Faculty Of Radiation Oncology Research Articles

Referral to radiation oncology prior to prostatectomy: Referral rates in a New Zealand tertiary Centre.

Radical prostatectomy and radical radiotherapy have equivalent survival outcomes in the treatment of localised prostate cancer but differing side-effect profiles. The 2018 Faculty of Radiation Oncology of the Royal Australasian College of Radiologists (RANZCR) position statement recommends that patients have the opportunity to discuss all suitable treatment options, ideally with the relevant specialist. This study aimed to determine the number and characteristics of men referred to radiation oncology before undergoing radical prostatectomy in the years immediately preceding the 2018 RANZCR position statement. The electronic records of all men who underwent a radical prostatectomy in the Auckland region between 1 January 2016 and 31 December 2017 were retrospectively reviewed for documentation of a referral or offer of referral to radiation oncology, or multidisciplinary meeting (MDM) consensus for surgery before prostatectomy. Patient and tumour variables were collected. Between 1 January 2016 and 31 December 2017, 234 patients underwent radical prostatectomy for prostate cancer in the wider Auckland region. Before undergoing prostatectomy, 89 of 234 patients (38.0%) were referred, offered but declined referral, or had MDM consensus for surgery. Age and urologist were most strongly correlated with the primary outcome; those offered referral were older than those who were not (P = 0.030). The practice of one urologist was an outlier, referring or recommending referral to 92.3% of patients (P < 0.0001). These results provide a benchmark for future studies assessing referral practices following the RANZCR position statement, and suggest a need for further education and advocacy regarding the role of radiotherapy in the treatment of localised prostate cancer.

The changing radiation oncology landscape in New Zealand.

This paper outlines the New Zealand (NZ) responses to the biennial facilities surveys of The Royal Australian and New Zealand College of Radiologists (RANZCR), Faculty of Radiation Oncology (FRO) from 2011 to 2019. The facilities survey is conducted by the FRO Economics and Workforce Committee (FROEWC) and focuses on equipment, treatment activities and staffing. The number of facilities increased by two to 10, both in the private sector. The total number of linear accelerators (linacs) increased by four; one in public and three in private. The majority of linacs were over 8 years old (62.5%). Treatment courses have increased by 19% and fraction numbers by 13.7%. Courses per linac have remained relatively constant. There was growth in IMRT, orthovoltage, high dose rate brachytherapy and paediatric treatments. There was a slow increase in number of radiation oncologists and trainees. The number of radiation therapists was unchanged with a 20% increase in treatment courses per radiation therapist. Physicist numbers have increased but 61.4% of physicists are overseas-trained and vacancies persist. The survey results indicate a rapidly changing radiation oncology landscape in NZ between 2011 and 2019. The challenges of increases in cancer numbers, treatment courses and complexity of treatments and a need to focus on quality standards against a set of minimal increase in machine numbers, ageing machines, static or slowly increasing staffing numbers and heavy reliance on overseas staffing require a national review of radiation oncology services to ensure a sustainable future.

Communication and collaboration skills training in Radiation Oncology in Australia and New Zealand: A qualitative study.

Effective communication and collaboration with patients, carers and between healthcare professionals improves patient management. This study aimed to explore essential communication and collaboration skills training (CCST) for a radiation oncologist (RO) to inform competencies, learning outcomes and enhance curriculum training methods. Eight focus group discussions with 10 fellows and 14 trainees of the Faculty of Radiation Oncology, Royal Australian and New Zealand College of Radiologists (FRO RANZCR) were conducted face to face between October 2018 and March 2019. Participants included doctors from culturally and linguistically diverse backgrounds, working in public and private, metropolitan, and rural sectors. Data were recorded, transcribed verbatim, managed in Excel, and coded using a qualitative content analysis framework. The study was approved by South Eastern Sydney Local Health District HREC (18/186). Participants provided informed written consent. After achieving thematic saturation, four predominant themes emerged. These were as follows: (1) Enablers and barriers to effective communication and collaboration; (2) written communication; (3) communicating bad news; and (4) multidisciplinary team meeting collaboration. Managing uncertainty and workplace culture emerged as interconnected sub-themes. There is a current lack of CCST in radiation oncology in Australia and New Zealand. The most common theme that emerged to improve CCST focused on increasing the exposure to a variety of communication and collaboration clinical scenarios, which are observed and upon which immediate structured feedback is given. Consultants and trainees offered tangible suggestions on how to improve the curriculum. These findings underscore the importance of using a combination of structured teaching methods and work-based assessments. CCST templates are recommended.

Feedback survey on the Royal Australian and New Zealand College of Radiologists Faculty of Radiation Oncology trainee research requirement.

The Royal Australian and New Zealand College of Radiologists Faculty of Radiation Oncology (FRO) requires trainees to complete a research project prior to the exit (phase II) examinations. We report results of a survey of current FRO trainees and Fellows graduating since 2013, regarding their experience of the overall requirement, supervision, barriers to project completion and subsequent publication. A 32-question online survey was sent via email to 285 FRO members in July 2019. Responses were anonymous. The overall response rate was 32% (trainees 41%, Fellows 21%); 70% of respondents were trainees. About three-quarters of projects were retrospective reviews (64%) or surveys (13%), 94% met College requirements at first submission, 71% were published, and 81% were presented at a scientific meeting. Most assistance was provided by the project supervisor (57%), statistician (47%), another consultant (36%) or the Director of Training (28%). Finding time amongst other clinical/curriculum commitments, rotating to another training site and availability of a suitable supervisor were notable obstacles. Over half (52%) of respondents were satisfied/very satisfied with the process overall and 20% dissatisfied/very dissatisfied; 19% and 30%, respectively, thought requiring acceptance for peer review and completion prior to the phase II examination unreasonable/very unreasonable. Four per cent reported being less likely to be involved in future research as a result of this experience. While the majority of respondents perceive the FRO research requirements as reasonable, a significant minority are not satisfied with aspects of the programme. Amendment of the pre-phase II stipulation may be worthy of consideration.

Faculty of Radiation Oncology 2018 workforce census.

This paper reports the key findings of the Faculty of Radiation Oncology 2018 workforce census and compares results with previous studies. The census was conducted in mid-2018 with distribution to all radiation oncologists and trainees listed on the college database in Australia, New Zealand, Singapore and overseas. There were new questions about hours spent on multidisciplinary meetings (MDTS), leadership positions held, management of inpatients, hypofractionation, stereotactic body radiation therapy (SBRT), income type and gynae-oncology work for radiation oncologists. Trainees were asked about time spent on planning and contouring. The overall response rate was 69.9% with 67.7% of radiation oncologists and 77.9% of trainees responding. There were 514 radiation oncologists with 60% male and a mean age of 49years (median=46years, range 31-91). The majority of respondents were Caucasian (57.7%) and from New South Wales (29.4%). Sixty-one per cent were subspecialists with breast, SBRT and urological cancers, the most popular areas of interest, and 56% held leadership positions. The majority worked in the public sector (55.7%), but 31.7% worked solely in the private sector with an average working week of 43.4hours (h) (median=44, range 2-110). Radiation oncologists spent an average of 3.6h on MDTS (median=4h), 2.2h (median=2h) on simulation and 8h (median=5h) on contouring per week. They averaged 245 new patients (median=250, range 30-695) and 25 inpatients (median=20) per year. Hypofractionation was used for radical treatment of breast (75%) and prostate cancer (49%). Radiation oncologists were mainly remunerated with a fixed income (53%) with 40% having some incentive-based income. There were 140 trainees with an equal male and female distribution. The large majority (88%) were satisfied with their career and network (83%). Most trainees worked between 36 and 55h per week with 15% having no protected time. Most trainees spent less than 5hours on planning each week and job availability remained a major concern (90%). The radiation oncologist numbers have increased significantly, but unemployment remains low. Many parameters remain similar to the 2014 census, but new information has been obtained on special interest areas, leadership positions, gynae-oncology, inpatients, hypofractionation use, remuneration and contouring. Trainee numbers remain stable with an increased percentage satisfied with their career with much less concern about oversupply. Protected time remains an issue with contouring time and teaching emerging as a potential issue.

The status of radiation oncology teaching in Australian and New Zealand medical schools.

Radiation therapy is a core component of curative and palliative cancer treatment; however, its indications and benefits remain poorly understood across the medical profession. An electronic survey focussing on curriculum content, teaching and assessment in radiation oncology and plans for curriculum change was developed. The Faculty of Radiation Oncology, Royal Australian and New Zealand College of Radiology (RANZCR) distributed the survey to all 24 Australian and New Zealand medical schools. The survey was conducted from November 2017 to January 2018 following ethics approval. Sixteen of the 24 (67%) medical Faculties in Australia and New Zealand responded. Ninety-four percent of Faculties had no formal radiation oncology curriculum. Most Faculties (87%) dedicated <15% of the total medical course to oncology, of which the majority (63%) dedicated <10% to radiation oncology. At least 50% of Faculties did not offer formal radiation oncology teaching to all students. When offered, students' exposure to radiation oncology was often <5days over the entire course (44%). The majority of medical schools (73%) are planning curriculum changes in the next 5years; however, most have no intention of changing radiation oncology teaching. Radiation oncology continues to be underrepresented in medical curricula throughout Australia and New Zealand with no plans for improvement by Faculties. This study supports the need for formal advocacy for improving radiation oncology education in medical schools and will form the basis of new national recommendations for radiation oncology curriculum development.

Targeting general practitioners: Prospective outcomes of a national education program in radiation oncology.

We report on learning outcomes of a standardized national education program aimed at improving general practitioner (GP) knowledge about radiation therapy (RT) and referral pathways to radiation oncologists (ROs). In 2014, a GP education program was developed through the Targeting Cancer public awareness campaign of the Royal Australian and New Zealand College of Radiologists (RANZCR) Faculty of Radiation Oncology. The sessions were held in RT departments and comprised of RO-led case-based group learning and a department tour. Pre- and immediate post-session surveys assessed four domains: Objective knowledge about RT, understanding of referral pathways to ROs, self-reported referral behaviours, feedback on the session. A 6-month follow up survey assessed ongoing knowledge retention. Eighteen sessions were held nationwide between October 2014 and March 2016. One hundred and seventy-four were surveyed. Pre-session, 96% of GPs reported their knowledge of RT required improvement. Post-session, 95% rated their knowledge as 'excellent', 'above average' or 'competent'. 32.5% of GPs were not aware of the location of their local RT department. 81% reported patients would benefit from having clearer referral pathways to ROs. 96% agreed the GP's role is to refer cancer patients to relevant specialists to discuss treatment options. However, only 49% were comfortable referring directly to an RO. Post-session rose to 92%. All respondents felt the session improved their understanding of RT. In the follow up survey, 17 respondents (94%) reported the session had improved their ability to care for cancer patients. A national GP education program improves GP knowledge about RT and may influence patient referrals for RT.

Employment for Radiation Oncologists in Australia and New Zealand—The Recent Graduates Study on Employment, Experiences, and Perspectives

There has been a large increase in the number of radiation oncologists entering the workforce in Australia and New Zealand. This may affect the balance of supply and demand. There is little “official” information on the subject. This study was undertaken to understand graduate experiences, ascertain current employment for new graduates, monitor trends and to provide recommendations to the Faculty of Radiation Oncology in Australia and New Zealand. An online survey was distributed to all radiation oncology graduates in Australia, New Zealand and Singapore from 2013 to 2015. 66/83 (80%) responses were obtained. Sixty five percent completed training in the same location as commencing training with 7.6% moving overseas after completion of training to complete fellowships. Ninety one percent were currently employed as consultants or fellows or locums with the majority in public sector practice. The majority sent more than 12 weeks seeking employment. One quarter of respondents resided and worked in a rural/regional area with 50% of those not working in a rural/regional area indicating they would consider so if certain requirements were met. Job satisfaction was met in 75% of respondents, but 7% were dissatisfied. There was a perception of very competitive job market by 87% of respondents due to the high number of trainees. Respondents thought better workforce planning, career guidance, broadening the scope of fellowship positions, controlling private practice positions and lobbying for more jobs would be useful. This first survey and study of recent graduates in Australia and New Zealand has provided some useful information revealing most graduates were employed with a competitive job market in Australia and New Zealand. Workforce planning is a major issue.

Radiation Oncology research grants awarded by the Royal Australian and New Zealand College of Radiologists: Value for money?

The Royal Australian and New Zealand College of Radiologists (RANZCR) and other medical colleges have provided research grants from their budgets for many years. This survey-based project aimed to determine whether the RANZCR Faculty of Radiation Oncology (FRO) is realizing value for money from its seed funding, and to compare this with grant activities of the other colleges. Eligible FRO grant recipients between 1999 and 2014 were surveyed regarding bibliometric data, subjective outcomes and factors considered important in completing their research projects. The other colleges were also approached via email and phone interviews. A records search identified 26 eligible individuals who received 42 grants for 41 projects. The survey response rate was 100%, identifying 33 secondary grants, 65 conference presentations, 10 prizes and 69 publications associated with the FRO grants and consequential research. At least seven higher degrees also resulted. The funding process was very positively perceived by grant recipients, and the two factors identified as most important in project completion were local infrastructure and RANZCR funding. In 2015, FRO allocated AUD$150K for grants compared with $10K-$2.6M from 10 of the other 15 Australasian Medical Colleges. In general, appraisal of funding outcomes relative to expenditure has been only low level until recently. This project has identified significant research output and subjective benefit from relatively modest FRO seed grants, implying a favourable cost-benefit ratio. Such outcomes monitoring needs to be more widely pursued within Australasian medical colleges.

Breast interest group faculty of radiation oncology: Australian and New Zealand patterns of practice survey on breast radiotherapy.

This patterns of practice study was conducted on behalf of the RANZCR Breast Interest Group in order to document current radiotherapy practices for breast cancer in Australia and New Zealand. The survey identifies variations and highlights potential contentious aspects of radiotherapy management of breast cancer. A fifty-eight question survey was disseminated via the Survey Monkey digital platform to 388 Radiation Oncologists in Australia and New Zealand. In total, 156 responses were received and collated. Areas of notable consensus among respondents included hypofractionation (77.3% of respondents would 'always' or 'sometimes' consider hypofractionation in the management of ductal carcinoma in-situ and 99.3% in early invasive breast cancer); margin status in early breast cancer (73.8% believe a clear inked margin is sufficient and does not require further surgery) and use of bolus in post-mastectomy radiotherapy (PMRT) (91.1% of participants use bolus in PMRT). Areas with a wider degree of variability amongst respondents included regional nodal irradiation and components of radiotherapy planning and delivery (examples include the technique used for delivery of boost and frequency of bolus application for PMRT). The results of these patterns of practice survey informs radiation oncologists in Australia and New Zealand of the current clinical practices being implemented by their peers. The survey identifies areas of consensus and contention, the latter of which may lead to a development of research trials and/or educational activities to address these areas of uncertainty.

Faculty of Radiation Oncology 2014 workforce census.

IntroductionThis paper reports the key findings of the Faculty of Radiation Oncology 2014 workforce census and compares the results with earlier surveys.MethodsThe census was conducted in mid‐2014 with distribution to all radiation oncologists, educational affiliates and trainees listed on the college database. There were six email reminders and responses were anonymous. The overall response rate was 76.1%.ResultsThe age range of fellows was 32–96 (mean = 49 years, median = 47 years). The majority of the radiation oncologists were male (n = 263, 63%). The minority of radiation oncologists were of Asian descent (n = 43, 13.4%). Radiation oncologists graduated from medical school on average 23 years ago (median = 22 years). A minority of fellows (n = 66, 20%) held another postgraduate qualification. Most radiation oncologists worked, on average, at two practices (median = 2, range 1–7). Practising radiation oncologists worked predominantly in the public sector (n = 131, 49%), but many worked in both the public and private sectors (n = 94, 37%), and a minority worked in the private sector only (n = 38, 14%). The largest proportion of the workforce was from New South Wales accounting for 29% of radiation oncologists. Radiation oncologists worked an average of 43 h/week (median = 43 h, range 6–80). Radiation oncologists who worked in the private sector worked less hours than their public sector or public/private sector colleagues. (38.3 vs. 42.9 vs. 44.3 h, P = 0.042). Victorians worked the fewest average hours per week at 38 h and West Australians the most at 46 h/week. Radiation oncologists averaged 48 min for each new case, 17 min per follow up and 11 min for a treatment review. Radiation oncologists averaged 246 new patients per year (median = 250, range = 20–600) with men (average = 268), Western Australians (average = 354) and those in private practice seeing more (average = 275). Most radiation oncologists considered themselves as specialists (n = 151, 60%), but nearly all those from South Australia were generalists (n = 15, 94%) as were three‐quarters of those from private practice. A minority of radiation oncologist respondents (10%) intended to retire within 5 years with a further 16% within 10 years.There was a stabilisation of trainee numbers in Australia and New Zealand with no increase compared with 2010 (142 in 2014 vs. 143 in 2010). The most common age bracket for trainees remained 31–35 years. One‐third of trainees were of Asian descent and nearly half held other degrees. The majority of trainees were satisfied with their career, but 30% were not entirely satisfied. Nearly half of trainee respondents would have reconsidered their choice of specialty had they known about the possible oversupply in the workforce with 12.4% undecided about continuing their career in radiation oncology. There were still 16% of trainees with no protected time during the working week, and a further 21% with only 1 h. Only one trainee respondent preferred to work in private practice, and job availability remained a concern for 89% of respondents.ConclusionsThe radiation oncologist workforce numbers have increased at a much slower rate, and unemployment remained low. Many parameters remained similar to the 2010 survey. However, there has been a decrease in the average number of new patients seen per year, working hours and also a slight decrease in the time spent per new patient. The trainee numbers have stabilised, but job availability remained a concern. A significant proportion of trainees were not satisfied with their career.

Guidelines for safe practice of stereotactic body (ablative) radiation therapy.

The uptake of stereotactic ablative body radiation therapy (SABR)/stereotactic body radiation therapy (SBRT) worldwide has been rapid. The Australian and New Zealand Faculty of Radiation Oncology (FRO) assembled an expert panel of radiation oncologists, radiation oncology medical physicists and radiation therapists to establish guidelines for safe practice of SABR. Draft guidelines were reviewed by a number of international experts in the field and then distributed through the membership of the FRO. Members of the Australian Institute of Radiography and the Australasian College of Physical Scientists and Engineers in Medicine were also asked to comment on the draft. Evidence-based recommendations (where applicable) address aspects of departmental staffing, procedures and equipment, quality assurance measures, as well as organisational considerations for delivery of SABR treatments. Central to the guidelines is a set of key recommendations for departments undertaking SABR. These guidelines were developed collaboratively to provide an educational guide and reference for radiation therapy service providers to ensure appropriate care of patients receiving SABR.

Australian &amp; New Zealand Faculty of Radiation Oncology Genito‐Urinary Group: 2011 consensus guidelines for curative radiotherapy for urothelial carcinoma of the bladder

Curative radiotherapy, with or without concurrent chemotherapy, is recognized as a standard treatment option for muscle-invasive bladder cancer. It is commonly used for two distinct groups of patients: either for those medically unfit for surgery, or as part of a 'bladder preserving' management plan incorporating the possibility of salvage cystectomy. However, in both situations, the approach to radiotherapy varies widely around the world. The Australian and New Zealand Faculty of Radiation Oncology Genito-Urinary Group recognised a need to develop consistent, evidence-based guidelines for patient selection and radiotherapy technique in the delivery of curative radiotherapy. Following a workshop convened in May 2009, a working party collated opinions and conducted a wide literature appraisal linking each recommendation with the best available evidence. This process was subject to ongoing re-presentation to the Faculty of Radiation Oncology Genito-Urinary Group members prior to final endorsement. These Guidelines include patient selection, radiation target delineation, dose and fractionation schedules, normal tissue constraints and investigational techniques. Particular emphasis is given to the rationale for the target volumes described. These Guidelines provide a consensus-based framework for the delivery of curative radiotherapy for muscle-invasive bladder cancer. Widespread input from radiation oncologists treating bladder cancer ensures that these techniques are feasible in practice. We recommend these Guidelines be adopted widely in order to encourage a uniformly high standard of radiotherapy in this setting, and to allow for better comparison of outcomes.

The Role of the Radiation Oncologist in Systemic Therapy an Australian and New Zealand Perspective

There has been considerable recent interest in radiation oncologists becoming more involved in prescribing systemic therapy. Radiation oncology and medical oncology have been very distinct disciplines with little overlap in Australia and New Zealand. However, the Faculty of Radiation Oncology identified systemic therapy as a priority to be investigated. The subsequent workforce survey in 2010 found that although the majority of radiation oncologists and trainees were not interested in becoming more involved in systemic therapy, there was still considerable interest. This manuscript identifies the key issues to consider if radiation oncologists are contemplating being more involved with systemic therapy.

Faculty of Radiation Oncology 2010 workforce survey

This paper outlines the key results of the Faculty of Radiation Oncology 2010 workforce survey and compares these results with earlier data. The workforce survey was conducted in mid-2010 using a custom-designed 17-question survey. The overall response rate was 76%. The majority of radiation oncologist respondents were male (n = 212, 71%), but the majority of trainee respondents were female (n = 59, 52.7%). The age range of fellows was 32-92 years (median: 47 years; mean: 49 years) and that of trainees was 27-44 years (median: 31 years; mean: 31.7 years). Most radiation oncologists worked at more than one practice (average: two practices). The majority of radiation oncologists worked in the public sector (n = 169, 64.5%), with some working in 'combination' of public and private sectors (n = 65, 24.8%) and a minority working in the private sector only (n = 28, 10.7%). The hours worked per week ranged from 1 to 85 (mean: 44 h; median: 45 h) for radiation oncologists, while for trainees the range was 16-90 (mean: 47 h; median: 45 h). The number of new cases seen in a year ranged from 1 to 1100 (mean: 275; median: 250). Most radiation oncologists considered themselves generalists with a preferred sub-specialty (43.3%) or specialists (41.9%), while a minority considered themselves as generalists (14.8%). There are a relatively large and increasing number of radiation oncologists and trainees compared with previous years. The excessive workloads evident in previous surveys appear to have diminished. However, further work is required on assessing the impact of ongoing feminisation and sub-specialisation.

Update of the International Consensus on Palliative Radiotherapy Endpoints for Future Clinical Trials in Bone Metastases

To update the international consensus on palliative radiotherapy endpoints for future clinical trials in bone metastases by surveying international experts regarding previous uncertainties within the 2002 consensus, changes that may be necessary based on practice pattern changes and research findings since that time. A two-phase survey was used to determine revisions and new additions to the 2002 consensus. A total of 49 experts from the American Society for Radiation Oncology, the European Society for Therapeutic Radiology and Oncology, the Faculty of Radiation Oncology of the Royal Australian and New Zealand College of Radiologists, and the Canadian Association of Radiation Oncology who are directly involved in the care of patients with bone metastases participated in this survey. Consensus was established in areas involving response definitions, eligibility criteria for future trials, reirradiation, changes in systemic therapy, radiation techniques, parameters at follow-up, and timing of assessments. An outline for trials in bone metastases was updated based on survey and consensus. Investigators leading trials in bone metastases are encouraged to adopt the revised guideline to promote consistent reporting. Areas for future research were identified. It is intended for the consensus to be re-examined in the future on a regular basis.

Australian &amp; New Zealand Faculty of Radiation Oncology Genito‐Urinary Group: 2010 consensus guidelines for definitive external beam radiotherapy for prostate carcinoma

External beam radiotherapy for prostate cancer has undergone substantial technological and clinical advances in the recent years. The Australian & New Zealand Faculty of Radiation Oncology Genito-Urinary Group undertook a process to develop consensus clinical practice guidelines for external beam radiotherapy for prostate carcinoma delivered with curative intent, aiming to provide guidance for clinicians on the appropriate integration of clinical evidence and newer technologies. Draft guidelines were presented and discussed at a consensus workshop in May 2009 attended by radiation oncologists, radiation therapists and medical physicists. Amended guidelines were distributed to radiation oncologists in Australia, New Zealand and Singapore for comment, and modifications were incorporated where appropriate. Evidence based recommendations for risk stratification, the role of image-guided and intensity-modulated radiation therapy, prescribed dose, simulation and treatment planning, the role and duration of neo-adjuvant/adjuvant androgen deprivation therapy and outcome reporting are presented. Central to the guidelines is the recommendation that image-guided radiation therapy should be used when definitive external beam radiotherapy for prostate cancer is prescribed. The consensus guidelines provide a co-operatively developed, evidence-based framework for contemporary treatment of prostate cancer with external beam radiotherapy.

RE: Faculty of radiation oncology endorsed guidelines for informed consent: Risk description

RE: Faculty of radiation oncology endorsed guidelines for informed consent: Risk description

Australian and New Zealand radiation oncology work practices in 2000.

In 1996, a Faculty of Radiation Oncology (FRO) survey was sent to all practising radiation oncologists in Australia and New Zealand (ANZ) ascertaining work practices and attitudes (n = 138). In December 2000, we sent all practising ANZ radiation oncologists (n = 183) a survey in which we reproduced questions about work practice (response rate 75%). The majority of ANZ radiation oncologists were male (n = 102, 73.9%), in full time employment (n = 125, 90.6%) and subspecialized (n = 103, 74.6%). The median number of new patients seen per year was 300 (range, 10-700). However, 15% of radiation oncologists saw 350 new patients per year and 19% saw greater than 400 new patients per year. The median time allocated to work was 50 h each week. Nearly all respondents (90%) desired some amount of protected time with a median desirable of eight hours each week (range, 2-30 h, mode 8 h). The majority (n = 95, 68.8%) of respondents were members of TROG. A minority (n = 25, 18.1%) had obtained a postgraduate qualification. Many also had a clinical academic appointment (n = 60, 43.5%). Over 70 percent of respondents (n = 100, 72.5%) indicated enrollment of their patients in clinical trials. The increase in radiation oncologists with postgraduate qualifications and commitment to clinical research, through TROG membership and patients recruited to clinical trials, is very encouraging. However, our findings demonstrate little, if any, improvement in the total weekly clinical workload of a radiation oncologist. The recent move to subspecialization has not resulted in a decrease in clinical workload. In some aspects of work practice, such as time for self-education and research, the situation appears to be worsening.

Faculty of Radiation Oncology survey of work practices

The aim of the present paper was to determine the current working conditions of practising radiation oncologists (RO) in Australasia and their attitudes towards their work and work environment. The authors were requested by the Faculty of Radiation Oncology to conduct a survey of Fellows' work conditions and attitudes. The need for such a survey arose from a workshop of the Faculty held in Sydney in 1995, to determine future directions of the Faculty. Issues of potential interest were identified at the workshop and supplemented by the authors into a survey consisting of both directed and open questions. Respondents were free to remain anonymous. An address list of RO was supplied by the Royal Australian and New Zealand College of Radiologists (RANZCR). Two mailouts were performed to increase the response rate. The survey was completed during the second half of 1996 and analysed in 1997. The response rate was 79% (63-100% according to state/country). The age range was 30-69 years (median: 43 years; mean: 44 years), and 78% of the respondents were male. A public centre was identified as the sole or main place of work for 84% of respondents. The number of RO per practice varied from one to 25 (median: 5). The estimated hours worked per week ranged from 20 to 79 (mean: 52 h; median: 50 h). There were significant differences in allocation of hours between public and private (more clinical hours for private (P = 0.008), more teaching hours for public (P = 0.007)) but no difference in total hours. The responses for clinical work profile were: 'general' 39%, 'largely subspecialty' 37% and both 2% (23% did not respond). The proportion whose practice was 'largely subspecialty' differed between public and private (53% vs 13%, respectively; P = 0.06), and varied according to the number of RO in the practice (62% for > five RO vs 35% for < or = five RO, P = 0.03). The need for subspecialization for the treatment of common tumours (breast, gynaecological etc.) was held by 78% of respondents and was related to the number of RO in the practice (100% for > five RO vs 81% for < or = five RO, P = 0.002). The number of new patients seen per RO in 1995 ranged from 0 to 700 (mean: 342; median: 350), with a significant difference between the mean numbers seen in public versus private settings (331 vs 409, respectively; P = 0.008). Administration of cytotoxics was supervised by 36% of RO across Australasia but was dependent strongly on the state/country of practice (P = 0.0002). The current and preferred roles in clinical management were scored as means of 7.9 and 8.7, respectively, on a linear scale from 1 (mainly technical role) to 10 (significant role in overall management). A total of 40% of RO were content with their current time allocation; the remainder generally wished to reduce clinical time and increase self-education and/or clinical research. Most indicated that they wanted some 'protected time'. Most were content to be called a 'radiation oncologist' and wished to retain this title; the most common alternative was 'clinical oncologist'. Much of the general comment related to perceived loss of control of clinical and academic aspects of oncology to other specialties. The present survey is the first to define current work practices and to explore attitudes to work. It is clear that many RO consider clinical workloads to be excessive, to the exclusion of other work-related activities. There was a strong feeling that significant changes will be required if RO are to maintain the role in cancer management for which they are trained.