our reviewers has been a long-cherished dream and we are thrilled to take this step in the right direction. It also moves us toward greater promotion of Open Access, which is a vehicle for wider public dissemination of radiation oncology research and higher citations of our early-career authors. It makes our journals more attractive as Open Access publishing venues for the best radiation-related research. It promotes the careers of our most dedicated and frequent reviewers. In addition, it provides our editors with a pathway to identify and recognize top reviewers and develop those persons for the future.
We will be rolling out other forms of recognition for editors and reviewers in the future. If you have ideas on this subject, please let me know. On behalf of myself and the other ASTRO journals editors, we look forward to the success of this endeavor and thank all of you for your ongoing support of the ASTRO journals.
Learn more: Reviewer Recognition Program
Posted: January 5, 2022
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By Anthony Zietman, MD, FASTRO
As I end my 10-year tenure as editor-in-chief of the Red Journal, I can draw breath and reflect on what this journal has become, and what, as a team, we have achieved for both its authors and its readers.
Starting with the authors, they had complained to me about the slow process of peer-review, the uncertain standards for acceptance, and the impression, rightly or wrongly, that there was a level of bias or favoritism toward work from certain institutions. To address these concerns, we gave the editorial board a structure and put the emphasis on youth and energy for its members. This created a system for manuscripts that flowed swiftly and without hindrance. We ensured that review was double-anonymized, meaning that neither reviewers nor authors knew one another’s identity or location. And we discussed within our editorial teams the criteria that had to be met to accept a paper and posted these on our website. Soon we had the time from submission to first decision down from many months to just three weeks, and our acceptance rate down from close to one half to only one in five papers.
The bar was raised, and every effort was made to keep it horizontal across disease sites. Today, the Red Journal’s Impact Factor is over 7, superb for a small specialty journal, and the feedback from authors is gratitude for the swift decisions (even if they are negative!) and a sense that the Red Journal has become a real destination for the best science in radiation oncology.
From the perspective of the reader, we wanted to ride the movement to web-based publishing and to take advantage of all that the web has to offer. This included immediate in press publication on acceptance, very important for topical papers. It also included several new features and categories such as Gray Zone, Cover Art and atlases that formed either teaching tools or fabulous collections for browsing. The interactive nature of the journal is only going to increase in the years ahead. We also chose to make the journal much more current in its discussions to truly reflect anything that a practicing radiation oncologist may be talking about that affects their personal or clinical decisions. Hence, we ran articles and discussion pieces on health policy and economics, the job market, equity and the future of the specialty. These, we believe, made the journal a far less dry read, and much more relevant.
And finally, I wanted us to live up to our title. Previously the words Physics and Biology had been printed on the cover in smaller font than the word Oncology implying lesser importance. That was an easy fix! But the word International is featured first and that needed to be honored if we were to be more than a North American journal. Attention to the composition of the editorial board, double-anonymized review and Around the Globe feature articles all helped to raise our global profile and now more than 50% of submissions come from nations other than the U.S. and Canada.
I was only the third editor-in-chief of the Red Journal in its more than 40-year history. If my tenure is remembered for anything I would like it to be that we brought the journal into the 21st century and into the lives of radiation oncologists by making it accessible, immediate and a “good read.” Social media has become the medical journal’s biggest competitor, but by adding value through thoughtful review and discussion, journals remain important and respected. A journal’s discussion is usually cooler and more reflective than those found in social media and, consequentially, more durable.
What I never realized before I took the post was how all-consuming it was. My desire to increase our speed of throughput, coupled with the endless decisions, editorials, features, invitations and production deadlines, meant that for 10 years I have not truly had a free day. There was always something that needed to be done for the journal! It seeped into every crack in my life, before breakfast, between patients, through the evenings and weekends. And, because we are a global journal, midnight in the U.S. is midday in Australia and they are submitting! The Chinese do not recognize Veterans Day, nor the British Patriots Day, and still the manuscripts come.
In the first few weeks since I have stepped back, I have reclaimed parts of my life that have been lying fallow for so many years. It was the greatest privilege of my career to serve the Red Journal, and it will be a great pleasure now to return to my “day job” and more. My garden and my dance floor need much more attention than I have been giving them these recent years!
Posted: December 21, 2021
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By Robert C. Miller, MD, MBA, FASTRO, and Faustin Laurentiu Roman, MsC
In the weeks leading up to the U.S. national elections in November 2020, while much of our nation’s attention was focused on political issues, there was a series of cyberattacks on U.S. health care institutions. The U.S Department of Health and Human Services (HHS) Office of the Assistant Secretary for Preparedness and Response, along with the Federal Bureau of Investigation (FBI) and the Cybersecurity and Infrastructure Safety Agency (CISA), issued an advisory on October 28, 2020, noting that “CISA, FBI and HHS have credible information of an increased and imminent cybercrime threat to U.S. hospitals and health care providers.”1
In a recent letter to the editor in ASTRO’s Advances in Radiation Oncology, Nelson and colleagues detail the challenges they faced when the University of Vermont Health Network was attacked on October 28 in a ransomware incident.2 The resulting IT outage lasted more than 40 days and was estimated to have cost more than $63 million to resolve.3 Delivery of radiation therapy was delayed for as many as 13 days for some patients due to the loss of the radiation oncology department’s information management system.
This incident was unique in the severity of the impact of the attack but hardly a unique occurrence. It does illustrate the trend away from broad-based attacks and toward persistent attempts to compromise high-value targets that have a high financial yield. The following challenges in cybersecurity and cybercrime will rise in importance throughout 20214:
- Social engineering attacks, such as email phishing and business email compromise.
- Increased attempts to exploit internet-facing vulnerabilities of organizations.
- Exploitation of system administration tools.
- Ineffective monitoring of critical IT systems.
- Human-operated ransomware risks.
The very technical and complex nature of radiation oncology5, combined with the escalation of cyber-attacks and changes of tactics from malicious actors, may influence the risk profile of service providers,6 especially when the delay in receiving treatments may prove to be fatal.7
Radiation oncology, reliant on connected technology, is particularly vulnerable.8 The inherent top threats to health care9, (e.g., communication errors, lost and stolen devices, insider threats), or more sophisticated cyber espionage threats,10 add up to a wide range of threat actors and risks that demands better collaboration, (e.g. threat intelligence sharing),11 meaningful action beyond compliance “tick-box” exercises, and appropriate funding to respond adequately and become resilient to the rising cybersecurity risks.
ASTRO’s Advances welcomes the submissions of scientific manuscripts, commentary and firsthand accounts of how providers and institutions are meeting these challenges. Our deadline for manuscript submission is October 31, 2021. To submit, send papers through the journal’s submission system and select “Cybersecurity” as the article type. Please reach out to the editorial office with any questions at email@example.com.
- Cybersecurity and Infrastructure Security Agency. “Alert (AA20-302A) Ransomware Activity Targeting the Healthcare and Public Health Sector.” Accessed online February 1, 2021: https://us-cert.cisa.gov/ncas/alerts/aa20-302a.
- Nelson, C. J., Lester-Coll, N. H., Li, P. C., Gagne, H., Anker, C. J., Deeley, M. A., & Wallace, H. J. (2020). Development of Rapid Response Plan for Radiation Oncology in Response to Cyberattack. Advances in radiation oncology, 6(1), 100613. https://doi.org/10.1016/j.adro.2020.11.001
- Becker’s Healthcare, “The 5 most significant cyberattacks in healthcare for 2020.” Accessed online February 1, 2021: https://www.beckershospitalreview.com/cybersecurity/the-5-most-significant-cyberattacks-in-healthcare-for-2020.html
- Thibodeaux, B. Five cyber threats to watch in 2021. Security. January 2021. Accessed online February 1, 2021: https://www.securitymagazine.com/articles/94343-five-cyber-threats-to-watch-in-2021
- The impact of cybersecurity in radiation oncology: Logistics and challenges (appliedradiationoncology.com)
- CISA Launches Campaign to Reduce the Risk of Ransomware | CISA
- Ralston, W. Wired magazine, Accessed online February 4, 2021 at: The untold story of a cyberattack, a hospital and a dying woman | WIRED UK
- Impact of Ripple20 Vulnerabilities on Healthcare IoT, Connected Devices (healthitsecurity.com)
- Healthcare Data Breaches & Security | Verizon Enterprise Solutions
- Beyond Compliance: Cyber Threats and Healthcare (fireeye.com)
- H-ISAC Information Sharing Best Practices - (h-isac.org)
Posted: June 8, 2021
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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
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By Anthony Zietman, MD, FASTRO
Ten years ago, I was chosen to become the editor-in-chief (EIC) of the Red Journal and, on reflection, I cannot believe how naïve I was entering the position, and how little I understood the qualities required to lead the journal well. I had a dreamy and romantic view that it was about reviewing some papers, making some great choices, and voila, as if by magic, quality would just shine out. What I did not realize was the level of 24/7 commitment required, the necessity to develop a dynamic and like-minded editorial team, the diplomatic stresses and the ethical, and even legal, challenges. Even though I had been chair of ASTRO previously, this position eclipsed that for its unique challenges. As my term concludes in 2021 and the search for my successor begins, I’ve been reflecting a lot on what it has taken to haul the Red Journal to where it is today and on what it will take for my successor to bring it to the next level. If you are considering the position, these are my tips.
The incoming editor-in-chief should be:
- A time management marvel. This journal moves very fast. With 15 issues per year and hundreds of pages per issue, there is always work to be done. Often this work cannot wait more than a day or two. The journal occupies nights and weekends and pops up between patients in clinics…every day.
- Dedicated to the journal. Along the lines of the above, the new editor should have a proven commitment to the journal, likely through editorial responsibilities, reviewing and/or writing. Because of the volume of work, the personal investment and the especially nuanced judgment required of this role, you’ll need to love the Red Journal — well before you apply. You will “need to bleed Red.”
- Ethical, insightful and diplomatic. Serving as the EIC of the Red Journal amounts to leading and shaping our specialty’s premier record of published research. As such, emotions surrounding the journal’s decisions can run high. The successful EIC must have a keen moral compass, be able to carefully manage conflicts of interest and scientific misbehavior and have the diplomatic skills to swiftly and gracefully handle difficult situations. The intellectual safety of the journal and of ASTRO and the scientific community can depend on it. A thick skin is essential — remember, most of the papers that come to the journal are rejected!
- An excellent writer. It is very important to be able to write well and to write quickly. Editorials, issue highlights, podcasts and similar communications need to be composed with tight turnaround times. Publishing this journal is a rapid endeavor, and being comfortable with writing quickly and decisively will help the process run smoothly.
- Well-connected. Do you have a diverse web of contacts who can be called upon to act as resources? Networks of connections within radiation oncology and beyond (broader oncology, policy and even politics) will be tremendously helpful. Authors of opinion pieces and editorials, or tie-breaker reviews for tricky papers, are often needed in haste.
- Visionary. As the EIC, you will be responsible for the entirety of the journal, its content and its editorial board. How will you make the journal your own? What new, innovative ideas would you like to enact? What should the journal look like in five years, and why? Scientific publishing has changed a great deal in the last 10 years and will undoubtedly continue to evolve. The incoming EIC should understand the threats and opportunities presented by this time of great change.
For the right candidate, this will be the most rewarding experience of their professional career. It was an incredible honor for me to be chosen to lead the Red Journal after Dr. Jim Cox and an even greater honor to see it fortify its position as the premier forum for science and ideas in our specialty. I have thoroughly enjoyed the opportunity, and when I pass the baton next year, I would love to do so into an equally proud set of hands. For those of you interested, view the job posting and details on how to apply at www.astro.org/RedJournalEIC.
Posted: May 5, 2020
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