Advanced radiation oncology technology within the Veterans Health Administration (VHA).

Abstract

52 Background: The rapid evolution of technology in the treatment of cancer has paralleled other technological advancements in modern society. Intensity Modulated Radiotherapy (IMRT), Image Guided Radiotherapy (IGRT), Brachytherapy (BT), Cone Beam Computed Tomography (CBCT), Stereotactic Radiosurgery (SRS), and Stereotactic Body Radiotherapy (SBRT) facilitate treatment with higher, more conformal radiation doses, potentially improving cancer control while reducing normal tissue toxicity. Recent Surveillance, Epidemiology and End Results (SEER) program data and physician surveys indicate prostate BT is declining and the integration of SRS and SBRT is slower compared to IMRT. As utilization of technology increases, an understanding of its availability within the VHA is necessary to ensure quality and patient safety. Methods: An electronic survey was sent to 82 Radiation Oncologists (ROs)at 38 active VHA Radiation Oncology Centers with subsequent follow-up phone calls. The survey occurred from May-June 2014. ROs were queried on the availability of advanced RT technologies including IMRT, IGRT, BT, CBCT, SRS and SBRT at their facility. Practitioner specific details: years in practice, academic appointment and VHA employment status were collected. Results: Responses were obtained from 62 ROs representing 75% of VHA ROs and 34 or 89% of facilities. Full time VHA employees made up 60% of respondents with 35% in practice for <5 years and 34% practicing for >20 years; 71% held an academic appointment. The Table shows on site availability of advanced RT technologies within the 34 VHA sites that responded. Conclusions: For veterans receiving cancer treatment, VHA ROs are able to routinely use IMRT and IGRT with CBCT capabilities. However, stereotactic (SRS and SBRT) and BT services are less available, and may require referrals externally or to other VHA facilities. Limited availability of SRS and SBRT parallels the community experience. Likewise the decreasing utilization of BT is common to the VHA and private sector. SBRT, SRS and BT require significant expertise and technology. [Table: see text]