^

ASTRO Blog

ASTRO Blog

Volunteer for the Radiation Oncology Institute

By Colleen A.F. Lawton, MD, FASTRO, ROI President, and Gita Suneja, MD, MSHP, ROI Vice President

The Radiation Oncology Institute (ROI) is growing and evolving. Our research portfolio continues to expand, and we are proud to support a diverse group of investigators exploring a wide range of topics to advance radiation oncology. ROI relies on the time and effort of our dedicated volunteers to carry out this important mission for the field, and we are grateful to those who are serving now or have served in the past. As ROI looks to the future, we are launching a new process for selecting and appointing volunteers for our committees to improve transparency and ensure a broad range of voices are represented.

ROI is now accepting applications through an open call for volunteers. We are looking for enthusiastic and engaged volunteers for the following committees:

  • Development: Be an advocate for ROI and help secure the resources necessary to fund practice-changing research and education. Share the impact of our research with the #radonc community and help develop innovative campaigns to drive forward the ROI mission.
  • Research: Shape the ROI’s research portfolio by helping to develop requests for proposals and review applications. All are welcome to apply, but new members with expertise in one or more of the following areas are especially needed: central nervous system malignancies, thoracic malignancies and artificial intelligence.

Job descriptions for each of the committees have been posted on the ROI’s website. Please be sure to review the roles and responsibilities before submitting your application for a committee so that you understand the expectations of service. In the description of your “Areas of Expertise” in your volunteer application, explain what you will add to the committee and your commitment to ROI.

You can volunteer for up to two ROI committees in order of preference, but appointments are expected to be one per ASTRO member to offer as many volunteer opportunities as possible. A limited number of positions are available for each committee. Appointments will be for one year starting January 1, 2023, and can be renewed. ROI is ASTRO’s Research Foundation, and as such, we are a separate 501(c)(3) charity with our own Board of Trustees and committees. However, because of the close affiliation, your volunteer service with ROI can be counted toward your overall service for ASTRO.

We are excited to introduce this new volunteer process and to welcome even more ASTRO members into the ROI community. ROI exists to heighten the critical role of radiation oncology in cancer care through research, and we believe having a more open call for volunteers will allow for greater representation on our committees so that we can better serve the entire field.

If you have any questions about the volunteer process, please email ROI. To volunteer for an ROI committee in 2023, submit your application by September 30, 2022.

Posted: August 30, 2022 | 0 comments


A Call to Support Ukrainian Radiation Oncology Practitioners in Fight against Two Evils: Cancer and War

By Nataliya Kovalchuk, PhD; Ruslan Zelinskyi, MS; Andrii Beznosenko, MD; Nelya Melnitchouk, MD; Viktor Iakovenko, PhD; Roman Kowalchuk, MD; Andrii Hanych, MD; Yuliia Severyn, MD;  Bohdana Bachynska, RTT; Oleh Duda, MD; Serhii Brovchuk, MS; Natalka Suchowerska, PhD

This blog is based on excerpts from a manuscript previously published in Advances in Radiation Oncology.

The full-scale Russian invasion of Ukraine on February 24, 2022, started an absolute horror of destruction and chaos for everyone on its path killing tens of thousands of civilians. Many more have been wounded, with approximately a quarter of Ukraine’s population displaced as of July 20.1 The Russian army is obliterating Ukrainian cities, targeting civilian infrastructure with missiles, deliberately damaging and destroying hospitals and clinics in violation of the Article IV of Geneva Convention.2 According to Ukraine’s Minister of Health, Viktor Liashko, during the first 100 days of war, more than 600 health care facilities sustained damages, 105 of which were rendered beyond repair. In addition, the Russian army deliberately targeted and damaged around 450 pharmacies and 200 ambulances.3

Before the full-scale Russian invasion, according to unpublished Ukrainian NCI (Tumor Registry) data, in Ukraine with a population of 44 million, an estimated 139,000 people were living with newly diagnosed cancer, and between 1,000 and 1,200 children were receiving active cancer treatment (AB, unpublished).4 As to radiation therapy, Ukraine is classified by DIRAC IAEA as a Low Middle Income country with level of availability 2.6 External Beam Radiation Therapy (EBRT) machines per 1 million of population.5 Prior to Russian annexation of Crimea, parts of Donetsk and Luhansk regions in 2014, Ukraine had 52 radiation therapy centers with 86 Co-60 machines (81%) and 20 linear accelerators (19%).5 Since 2014, Ukraine has lost control of 10 cancer centers and over 13 EBRT machines in the occupied part of Donbass and five machines in Crimea (a total of 17% of Ukrainian EBRT machines).6

To remedy the growing need, 16 linear accelerators were installed by 2022, and the ratio of Co-60 to linear accelerators became 54% to 46% (excluding EBRT machines in the occupied territories since 2014). The Ministry of Health of Ukraine planned to purchase an additional 20 linear accelerators, but this plan did not materialize as the Russian full-scale invasion shattered Ukraine. In six months of the war, in addition to 10 cancer centers occupied since 2014, three other cancer centers are under occupation, three cancer centers suspended operation, and two cancer centers are under constant shelling. Even if the war stopped today, the inflicted damages to the health care infrastructure will last for years to come.

Help Ukraine Group – How can you help?

A group of oncology practitioners organized Help Ukraine Group (HUG) to connect with cancer providers in Ukraine and establish a feedback loop of determining the need and providing support. We interviewed Dr. Beznosenko, Chief Medical Officer of National Cancer Institute in Kyiv and the president of Ukrainian Society of Medical Oncology,7 who said, “There is an acute need for chemotherapy medications and disposable medical devices. The supply chains became disrupted by the war, and the hospital is running out of medication.” Many medical warehouses were destroyed or are unavailable due to logistical issues, airports are not operational, many bridges and highways damaged. Tender agreements are challenging to procure during the war. Disposable devices are needed in almost every radiotherapy center.

The HUG members collected the data on the need and requested donations from CIVCO and Orfit. For items that were not donated, HUG members applied for Union for International Cancer Control (UICC) Solidarity Fund and obtained the funding.8 Many thanks to CIVCO and Orfit for their generous donations. First shipments of immobilization devices are on the way to Ukraine. More sustained support needs to be established to provide disposable medical supplies and chemotherapy medications. We call on the professional organizations to organize a “Support Ukraine” fundraiser with their membership and industry.

Ukraine has only three PET/CT scanners, all in Kyiv, only two of them functioning after the war broke out. Patients from all over Ukraine have to risk their lives and travel to Kyiv for a diagnostic or follow-up CT scan, leading many to abandon the scan altogether. According to the European Association of Nuclear Medicine, one PET/CT scanner is needed per 1.5-2 million people, which would translate into 22 scanners for Ukraine. In order to reduce oncologic morbidity and mortality as the result of war, HUG members are calling on PET/CT scanner and cyclotron vendors to donate at least one PET/CT and cyclotron to Lviv Oncology Regional Therapeutic and Diagnostic Center to overcome war-related disparities.

In response to Dr. Beznosenko’s request, HUG members are organizing a training program in the U.S., Canada and Australia for the Ukrainian female physicians of various specialties, including radiation oncologists, medical oncologists, surgeons, anesthesiologists, pathologists and medical physicists. The first set of trainees arrives at Stanford in August. Please contact HUG if your institution is willing to provide funding for a visiting scholarship for the Ukrainian female doctors or medical physicists. Ukraine needs help in modernizing the training for radiation oncologists and medical physicists as the training in Ukraine is based on Co-60 technology. HUG members are also creating educational materials for transitioning from 3-D to IMRT/VMAT. We thank Rayos Contra Cancer for donating training videos for us to translate.9

A team of Stanford medical and computer science students led by Solomiia Savchuk created a TeleHelp Ukraine initiative to provide remote medical advice and mental health support for Ukrainians with the help of American doctors-volunteers and interpreters. HUG members are grateful to MIM Software Inc. for providing a free software license to host a MIM cloud DICOM repository for medical images from Ukrainian patients that further inform the video consultations. This telemedicine effort urgently needs physicians of various specialties.10

We call on all radiation oncology vendors to provide their support, donate equipment and software, enhance support for equipment maintenance and service, and provide training. Ukrainians are grateful to Varian and Elekta for organizing free training courses for Ukrainian radiation oncologists and physicists. We are also grateful to Limbus AI Inc. for providing free licenses for automatic contouring software and RADformation for donating automatic 3-D planning, automatic contouring, secondary plan check and secondary MU calculation to Ukrainian cancer centers, which will facilitate streamlining the treatment planning workflow.

Even if the war were to stop today, the long-lasting effect of the decimated health care system in Ukraine will last for years. It is imperative that the effective cancer recovery plan in Ukraine should have radiation therapy at its heart with precise coordination among governing bodies, professional and patient organizations, multidisciplinary professionals and industry.11 But all these efforts start with individuals, and the individual power and will of Ukrainians to fight for their cancer patients is truly inspiring. Let’s help these Ukrainian doctors-heroes to win over two evils: the cancer and the war.

HUG also encourages you to view and share this video, created by Dr. Kovalchuk, to see first-hand accounts of the devastation of oncology facilities in Ukraine. If you are interested in providing support for Ukrainian cancer centers, please consider contributing to this Go Fund Me fundraiser, organized by HUG, and share the link with colleagues.

References:

  1. https://reliefweb.int/report/ukraine/ukraine-situation-report-20-jul-2022-enruuk
  2. https://www.un.org/en/genocideprevention/documents/atrocity-crimes/Doc.33_GC-IV-EN.pdf
  3. https://moz.gov.ua
  4. Kizub D, Melnitchouk N, Beznosenko A, Shabat G, Semeniv S, Nogueira L, Watson PJ, Berg K, Trapido EJ, Espinel Z, Shultz JM. Resilience and perseverance under siege: Providing cancer care during the invasion of Ukraine. Lancet Oncology. 2022 May;23(5):579-583.
  5. https://dirac.iaea.org/
  6. Starenkiy VP, Petrichenko OO, Averyanova L. External beam radiotherapy facilities in Ukraine. Trends and challenges. Problems of Atomic Science and Technology. 2017;112(6):126-129.
  7. Kovalchuk N, Beznosenko A, Kowalchuk R, Ryzhkova J, Iakovenko V, Kacharian A. While Ukrainian Soldiers are Fearlessly Defending Their Country, Ukrainian Oncologists are Bravely Battling Cancer. Adv Radiat Oncol. 2022 Apr 20;7(6):100965.
  8. https://www.uicc.org/news/uicc-solidarity-fund-ukraine-opens-call-grants-qualifying-organisations
  9. https://www.rayoscontracancer.org/training-programs  
  10. https://www.telehelpukraine.com/i-want-to-help-1
  11. Price P, Sullivan R, Zubarev M, Zelinskyi R. Radiotherapy in conflict: Lessons from Ukraine. Lancet Oncology, 2022 Jul;23(7):845-847.

Affiliation details:

Kovalchuk – PhD, Stanford University, Stanford, CA, USA
Zelinskyi – MS, Spizhenko Clinic, Kyiv, Ukraine
Beznosenko – MD, National Cancer Institute, Kyiv, Ukraine
Melnitchouk – MD, Brigham and Women’s Hospital, Boston, MA, USA
Iakovenko – PhD, University of Texas Southwestern Medical Center, Dallas, TX, USA
Kowalchuk – MD, Mayo Clinic, Rochester, MN, USA
Hanych – MD, Mariupol Oncological Dispensary, Mariupol, Ukraine
Severyn – MD, National Specialized Children's Hospital OKHMATDYT, Kyiv, Ukraine
Bachynska – RTT, National Specialized Children's Hospital OKHMATDYT, Kyiv, Ukraine
Duda – MD, Lviv Regional Cancer Center, Lviv, Ukraine
Brovchuk – MS, Kyiv Regional Cancer Center, Kyiv, Ukraine
Suchowerska – PhD, University of Sydney, Sydney, Australia

Posted: August 17, 2022 | 0 comments


#FixPriorAuthNow: ASTRO Prior Authorization Advocacy and Resources

By Howard Sandler, MD, MS, FASTRO, and Constantine Mantz, MD, FASTRO

ASTRO members are frustrated by the scourge of restrictive and burdensome prior authorization requirements that frequently result in care delays or outright denials of coverage, and ASTRO is dedicating significant advocacy resources, across the Health Policy and Government Relations Councils, to this issue.  In member surveys, radiation oncologists consistently rank prior authorization as the top challenge facing practices, and ASTRO has conducted and publicized numerous studies demonstrating the negative impact of prior authorization on patients and practices.

The Health Policy Council’s Payer Relations Committee (PRC) engages with Radiation Oncology Benefit Managers (ROBM) and payers to educate them on appropriate coverage and directly advocate on behalf of members that are experiencing delays or denials for standards of care that are reasonable and appropriate. In addition to regular communications with ROBMs and payers, ASTRO issues Model Policies for each radiation therapy modality of treatment that are designed to educate payers on appropriate coverage based on clinical evidence. ASTRO also provides ROBMs and payers with a copy of the ASTRO Radiation Oncology Coding Resource and access to webinars that detail appropriate coverage policies. Despite these efforts, ASTRO members continue to face restrictive coverage policies, some of which are described below.

eviCore, a ROBM that contracts with many payers, has determined that conventional fractionation schemes for breast and prostate cancer are no longer medically necessary. They will only approve hypofractionation, which is a shorter course of treatment, for these two disease sites. This restrictive policy ignores the fact that some patients have certain clinical characteristics that are more suitable for longer course treatments. ASTRO has pushed back on this policy, as it is merely designed to save money.  Additionally, it does not take into consideration the clinical characteristics of the patient, nor does it recognize the important role of shared decision making between a doctor and their patient. Despite our efforts, eviCore refuses to reconsider this policy.

Another issue ASTRO frequently hears about is complaints regarding eviCore’s peer-to-peer reviews. These coverage determination reviews have increased dramatically during the COVID-19 PHE, consuming significant amounts of physician time and causing a high level of frustration. ASTRO members frequently report that peer reviews often involve a physician that is not a radiation oncologist, resulting in inappropriate denials and delayed care. In order to help address the issue, ASTRO has devoted a section of its website to house sample ROBM appeal form letters that radiation oncology practices have successfully used to appeal denials. This allows practices across the radiation oncology community to share letters with other radiation oncologists to help save time and administrative burden associated with growing denials and delays in care.

Private payers are also utilizing prior authorization as part of their coverage review process. ASTRO has written numerous letters to payers about inappropriate prior authorization denials and restrictive medical policies. ASTRO sent a comment letter to eviCore on their oligometastases policy, after several members reported receiving denials that did not align with current guidelines.

UnitedHealthcare (UHC) recently announced the establishment of a prior authorization electronic portal for approval of all the following services: IMRT, PBT, SBRT and IGRT; “Special and Associated radiation therapy services;” and fractionated breast, prostate and lung cancers, and bone metastasis. This list encompasses a significant portion of the services delivered by radiation oncologists. ASTRO’s Payer Relations Committee, Health Policy Committee and Clinical Affairs and Quality Council met with UHC to emphasize the negative impact this policy would have on radiation oncologists and their patients. UHC made modest modifications; however, members still report delays in patient care and other administrative burdens despite the electronic format.

ASTRO supports professionally developed and vetted clinical practice guidelines, appropriateness of care criteria, and consensus-based model policies developed in a transparent manner with peer review and input as a foundation for clinical decision making. We oppose restrictive practice guidelines that oversimplify the process of individual patient management and abrogate the professional judgements that are often only possible within the private boundaries of a direct patient-doctor relationship.

With prior authorization out of control, one of ASTRO’s top advocacy priorities is to push Congress and Medicare to intervene. ASTRO has sent numerous letters to the Centers for Medicare and Medicaid Services describing how restrictive prior authorization practices are keeping patients from the care they need and the care they have paid for in premiums. Congress is getting closer to passing ASTRO-backed legislation to enact significant prior authorization reforms. Passage of the Improving Seniors Timely Access to Care Act may possibly occur later this year, as now more than 330 representatives and senators have cosponsored the bill. The bill was a priority focus during ASTRO Advocacy Day, as radiation oncologists pressed their members of Congress during more than 100 meetings in May to advance the legislation.

ASTRO is committed to reining in excessive prior authorization, and we encourage members to voice their concerns directly to members of Congress via ASTRO’s grassroots system and social media. If you are experiencing difficulties with eviCore or payers, please contact Emilio Beatley, ASTRO Health Policy Analyst, so we can provide resources and engage on your behalf.

Posted: June 8, 2022 | 0 comments


Updates from 2021 Survivor Circle Grants Awardees

By Jennifer Jang, ASTRO Communications

Two Chicago-area organizations, Cancer Support Center and LivingWell Cancer Resource Center, were selected as ASTRO’s 2021 Survivor Circle grant winners for the services they provide to cancer patients, their families and caregivers. Each organization received a $10,000 grant late last year and were honored at the 63rd Annual Meeting in Chicago. Specifically, the Survivor Circle Grant Program provides financial gifts to two cancer support organizations in the state hosting ASTRO’s Annual Meeting. ASTRO followed up with both organizations to learn more about how the grants provided tangible aid since last fall.

The Cancer Support Center (CSC), located in Chicago, is a community-based non-profit organization with two facilities in Chicago’s Southland neighborhoods of Homewood and Mokena. CSC serves anyone seeking oncology care and focuses on a health equity initiative providing services to communities of color with high cancer morbidity rates. According to Executive Director Sue Armato, CSC uses the Five Point Model of Cancer Care, which comprises Counseling/Stress Management, Education, Nutrition, Fitness and Body Image. “Navigators,” as they call their providers, address these points at the first meeting, when the first time “participants,” as they call their clients, come in the door.

Pre-COVID-19, when a cancer patient came to CSC, they immediately met with a program navigator who began the patient support process. “We thought in person was best,” Ms. Armato said. But since COVID, they discovered that “We actually can achieve the same level of care through well-made and intentional videos.” To respond to this need, CSC chose to use the grant to develop a series of introductory videos focusing on how supportive care can improve their participants’ lives.

To date, CSC now has ready the "story" content outline for each of the three videos, identified who will be filmed and developed standard slide content. They have secured a videographer/filmmaker who understands CSC’s important work and has done previous work for them successfully. The videos will be produced this month, with the goal of having them ready for distribution and sharing by June 5, National Cancer Survivors Day. CSC has spent only a quarter of the funds thus far, limited to the development of video content and deposit for videographer. Once the remainder of the funds is spent on video development and release, CSC anticipates vast impact on future clients. After all, the videos’ reach will widen the opportunity to explain the need for supportive oncology and why it is such an important part of any cancer journey. The videos will explore how CSC supports cancer patients and what one can expect when they seek supports and resources, which will help to demystify the supportive oncology process.

Expanding their reach, CSC will share these videos on their website and with eight hospital partners along with oncology centers throughout their service area. CSC is also developing a partnership with the local community college where they will develop programs for supportive oncology care, sharing these videos as part of that effort. CSC looks forward to showing these videos ultimately to help newly diagnosed individuals, so that they may know the importance of supportive care and, for those who have been on a longer cancer journey, that CSC is a resource for them too.

Similarly, the LivingWell Cancer Resource Center, the other recipient of the 2021 Survivor Circle Grant, has also expanded their breadth of reach using the new funding, but in a more physical way. Upon receiving the funding, their social work team mobilized to support patients needing transportation to and from appointments. The grant removed a barrier to patient care in the most practical way, as many LivingWell participants tend to rely on rides from family, friends or caregivers, often scheduling appointments based on when they will have reliable rides. When rides are not available, patients often have no choice but to cancel their appointments, delaying much-needed care.

From mid-November 2021 through March 2022, LivingWell provided 51 rides, totaling $1,165. The average mileage per ride was 12.5 miles, with the longest distance being 32 miles. The majority of rides was associated with Northwestern Medicine Warrenville Cancer Center (86%), while a smaller portion was for centers in Geneva and DeKalb. To ensure grant funding was used with discretion, LivingWell social workers coordinated the rides.

The Survivor Circle Grant has helped LivingWell Cancer Resource Center reinforce their efforts to provide a foundational component of their purpose, increasing access to care. Alongside the grant, LivingWell has bolstered their efforts with other partnerships, including the American Cancer Society, which is piloting its Road to Recovery program, using community volunteers to provide rides in DuPage and Kane counties. Limitations to the pilot include the requirements that both volunteers and patients must be based in DuPage or Kane counties to participate. To compensate for this limitation, the funds from ASTRO have helped to support Uber Health, funding transportation for patients when free rides were unavailable otherwise. The grant has enabled the social workers to ensure patients are able to keep their appointments. However, the challenge of securing Uber rides remains for the DeKalb community due to a lack of available drivers. To address this issue, LivingWell has identified three local vendors, Non-Emergency Wheelchair Transport, New Era Non-Medical Transportation and Hail a Taxi, to provide future assistance for patient transportation needs. These new vendors will help provide available drivers for any future patient need and allow for the remaining funds of the grant to be used in a meaningful way.

The Cancer Support Center and LivingWell Cancer Resource Center Community have used their funds to multiply their impact. Similarly, we encourage cancer support organizations in this year’s Annual Meeting state, Texas, to consider how they too might strengthen their support. To be considered, please apply by this Friday, May 13. For questions, contact Beth Bukata.

Posted: May 11, 2022 | 0 comments


How to Become a Licensee or an Authorized User for Radiopharmaceuticals

By Cindy Tomlinson, Senior Patient Safety and Regulatory Affairs Manager

Is your practice interested in becoming licensed to use radiopharmaceuticals? Or, are you interested in becoming an authorized user to administer radiopharmaceuticals? With new radiopharmaceuticals gaining approval from the U.S Food and Drug Administration and more in the pipeline, now is a good time to understand some practical steps to take.

Before starting the process, however, it is important to note that agreement states1 may have different forms or requirements for obtaining a license, and we recommend familiarizing yourself with those requirements to ensure compliance. Links to state radiation protection programs, as well as links to state regulations, can be found on ASTRO’s State Regulatory Library.

  • If your practice or facility is already licensed to use byproduct materials, the next step is to discuss necessary license amendments with your radiation safety officer. Compliance requirements differ based on whether you have a broad scope license or a limited scope license:
    • If your practice or facility has a broad scope license and changes to the license are needed, including revisions to the list of authorized users, your radiation safety officer can handle those in house. Keep in mind that these changes are subject to review during regulatory inspections.
    • If your practice or facility has a limited scope license, you will need to submit the specific training and experience for each proposed user, and the facilities and equipment available to support each proposed use, to the appropriate regulatory agency (either the Nuclear Regulatory Commission (NRC) or the agreement state) for review and approval. If the licensee wishes to make changes, such as adding or removing an authorized user, the regulatory agency must approve the requested change. In this case, the NRC has forms for licensees to fill out, while agreement states may have their own forms, so it is important to contact your state’s radiation protection program to find out what forms are applicable to your situation.
  • If your practice or facility is not already licensed to use byproduct material, you must submit an application to the NRC or your agreement state. Fees are assigned to each license type as are program codes for medical facilities, practices and laboratories.


ASTRO believes that it is important for radiation oncologists to expand their scope of practice to include radiopharmaceuticals. ASTRO has worked with Congress and the NRC to ensure that appropriate training and experience requirements for radiopharmaceuticals remain intact.

If you have any questions, please contact Cindy Tomlinson.

 
[1] Agreement states are those states who have entered into an agreement with the NRC effectively assuming the role of the NRC.
Posted: April 26, 2022 | 0 comments