Assessment of Lymphoma and Other Hematologic Malignancies Training Needs Amongst Radiation Oncology Residents

Abstract

The use of radiation therapy in the management of hematologic (heme) malignancies is heterogeneous and radiation oncology resident comfort with the management of this diverse group of diseases is unknown. Together, the International Lymphoma Radiation Oncology Group (ILROG) and Association of Residents in Radiation Oncology (ARRO) performed a study to assess current training opportunities for RO residents in treatment of heme patients and interest in a dedicated away elective to augment their existing training experience. RO residents (PGY2-5) in the ARRO email database (n=572) were sent an anonymous questionnaire in December 2018. Question types included binary, Likert-type scale (1=not at all, 5=extremely; reported as median [interquartile range]), and multiple choice. 134 residents (23%) completed the survey with majority of responses from PGY4/5 residents (64%) and in programs with ≥5 residents (93%). 112 residents (84%) reported having faculty who specialize in heme, and 95 residents (71%) reported having a heme rotation, most commonly ≥8 weeks in length. However, only 38 residents (40%) reported that these heme rotations were dedicated, i.e. >50% heme patients. Of 112 respondents, the percentage of residents reporting at least 4 cases with each diagnosis were: Non-Hodgkin lymphoma (83%), multiple myeloma (82%), cutaneous lymphoma (59%), Hodgkin lymphoma (53%), adult leukemia (46%). Residents reporting at least 4 cases of specialized treatment techniques were: breath hold for mediastinal lymphoma (39%), adult craniospinal irradiation (17%), total skin irradiation (39%), adult total body irradiation (68%), and proton therapy (36%). Residents reported feeling “moderately” prepared to advocate for radiation therapy in multidisciplinary conferences (3 [2-3]), to make clinical decisions once patients are referred (3 [2-4]), to oversee and critique treatment planning (3 [2-4]).They reported feeling “moderately” to “quite” prepared to contour heme cases using the involved site radiation therapy (3.5 [3-4]) and “quite” prepared to incorporate the Five Point Scale into treatment decisions (4 [3-5]). Overall, residents felt only “moderately” (3[2-3]) prepared to treat heme patients with 23% of residents responding that they felt “quite” or “extremely” comfortable. 49% of respondents were potentially interested in a RO away elective focused on heme, to increase comfort with treating heme patients (65%). Residents rated hands-on contouring modules, oral exams, and instruction on specialized techniques as the most worthwhile activities in an elective. Hematologic malignancies training is an important component of RO residency, yet less than 25% of surveyed trainees reported feeling well prepared to treat heme patients. Programs should explore opportunities to increase resident exposure; perhaps through participation in a dedicated heme elective in select programs or through on-line educational activities.