Academic Radiation Oncology Department Research Articles

A framework for medical physics compensation in an academic department.

Compensation is a key component of career satisfaction and professional growth. A new compensation model was developed to provide a framework for career growth and a compensation ladder for medical physicists with clinical responsibilities in an academic radiation oncology department. The goals for the new model were: (1) create a market competitive plan to support recruitment and retention of top physics talent, (2) incentivize clinical effort, innovation, citizenship/professional service, and academic achievement, (3) provide compensation growth opportunities separate from medical school promotions, and (4) create consistent, transparent, and fair metrics applicable to all clinical physicists in the department. The model includes a base salary, and credits for board certification, clinical tier, leadership, and academic level. Further, metrics were developed to inform the clinical tier. Years of experience is not explicitly included in the model. The model was successfully implemented for clinical physicists in a relatively large academic radiation oncology department.

Disease Site Specialization in the Academic Radiation Oncology Workforce: Evidence of Gender Differences

Because some stakeholders within medicine seek to diversify and attain greater workforce equity, it is critical to understand gender-based divisions within specialization. Radiation oncology (RO) has one of the smallest proportions of women representation of all specialties, and to our knowledge, no prior studies have investigated gender differences in all the disease site specializations within RO. Thus, we analyzed the relationship between gender and disease site(s) treated in academic RO (ARO). Faculty gender and disease site(s) treated by faculty from ARO departments were collected via publicly available department websites in January 2020. X2 analyses were conducted to assess differences between the proportions of women faculty treating each disease site. Of 1337 ARO faculty, 408 (30.5%) were identified as women. Breast, gynecology, and pediatrics had the largest proportions of women faculty (all >40%; P < .001). A majority (53%; P < .001) of women ARO faculty treated breast. Genitourinary, thoracic, and head and neck had the smallest proportions of women faculty (all <25%; P < .001). Women ARO faculty were twice as likely to treat breast and gynecologic malignancies compared with men faculty (risk ratio [RR] with 95% CI, 2.01 [1.75-2.50]; P < .001 and RR [95% CI], 2.06 [1.72-2.79]; P <.001, respectively). Men ARO faculty were 3 times more likely to treat genitourinary cancer compared with women faculty (RR [95% CI], 0.40 [0.34-0.48]; P < .001). There was no difference in the mean number of disease sites treated between women and men ARO faculty (2.63 vs 2.53; P = .29). Gender differences in disease site specialization were observed in ARO. Future research into the drivers of disease site selection should be explored.

Association of socioeconomic disadvantage with lower patient satisfaction at an academic radiation oncology center.

347 Background: The correlation between socioeconomic status and healthcare outcomes is well-established. Patient satisfaction serves as a crucial indicator of healthcare quality, however, it is unclear if patient satisfaction relates to patient socioeconomic status. To assess socioeconomic status, the Area Deprivation Index (ADI) is utilized, encompassing factors such as income, education, employment, and housing quality to measure the status of a neighborhood. The purpose of this study was to evaluate if there was a correlation between socioeconomic status and the likelihood a patient would recommend the facility or provider. Methods: This is a single-institution study evaluating the responses to a CMS approved patient satisfaction vendor survey of patients seen at an outpatient academic radiation oncology department from May 2021 through March 2023. ADI was collected using the Neighborhood Atlas, including both national percentiles and state deciles, with the higher values indicating greater socioeconomic disadvantage. Univariate (UVA) and multivariate (MVA) logistic regression analyses were conducted using the survey recommendation scores between 0 and 10 as the primary outcome. We used the score ≥9 to represent increased likelihood for recommendation for facility or provider and &lt;9 represented decreased likelihood. Results: There were 5,403 survey results included in our analysis. The mean state and national ADI in our cohort were 3.9 (range 1-10) and 50.35, respectively. Patients with state and national ADI scores below the mean were more likely to recommend the provider than those above the mean, 95.6% versus 93.6% (p=0.002) and 95.8% versus 93.6% (p&lt;0.001), respectively. There was no difference in the likelihood of recommending the facility between the groups. On univariate analysis state ADI &lt;3.9 (OR 1.46, p=0.016) and national ADI &lt;50.35 (OR 1.43, p=0.023) were associated with increased likelihood to recommend the facility or provider. On multivariate analysis, state ADI &lt;3.9 (OR 1.44, p=0.018) and national ADI &lt;50.35 (OR 1.40, p=0.033) remained significant. Conclusions: The findings of this study highlight the significance of socioeconomic status as an independent factor influencing patient satisfaction and their likelihood to recommend a healthcare provider. Providers should consider the unique needs of socioeconomically disadvantaged individuals.

Long-Term Outcomes of Multidisciplinary Radiation Oncology Equity and Inclusion Committee Programming at an Academic Health System

Academic radiation oncology departments are increasingly implementing educational programs to promote diversity, equity, and inclusion, but data on their impact remains sparse. This study aimed to assess learning outcomes and perceived impact of the programming of a multidisciplinary radiation oncology equity and inclusion committee (EIC). Since August 2020, a committee of radiation therapists (RTTs), physicians (MDs), nurses (RNs), and administrators (ADs) has led an alternate-monthly online EIC meeting open to all radiation oncology employees at one health system. Learning goals of EIC programming are (1) to understand disparities in healthcare practice and outcomes for marginalized populations, (2) to discuss current events relevant to marginalized groups, and (3) to identify and address personal bias. EIC has featured expert guest speakers, open discussion, cultural events, and individual storytelling. In February 2023, we conducted a department-wide survey evaluating participation in one or more EIC meetings. EIC participants also completed an evaluation focused on learning goal achievement and program strengths/weaknesses. Multiple choice responses and 5-point Likert scale survey items were descriptively analyzed; open responses were qualitatively coded and categorized into themes. There were 84 survey respondents, corresponding to a department response rate of 53%. Of these, 37 (44%) indicated participation in at least one EIC meeting. Participants were 35% RTTs, 16% MDs, 14% ADs, 3% physicists/dosimetrists, 3% RNs, and 19% undisclosed profession; 46% identified as a racial, ethnic, sexual, and/or gender minority. 41% of participants attended 5 or more sessions. Participants reported high overall value of the EIC meeting (mean value 3.7 / 5, SD 1.2) and 89% would recommend participation. There was strong agreement with achievement of EIC learning goals (mean agreement [MA] 3.9 / 5, SD 0.91), and most participants reported improved capability to understand (61%, MA 3.72 / 5, SD 0.99) and address (61%, MA 3.75 / 5, SD 0.83) the specific needs of their patients from marginalized groups. The three most common themes of EIC strengths were educational value, speaker quality, and improved work relationships. Commonly requested improvements included more practice scenarios, increasing participation, and giving more equitable attention to all minority groups. Among EIC non-participants, 75% reported non-participation due to scheduling, 71% felt that having an EIC was valuable, and 59% reported a desire to attend an EIC meeting in the future. Nearly 3 years since implementation, EIC programming is highly valued. The majority of participants report achievement of learning goals and perceive self-improvement in care for marginalized groups as a result of participation. Further research is needed to externally validate the impact of this programming on learning and patient care domains.

Characterizing Wellness Leadership in Academic Radiation Oncology Departments in the United States

Burnout is prevalent in radiation oncology (RO), with 56% of respondents in a 2020 survey reporting symptoms of burnout. This has led to an increased effort to promote physician wellness via formal wellness-directed initiatives in recent years. However, little is known about the specifics of wellness activities and their impact. We aim to characterize current wellness leadership positions and efforts within academic RO departments. A total of 120 US academic RO department chairs were contacted to inquire whether they had a departmental wellness leader, with a request for leader contact information, if applicable. Wellness leaders were invited to complete an anonymous survey in January and February 2023 via a survey platform. Questions assessed leader demographics, role structure, resources, current initiatives, and impacts to date. Descriptive statistics and summaries of free text responses are reported. Seventy-one chairs (59%) responded, among which 43 (61%) reported having departmental wellness leaders. On interim analysis, 11 (26%) responded to the survey. 82% were female and 73% were physician faculty. Leaders spanned career stages, and respondent ages ranged from 32-66. Wellness leaders were commonly in formal departmental committees (n = 4) or implemented hospital initiatives without independent departmental programming (n = 5). Committees had all been started since 2020. 5 respondents stated departmental wellness leadership was required by their institution. Some leaders were provided with administrative support (n = 4) and/or departmental program funding (n = 4), however only 1 had protected time for wellness work. Challenges included limited bandwidth (n = 7), lack of departmental interest (n = 4), and limited funding (n = 4). The most commonly completed initiatives include programming and education (n = 4) and improved support for caregivers (n = 3). No departments had hired physician coaches or created a peer support network. Of 14 initiatives, departments had, on average, implemented 2. 36% and 27% of respondents agree that because of wellness initiatives the department is more aware of the importance of wellness and wellness-promoting strategies, respectively. Only 9% and 18% felt initiatives changed a culture of constant availability and encouraged use of full PTO and limiting work off hours, respectively. Leaders highlight the importance of a dedicated individual to tangibly implement changes and the unique opportunity of someone within RO to understand the specific challenges faced by those in our field. Wellness leadership roles exist in many RO departments. However, these roles are new and evolving, with a limited number of fully implemented initiatives to date. Longitudinal data collection and follow-up will help establish the impact of these roles on bringing positive change to departments. Full results will be presented at ASTRO 23.

P08.10.B COIMBRA: THE IMPACT OF RADIOTHERAPY ON QUALITY OF LIFE AND DISEASE PROGRESSION IN PATIENTS WITH BRAIN METASTASES AND THEIR CAREGIVERS

Abstract INTRODUCTION Brain metastases (BMs) are diagnosed in 10-30% of all cancer patients, and this incidence is expected to rise due to advancements in primary tumor management. Besides improving survival, the impact of treatment on quality of life (QoL) and course of disease is highly relevant for patients and their caregivers. The Cohort for patient-reported Outcomes, Imaging and trial inclusion in Metastatic BRAin disease (COIMBRA) study aims to gather data on natural disease progression, treatment response, tumor recurrence, complications, QoL (for both patient and caregiver), cognitive performance and survival of patients with BMs. Additionally, the study evaluates feasibility, performance and added value of new MRI techniques in patients with BMs, while providing an infrastructure for efficient and pragmatic randomized evaluation of new interventions. DESIGN/ METHODS The prospective COIMBRA study is designed to monitor a cohort of patients with BMs and their caregivers who are referred to a tertiary academic radiation oncology department (ClinicalTrials.gov Identifier: NCT05267158). The study is designed according to the Trials within Cohorts (TwiCs) framework, an adaptive design that allows for the evaluation of multiple interventions over time. Patients receive state of the art treatment, which includes stereotactic radiosurgery (SRS) or whole brain radiotherapy (WBRT). Clinical data, QoL and cognitive functioning are collected at baseline and at regular intervals post-treatment. Additionally, new MRI techniques can be evaluated for their feasibility and performance in patients with BMs. PRELIMINARY RESULTS Since April 2019, 419 patients have been included of whom 51.2% were men and the majority of the patients had lung cancer (53.6%). SRS was administered in 92.4% and 68.1% received systemic therapy. Median overall survival was 18.3 months. Questionnaires available at both baseline and 6 months after radiotherapy showed that 65.3% experienced stability or improvement in QoL measured via the EORTC QLQ-C30 questionnaire. Fewer patients reported anxiety or depression after SRS compared to before treatment (28.4% vs 47.8%). Caregivers’ baseline responses indicated that 59% had to adjust their daily lives due to the patients’ diagnosis. CONCLUSION Our study successfully collected in-depth clinical and QoL data from patients with BMs and their caregivers. The results suggest a modest improvement in anxiety and QoL after SRS. These findings highlight the need for ongoing evaluation of interventions in this patient population in order to ultimately guide personalized treatment strategies.

Pediatric Experience and Outcomes from the First Single-Vault Compact Proton Therapy Center.

The first single-vault compact proton therapy center opened in 2013, utilizing a gantry-mounted synchrocylotron. The center was placed within a large academic radiation oncology department with a high priority for pediatric cancer care. Here we performed a retrospective study of pediatric (≤21 years) patients treated with proton therapy at our institution between 2013-2022. Patient, tumor, and treatment characteristics were obtained including race, socioeconomic status, insurance type, distance travelled, need for anesthesia, and outside referrals for proton therapy. In total, 250 pediatric patients were treated with proton therapy comprising 18% of our proton patient volume. Median follow-up was 3.1 years, 38.4% were female and 83% were white. The majority of cases were CNS (69.6%) and a large number of patients (80/250, 32%) required craniospinal irradiation. Anesthesia was required for 39.6% of patients. Average distance travelled for treatment was 111 miles and 23% of patients were referred from outside institutions for proton therapy. Insurance type was private/commercial for 61.2% followed by Medicaid for 32%. We found that 23% of patients lived in census tracts with >25% of people living below the national poverty line. Overall survival at 3 years was excellent at 83.7% with better outcomes for CNS patients compared to non-CNS patients. There were no cases of secondary malignancy at this early time point. As the world's first compact proton therapy center, we found that proton therapy increased our pediatric volume and provided proton therapy to a diverse group of children in our region. These data highlight some of the expected patient and tumor characteristics and necessary resources for providing pediatric proton beam therapy.

TIPS-16 A PROSPECTIVE COHORT STUDY ON THE IMPACT OF RADIOTHERAPY ON QUALITY OF LIFE AND DISEASE PROGRESSION IN PATIENTS WITH BRAIN METASTASES AND THEIR CAREGIVERS

Abstract INTRODUCTION Brain metastases (BMs) are diagnosed in 10-30% of all cancer patients, and the incidence is expected to rise due to advancements in primary tumor management. Besides survival, the impact of treatment on quality of life (QoL) and course of disease is highly relevant for patients and their caregivers. The Cohort for patient-reported Outcomes, Imaging and trial inclusion in Metastatic BRAin disease (COIMBRA) study aims to gather data on natural disease progression, treatment response, tumor recurrence, complications, QoL (for both patient and caregiver), cognitive performance and survival of patients with BMs. Additionally, the study evaluates feasibility, performance and added value of new MRI techniques in patients with BMs, while providing an infrastructure for efficient and pragmatic randomized evaluation of new interventions. DESIGN/METHODS COIMBRA is an observational, prospective cohort for patients with brain metastases and their caregivers that are referred to a tertiary academic radiation oncology department. The study is designed according to the Trials within Cohorts (TwiCs) framework. ClinicalTrials.gov Identifier: NCT05267158. PRELIMINARY RESULTS Since April 2019, 419 patients have been included of which 51.2% were men and the majority of the patients had lung cancer (53.6%). Stereotactic radiosurgery (SRS) was administered in 92.4% and 68.1% received any systemic therapy. Median Overall Survival was 18.3 months. Questionnaires available at both baseline and 6 months after radiotherapy showed that 65.3% experienced stability or improvement in QoL measured via the EORTC QLQ-C30 questionnaire. Fewer patients reported anxiety or depression after SRS compared to before (28.4% vs 47.8%). Caregivers’ baseline responses indicated that 59% had to adjust their daily lives due to the patient’s diagnosis. CONCLUSION Our study successfully collected clinical and QoL data from a large cohort of patients and their caregivers. The results suggest a modest improvement in anxiety and QoL after radiotherapy.

Challenges and Solutions for Establishing Robust Diversity, Equity, and Inclusion Efforts in US Academic Radiation Oncology Departments

Challenges and Solutions for Establishing Robust Diversity, Equity, and Inclusion Efforts in US Academic Radiation Oncology Departments

Predictors of Financial Toxicity in Patients Receiving Concurrent Radiation Therapy and Chemotherapy

Financial toxicity (FT) is a significant concern for patients with cancer. We reviewed prospectively collected data to explore associations with FT among patients undergoing concurrent, definitive chemoradiation therapy (CRT) within a diverse, urban, academic radiation oncology department. Patients received CRT in 1 of 3 prospective trials. FT was evaluated before CRT (baseline) and then weekly using the European Organization for Research and Treatment of Cancer Core Quality of Life Questionnaire Core-30 questionnaire. Patients were classified as experiencing FT if they answered ≥2 on a Likert scale question (1-4 points) asking if they experienced FT. Rate of change of FT was calculated using linear regression; worsening FT was defined as increase ≥1 point per month. χ2, t tests, and logistic regression were used to assess predictors of FT. Among 233 patients, patients attended an average of 9 outpatient and 4 radiology appointments over the 47 days between diagnosis and starting CRT. At baseline, 52% of patients reported experiencing FT. Advanced T stage (odds ratio, 2.47; P=.002) was associated with baseline FT in multivariate analysis. The mean rate of FT change was 0.23 Likert scale points per month. In total, 26% of patients demonstrated worsening FT during CRT. FT at baseline was not associated with worsening FT (P=.98). Hospitalization during treatment was associated with worsening FT (odds ratio, 2.30; P=.019) in multivariate analysis. Most patients reported FT before CRT. These results suggest that FT should be assessed (and, potentially, addressed) before starting definitive treatment because it develops early in a patient's cancer journey. Reducing hospitalizations may mitigate worsening FT. Further research is warranted to design interventions to reduce FT and avoid hospitalizations.

Cannabis Use in Patients Seen in an Academic Radiation Oncology Department

PurposeCannabis use rates are increasing in the United States. Patients with cancer use cannabis for many reasons, even without high-quality supporting data. This study sought to characterize cannabis use among patients seen in radiation oncology in a state that has legalized adult nonmedical use cannabis and to identify key cannabis-related educational topics. Methods and MaterialsCannabis history was documented by providers using a structured template at patient visits in an academic radiation oncology practice October 2020 to November 2021. Cannabis use data, including recency/frequency of use, reason, and mode of administration, were summarized, and logistic regression was used to explore associations between patient and disease characteristics and recent cannabis use. A multivariable model employed stepwise variable selection using the Akaike Information Criterion. ResultsOf 3143 patients total, 91 (2.9%) declined to answer cannabis use questions, and 343 (10.9%) endorsed recent use (≤1 month ago), 235 (7.5%) noted nonrecent use (>1 month ago), and 2474 (78.7%) denied history of cannabis use. In multivariable analyses, those ≥50 years old (odds ratio [OR], 0.409; 95% confidence interval [CI], 0.294-0.568; P < .001) or with history of prior courses of radiation (OR, 0.748; 95% CI, 0.572-0.979; P = .034) were less likely, and those with a mental health diagnosis not related to substance use (OR, 1.533; 95% CI, 1.171-2.005; P = .002) or who smoked tobacco (OR, 3.003; 95% CI, 2.098-4.299; P < .001) were more likely to endorse recent cannabis use. Patients reported pain, insomnia, and anxiety as the most common reasons for use. Smoking was the most common mode of administration. ConclusionsPatients are willing to discuss cannabis use with providers and reported recent cannabis use for a variety of reasons. Younger patients new to oncologic care and those with a history of mental illness or tobacco smoking may benefit most from discussions about cannabis given higher rates of cannabis use in these groups.

Gender Differences in the Research Productivity of Radiation Oncology Resident Graduates in the United States: 2015 to 2019

PurposeIt is well-documented that gender disparities exist in academic radiation oncology departments. The purpose of this study was to analyze gender differences in research productivity during residency among recent graduates of radiation oncology training programs in the United States (US). Methods and MaterialsWe used several publicly available sources to create a database of US radiation oncology residents who graduated between 2015 and 2019. We systematically collected gender information from the National Plan and Provider Enumeration System National Provider Identifier Registry and Medicare claims registry. Postresidency employment information was collected using several publicly available sources. PubMed was queried to identify first-author publications of residents. A secondary analysis of metadata including impact factor, number of citations, modified Hirsch index (h index), and type of publication was performed. A multivariable linear regression was performed to evaluate the effect of gender on research productivity during residency. ResultsThere were 910 total graduates identified during this period and who were entered into this database, of whom all had available gender information. Female trainees comprised 29.0% (n = 264) of RO residents and had fewer first-author publications and citations, had lower mean modified h index, and were published in journals with lower impact factors. On multivariable linear regression analysis, female gender was independently associated with decreased total number of publications (P = .005), mean number of citations (P < .001), and modified h index (P = .001) when controlling for residency size and advanced (PhD or master's) degrees. ConclusionsIn the US, female RO trainees had lower research productivity, which was not explained by advanced degrees or residency size. A significant gender gap in trainee research productivity persists, which has known implications in terms of academic achievement, promotions, and career trajectory. Future interventions to improve resident research productivity and mentorship are warranted.

The Current State of Departmental Diversity, Equity, and Inclusion Efforts Within US Academic Radiation Oncology Departments

Promoting a diverse workforce of healthcare professionals that delivers equitable patient care is an important goal in oncology, as in all of medicine. While most medical schools have a diversity office and associated initiatives, little is known about radiation oncology (RO) department-level efforts to promote diversity, equity, and inclusion (DEI). We describe the current state of DEI leadership and initiatives in RO departments in the US to guide future policies and programs. A total of 124 US RO departments affiliated with a medical school were contacted to identify departmental DEI leadership. Identified DEI leaders were asked to complete an anonymous survey assessing characteristics of their departmental DEI leadership, committee/organizational structure, activities, and perceived barriers to, and impact of, their work. Descriptive statistics are reported. Among 85 RO departments that responded (68.5% response rate), 48 (56.5%) reported having a departmental DEI leader. Thirty-four DEI leaders completed the survey (70.8%). Most DEI leaders were assistant or associate professors (n=28, 82.2%), women (n=25, 73.1%), and identified with at least one non-White race or Hispanic ethnicity (n=18, 53.6%). Nineteen (55.9%) had an associated departmental DEI committee; with 10 (52.6%) starting in 2020 or later. Few DEI leaders had administrative support (38.2%), funding (29.4%), protected time (23.5%), or increased compensation for added duties (23.5%). Seventeen (51.7%) believed their DEI-focused efforts were considered for promotion. The most reported initiatives included offering programming/education, supporting students from backgrounds underrepresented in medicine, improving recruitment practices/hiring, and implementing pipeline/pathway projects. The perceived impact of DEI initiatives included an increased culture of respect (89.7%), improved healthcare disparity awareness (75.9%), and improved systematic/structural racism awareness (79.3%). Departmental DEI efforts are increasingly common within RO, however, the structure, resources, and recognition associated with DEI work are variable. Additional dedicated resources and recognition for these efforts will help ensure a culture of inclusive excellence for the RO workforce and patients.

Patients Seen in Radiation Oncology Who Use Cannabis Are More Likely to Also Have Active Prescriptions for Opiates or Benzodiazepines

<h3>Purpose/Objective(s)</h3> With changes in state legal frameworks governing cannabis access, more people in the United States have begun using cannabis. Individuals with cancer endorse many reasons for cannabis use in the face of limited data. Some have suggested that cannabis may serve as an alternative to prescription medications such as opioids, benzodiazepines, and sleep aids for symptom management. We hypothesized that patients with cancer using cannabis would be less likely to have active prescriptions for these medication classes commonly used to manage pain, anxiety, and insomnia, respectively. <h3>Materials/Methods</h3> Clinician-collected cannabis history data documented via an electronic medical record-embedded form were abstracted using Michigan Radiation Oncology Analytics Resource (M-ROAR) for adult patients seen in an academic radiation oncology department from 10/2020 to 11/2021 under an IRB-approved protocol. Logistic regression was used to explore associations between recent cannabis use and prescriptions for narcotics, benzodiazepines, and sleep aids. <h3>Results</h3> Data were available for 3059 unique patients, including 343 (11.2%), 235 (7.7%), and 2481 (81.1%) endorsing recent (in the last month), non-recent only (use of cannabis in the past but not in the last month) and no history of cannabis use, respectively. Among those who recently used cannabis, 6.1% used cannabis more than 1 time per day, 54% used cannabis daily, and 21% used cannabis at least weekly but not every day. Most patients smoked cannabis (46%) or used edible forms of cannabis (35%). The most common reasons for cannabis use were pain (27%), insomnia (18%), and anxiety (15%), so we examined concurrent use of cannabis along with prescription opiates, sleep aids, and benzodiazepines. Patients who recently used cannabis were more likely to have an active prescription for an opioid medication (OR: 1.52; 95% CI: 1.21, 1.905; p <0.001) than patients who did not report recent cannabis use. There was no relationship between sleep aid medication prescription and recent cannabis use (OR: 0.62; 95% CI: 0.27, 1.43; p=0.261), but individuals using cannabis were more likely to have an active prescription for a benzodiazepine (OR: 1.40; 95% CI: 1.07, 1.82; p = 0.013). <h3>Conclusion</h3> The use of prescription opiates and prescription benzodiazepines is more prominent in patients who endorse cannabis use. Our data therefore do not support the hypothesis that cannabis use eliminates the need for medications to manage pain or anxiety. This suggests that for many patients, cannabis is used as an adjunct alongside conventional evidence-based therapies for symptom control and not as an alternative to such agents. Patient education is key to help individuals with symptoms locate evidence-based therapies and optimize them for safety and efficacy as we await high quality evidence that supports or refutes the efficacy of cannabis for management of many symptom classes in patients with cancer.

Development and Implementation of an Evidence-Based Pregnancy Screening Protocol in an Academic Radiation Oncology Department

<h3>Purpose/Objective(s)</h3> National guidelines give broad recommendations for which patients should be screened and timing of screening. Previous survey of ASTRO member institutions indicated that approximately 30% of centers did not have a clear pregnancy screening protocol. In this department, screening was done on the basis of individual physician clinical judgement. The purpose of this project is to develop an institutional protocol that defined patient criteria and timing for pre-radiation pregnancy screening in patients and to compare rates of screening before and after policy implementation. <h3>Materials/Methods</h3> A review of both radiation oncology and OB/GYN literature was performed with attention to risks of radiation to the fetus, current pregnancy screening protocols, and women at risk for pregnancy. Our institutional protocol defined the "at risk" population as female patients age 12-50 with intact reproductive organs. Contraceptive use was not considered an exclusion from screening. Screening would not be required for boost simulations or replans. Screening had to be performed within 30 days of CT simulation. Our policy was implemented 10/1/21. All CT simulations from 1/1/18-9/30/21 were reviewed. The medical record of patients meeting screening criteria was reviewed in further detail to establish the baseline screening rate. The medical records of patients meeting screening criteria from 10/1/21-1/31/22 was reviewed to establish an adherence rate after implementation. <h3>Results</h3> From 1/1/18-9/30/21, a total of 5,107 CT simulations were performed. Of these, 414 were performed on women age 12-50. 49 had prior removal of reproductive organs. This left 365 women as the baseline population. Screening occurred per the newly developed protocol in 189 of these women (51.8%.) There was one positive test. Retesting was negative, and the patient proceeded with treatment. An additional 64 patients underwent screening deviating from our current protocol. This included testing within 3 months but greater than 1 month from the date of CT simulation as well as screening after the date of simulation but prior treatment initiation. 112 of 365 women did not have documented pregnancy screening prior to CT and treatment initiation (30.6%). After the implementation of the screening protocol on 10/1/21, a total of 403 patients underwent CT simulation through 1/31/21. Of these, 34 were women age 12-50. 7 had prior removal of reproductive organs. Of the remaining 27 patients, 25 underwent screening per protocol (92.5%). One patient was 49 years old and refused testing. The other was tested before the initiation of therapy. <h3>Conclusion</h3> Our conclusion is implementation of a pregnancy screening protocol in an academic medical center radiation oncology department improved the screening rate for women at risk for pregnancy prior to radiation treatment planning. The use of a standardized policy eliminates inter-provider variation and improves patient safety.

Audit of radiation oncology practice: Lessons from a new private hospital in Delhi, India.

The objective of this audit was to analyze the radiotherapy (RT) practice in a newly established tertiary private hospital. With increasing radiation oncology (RO) facilities in private sector, this report is the first audit from a private health organization in India. The audit of all consecutively registered patients in RO has focused to extract data from the time of RT simulation planning till the completion of RT course. The patient and disease characteristics,RT-related treatment factors and compliance were analyzed in-depth. In this newly established RO department, the vendor-supplied equipment, e.g., RT planning system, treatment delivery (linear accelerator and brachytherapy), and RO information system (ROIS), are integrated with enterprise-wide hospital information system into unified paperless workflow management for the patient care records in a prospective manner. This analysis comprised consecutive 328 patients who consented for RT simulation and planning from April 20, 2018, to December 31, 2019. RT course compliance was 94.8% (311/328 patients), and treatment intent-wise: curative plus adjuvant in 60.2% and palliative RT in 36%. RT technique was conformal in all 100%, with volumetric arc radiotherapy (VMAT) delivered to 66.6% of patients. With overall median RT course duration of 29 days (range 1-81 days), the patients were delivered a median of 20 fractions. Compared to the previously published audit from an academic RO department in Delhi, this audit from a private hospital has shown (i) lesser waiting time, (ii) improved treatment compliance, (iii) utilization of higher techniques, and (iv) a lower duration of RT course.

A Survey to Assess and Delineate Approaches to Medical Student Outreach to Promote Diversity at Academic Radiation Oncology Programs

The aim of this study was to assess how academic radiation oncology departments engage medical students who are either female and/or from racial and ethnic demographic groups that are underrepresented in medicine. An electronic survey was sent to all 83 radiation oncology residency program directors (or if applicable medical student directors) whose department is affiliated with an on-site medical school. Questions assessed whether any faculty in the participants' department offer exposure in radiation oncology specifically to medical and premedical student groups whose members are typically women and others underrepresented in medicine, or promote the American Society for Radiation Oncology's Minority Summer Fellowship Award. Barriers to these types of involvement were also assessed. A representative from 54 out of 83 programs responded (response rate 65%). Faculty from 83% of departments had given a presentation to an oncology or radiation oncology medical student interest group. However, faculty from only 18% of departments had given a presentation to a Student National Medical Association chapter, 9% to a Latino Medical Student Association chapter, and 11% to an American Medical Women's Association chapter. Faculty from 15% of departments actively promote the Minority Summer Fellowship to the general student body, and 24% promote it to any minority students who express interest in radiation oncology. Faculty from 22% of departments had given a presentation to a premedical student group, 10% to an undergraduate student group focused on minority or female students, and 20% to a pipeline program for high school (or younger) women or other students who are underrepresented in medicine. Lack of awareness of the existence of such programs, or not being invited, were the most common barriers to participation. Most academic radiation oncology departments do not offer educational outreach specifically targeting women or minority students or promote the Minority Summer Fellowship. Further efforts are needed to break from the status quo and attract a more diverse workforce.

Patient Reported Outcome Measure (PROM) Collection Rates When Part of Routine Clinical Workflow in an Academic Radiation Oncology Department

Patient reported outcome measures (PROMs) are tools, usually questionnaires, that measure patient reported outcomes (PROs), directly recording a patient's health status and symptoms without interpretation by clinicians. Use of PROs can improve patient survival, quality of life, and financial toxicity. The goal of this study was to assess the collection rate of PROs in our academic radiation oncology department since implementing an electronic PROs collection system as a part of routine clinical care in 2016. Our hypothesis was that we could collect PROs from a significant proportion of our patients using digital tools without significantly changing our clinical workflows.Patients were assigned cancer-specific PROMs by their clinicians, and could submit answers by using a tablet provided in clinic or by using our electronic health record (EHR)-associated patient portal on a computer or mobile device (tablet or phone). We analyzed the collection rate of PROs from adult patients who received care in our department between March 2016 and March 2020. A Chi-squared test was used to compare groups.In total, we requested 216,842 PROMs from 22,471 patients (43% male, 57% female) from 176,904 visits. We received 127,686 PROMs from 77,689 encounters (43.9%) where patients were assigned at least one questionnaire. Among the collected PROMs (where at least one question was answered), 72% were answered completely. The number of collected PROMs increased over time, and the completely answered rate also increased over time. Patients who were more likely to answer PROMs were female, white, married or had a civil union or life partner, lived in-state, spoke English, had completed fewer years of schooling, and had a work status of full time or not retired or disabled. Most surveys were collected using a tablet in clinic (94%) from patients with breast (33%), genitourinary (19%), or thoracic (14%) malignancies during on treatment visits (54%). All P-values for described patterns were < 0.001.PROs can be collected with relatively high rates from all patients in an academic radiation oncology department, though variations exist. This suggests that more radiation oncology clinics should try to incorporate PROs into routine patient care if they have sufficient resources. Implementation strategies should be shared among institutions, especially if they share EHR vendors.

Cannabis Use in Patients Seen in an Academic Radiation Oncology Department

Cannabis use rates are increasing throughout the United States along with shifts in state-level policy. Patients with cancer use cannabis for a broad range of indications, but there is limited quality data to support many of these uses. To date, few studies have sought to understand cannabis use in populations of patients served by radiation oncology departments.Standardized electronic medical record prompts were used by clinicians for cannabis history documentation for 1050 adult patients seen for initial consultation or follow-up between 10/2020 and 2/2021 at an academic radiation oncology department. Cannabis use data, including recency/frequency of use, indication, and mode of administration, were later gathered using the Michigan Radiation Oncology Analytics Resource (M-ROAR) under an IRB-approved protocol. Cannabis use characteristics were summarized, and logistic regression was used to explore associations between age and gender and recent cannabis use.In total, 54 (5.1%) of 1050 unique patients declined to answer questions about cannabis use. Of the remaining 996 patients, 106 (10.6%) endorsed recent cannabis use (≤1 month ago), 71 (7.1%) noted remote use (> 1 month ago), and 819 (82.2%) denied history of cannabis use. The median age of those with recent cannabis use was 59.5 (IQR: 49.7-66.4) vs. 65.4 (IQR: 57.1-73.5) in all others. A multivariable logistic regression analysis revealed an association between age (OR 0.96; 95% CI: 0.95-0.97; P < 0.001) but not gender (male OR 1.24; 95% CI: 0.82-1.88; P = 0.310) and recent cannabis use. Patients noted pain (46.2%), anxiety (23.6%), insomnia (17.9%), "for the high" (17.0%), nausea (15.1%), poor appetite (14.2%), "to fight cancer" (4.7%), and depression (1.9%) as indications for use. The most common mode of administration was inhalation via smoking (47.2%), followed by oral (edibles, 36.8%), topical (15.1%), oral (drinks, 4.7%), vaping (3.8%), sublingual (1.0%), and rectal (1.0%). Most patients used cannabis daily (58.5%). Only 4 individuals (3.8%) noted use multiple times daily, while the remainder endorsed weekly (20.8%) or less than weekly (17.0%) use.Approximately 10% of patients seen in a radiation oncology department reported recent cannabis use for a variety of reasons. These findings suggest a need for: 1) collection of cannabis use history in radiation oncology departments, 2) efforts to destigmatize cannabis use to facilitate frank discussions between patients and providers, 3) patient education about the fact that cannabis is not an evidence-based cancer treatment, 4) recommendation against inhaled forms of cannabis, which may carry risk of pulmonary toxicity, and 5) careful application of proven therapies to address symptoms when appropriate to provide alternatives to cannabis. Further research is needed to assess changes in cannabis use patterns over the course of cancer treatment and to evaluate risks and benefits of cannabis use in patients with cancer.

Implementation of a Novel Radiation Oncology Physician Productivity Model

<h3>Purpose/Objective(s)</h3> Historical models of physician productivity in radiation oncology focus on external-beam (EBRT) volume. As the field has transitioned to hypofractionated regimens, stereotactic treatments, and an increase in radiation oncology procedures, this model has become outdated and no longer reflects physician work effort and productivity. Here we propose a new productivity model that takes into account technological advances in the field, work effort associated per plan, supervision requirements, and physician time for procedures. <h3>Materials/Methods</h3> An anonymous survey was completed by each faculty physician across an academic radiation oncology department that includes a main campus, proton center, and 3 community practices. Faculty were asked to assign the amount of time required to complete various activities, including but not limited to contouring tasks by modality (3D, intensity-modulated radiation therapy [IMRT], proton treatment), plan review, and amount of physician time required during procedures such as brachytherapy and radioembolization. <h3>Results</h3> All faculty physicians completed the 23-question survey. Mean time values were assigned to each activity. For example, contouring for 3D plans was assigned a smaller time value than IMRT; or a vaginal cylinder brachytherapy treatment was assigned a smaller time value than an interstitial implant. Each physician was evaluated on his/her annual volume of treatments and procedures, and this quantity was multiplied by the time modifier. Work effort was also assigned based on administrative roles, which often take physicians away from clinical work. When compared to EBRT, this model was more reflective of work effort and more accurately mirrored productivity and RVU generation. <h3>Conclusion</h3> Our physician productivity model was well accepted by faculty and unanimously deemed to be more reflective of physician productivity than EBRT volume. This model has allowed us to deploy physician support services more equitably across our varied practice sites. This model is now utilized as our primary means to assess physician productivity and associated supportive resource deployment. As our field of rapidly changing technology, procedures and administrative requirements evolve, so will such physician productivity models be required too.