Full-time Equivalent Radiation Oncologists Research Articles

Comparing Radiotherapy Infrastructure in Chile with International Standards and Planning for Future Needs

Cancer is an important cause of morbidity and death. Approximately 60% of patients will require radiotherapy during the course of their illness. European standards of care estimate a need of one radiation oncologist for every 130-300 new radiation oncology patients per year, with at least one Linear Accelerator (LINAC) for every 250-400 patients that require treatment. Aims: Describe at the national and subregional level the available infrastructure and medical human resources at radiation oncology facilities in Chile estimating the current infrastructure gap and future needs according to expected population and cancer incidence growth to year 2025. Department heads of every radiation oncology units in the private and public sector in Chile were individually contacted to collect information on Full Time Equivalent (FTE) radiation oncologists in their center, number, and age of radiation oncology units and total number of radiation oncology courses delivered in each center. Population estimates for ear 2025 where retrieved from the national statistics institute. Cancer incidence estimations where extracted from the National Cancer Registries. In 2018 Chile has 22 radiation oncology facilities with 41 operative LINACS and 74 FTE radiation oncologists (FTE), amounting to 4,1 radiation oncologists for every 1 million inhabitants. In year 2017 one FTE treated on average 220 annual patients. There are 2,51 LINACS for every 1000 treated patients, treating 397 annual patients on average. Of the 41 LINACS operative in the country, 15 of them have been operative for more than 10 years and could reasonably be considered in need of replacement in the near future. Interestingly, 10 of the 15 obsolete LINACS are in the private sector, which has 25 LINACS, which means private clinics have been slower to update their infrastructure than the public sector. With an estimated cancer incidence of 216.9 every100.000 people the current need is approximately 62 LINACS and 80 FTE. Estimating incidence to year 2025 a total of 68 LINACS and a minimum of 88 FTE would be required to meet national needs. Chile currently has a reasonable physician radiation oncology staffing but is lacking on treatment units and replacement of obsolete units. By 2025 an almost doubling of the total number of LINACS will be required considering the need for replacement of obsolete units if Chile is to compare to international standards of care.

Abstract A61: Student Institute to Stimulate Interest in Radiological Sciences Academic Careers (SISIRSAC): A novel near-peer mentoring approach

Abstract Introduction: The World Health Organization predicts that 26.4 million new cancer cases will be reported in 2030 alone [1]. Between 2010 and 2020, the number of patients receiving radiotherapy is expected to increase by 22% [2]. Assuming the current graduation rate of 140 residents/yr remains constant; the number of full-time equivalent radiation oncologists is expected to increase by only 2% [2]. The number of residents would have to increase to 280 per year for the years 2014 to 2019 to equal expected demand [2]. For these reasons, when considered in aggregate, it is necessary to establish an effective mentoring paradigm in radiological science not just for medical students (MS) but also for high school (HS) and college undergraduate (UG) students, to promote a greater general awareness of the study of oncology as well as its therapeutic implementation. Methods: Research experience in the Dept. of Radiation Medicine provides full-time summer and/or all year round research educational experience to HS, UG, and MS interns. Interns are paired in a “near-peer” fashion; that is, a junior or less experienced student matched with a senior or more experienced student. Each student pair is subsequently matched with an experienced faculty scientist or preceptor. All interns spend a minimum of 10-12 wks working full-time in the preceptor's laboratory. Preceptors are encouraged to involve interns as much as possible in all facets of the research process, such as reading the relevant literature, participating in regularly scheduled lab meetings and journal clubs, research seminars as well as multidisciplinary tumor boards. Didactic sessions on how to conduct scientific research and program evaluation from learners will be a core of the program. Results: From 2007-2012, the Dept. has mentored & sponsored a total of 44 students, not including students in its graduate and postgraduate programs, or international students. A proud feature of the Department's mentorship program is that HS interns, like their US and MS counterparts, are active participants who contribute significantly in the preparation of scientific abstracts for national and international conferences, as well as in the drafting of associated scientific manuscripts. While most HS interns typically start on short-term projects, they understand that research questions may not necessarily be answered in a limited time period. Eight of our HS students have co-authored at least one scientific abstract and/or peer-reviewed manuscript; 3 HS students successfully competed in regional and/or national science fairs, one of our US interns was a laureate of the American Association of Physicist in Medicine Summer Research Fellowship, 2 of our US interns have successfully earned college credits for their research, 5 of our MS participants have successfully secured competitive Research Medical Student Grant awards from the Radiological Society of North America, and one MS was a Tartar Trust Fellow. Conclusion: Based on the success of our current program, we plan to submit an R25 that will specifically meet the goals for the NCI Cancer Education Grant Programs initiatives through the following specific aims: Aim 1: To increase the number of students with interest in cancer and radiation research by identifying and selecting high school, undergraduate and medical students with strong interests in the biomedical, clinical, or epidemiologic aspects of cancer and emphasize the recruitment of women and underrepresented minorities into the program. Aim 2: Create and implement a structured mentored research and educational experience with emphasis on radiological sciences, near-peer mentorship and dyadic mentorship.

Japanese structure survey of radiation oncology in 2009 with special reference to designated cancer care hospitals

The structure of radiation oncology in designated cancer care hospitals in Japan was surveyed in terms of equipment, personnel, patient load, and geographic distribution, and compared with the structure in other radiotherapy facilities and the previous survey. The Japanese Society for Therapeutic Radiology and Oncology surveyed the national structure of radiation oncology in 2009. The structures of 365 designated cancer care hospitals and 335 other radiotherapy facilities were compared. Designated cancer care hospitals accounted for 50.0% of all the radiotherapy facilities in Japan. The patterns of equipment and personnel in designated cancer care hospitals and the other radiotherapy facilities were, respectively, as follows: linear accelerators per facility: 1.4 and 1.0; dual-energy function: 78.6 and 61.3%; three-dimensional conformal radiotherapy function: 88.5 and 70.0%; intensity-modulated radiotherapy function: 51.6 and 25.3%; annual number of patients per linear accelerator: 301.3 and 185.2; Ir-192 remote-controlled after-loading systems: 31.8 and 4.2%; and average number of full-time equivalent radiation oncologists per facility: 1.8 and 0.8. Compared with the previous survey, the ownership ratio of equipment and personnel improved in both designated cancer care hospitals and the other radiotherapy facilities. Annual patient loads per full-time equivalent radiation oncologist in the designated cancer care hospitals and the other radiotherapy facilities were 225.5 and 247.6, respectively. These values exceeded the standard guidelines level of 200. The structure of radiation oncology in designated Japanese cancer care hospitals was more mature than that in the other radiotherapy facilities. There is still a shortage of personnel. The serious understaffing problem in radiation oncology should be corrected in the future.

Development by a Large Integrated Health Care System of an Objective Methodology for Evaluation of Medical Oncology Service Sites.

Aurora Health Care (AHC) is the largest health care system in Wisconsin, with 14 acute care hospitals. In early 2010, a group of 18 medical oncologists became affiliated with AHC. This affiliation added 13 medical oncology infusion clinics to our existing 12 sites. In the era of health care reform and declining reimbursement, we need an objective method and criteria to evaluate our 25 outpatient medical oncology sites. We developed financial, clinical, and strategic tools for the evaluation and management of our cancer subservice lines and outpatient sites. The key to our success has been the direct involvement of stakeholders with a vested interest in the services in the selection of the criteria and evaluation process. We developed our objective metrics for evaluation based on strategic, financial, operational, and patient experience criteria. Strategic criteria included: population trends, full-time equivalent (FTE) medical oncologists/primary care physicians, FTE radiation oncologists, FTE oncologic surgeons, new annual cases of patients with cancer, and market share trends. Financial criteria per site included: physician work relative value units, staff FTE by type, staff salaries, and profit and loss. Operational criteria included: facility by type (clinic v hospital based), hours of operation, and facility detail (eg, No. of chairs, No. of procedure and examination rooms, square footage). Patient experience criteria included: nursing model primary/nurse navigators, multidisciplinary support at site, Press Ganey (South Bend, IN; health care performance improvement company) results, and employee engagement score. The outcome of our data analysis has resulted in the development of recommendations for AHC senior leadership and geographic market leadership to consider the consolidation of four sites (phase one, four sites; phase two, two sites) and priority strategic sites to address capacity issues that limit growth. The recommendations if implemented would result in significant cost savings, currently being quantified as a result of consolidation and improved efficiency. A reinvestment of these cost savings would be required to address facility expansion and program enhancement to maximize patient-centered expert care consistently across all of our remaining sites of service.

The Future of Radiation Oncology in the United States From 2010 to 2020: Will Supply Keep Pace With Demand?

Prior studies forecasted an incipient shortage of medical oncologists as a result of the aging US population, but the radiation oncology workforce has not been studied. Accordingly, we projected demand for radiation therapy and supply of radiation oncologists in 2010 and 2020 to determine whether a similar shortage may exist for this specialty. Demand for radiation therapy in 2010 and 2020 was estimated by multiplying current radiation utilization rates (as calculated with Surveillance, Epidemiology, and End Results data) by population projections from the Census Bureau. Supply of radiation oncologists was projected using data from the American Board of Radiology inclusive of current radiation oncologists and active residents, accounting for variation in full-time equivalent status and expected survival by age and sex. Between 2010 and 2020, the total number of patients receiving radiation therapy during their initial treatment course is expected to increase by 22%, from 470,000 per year to 575,000 per year. In contrast, assuming that the current graduation rate of 140 residents per year remains constant, the number of full-time equivalent radiation oncologists is expected to increase by only 2%, from 3,943 to 4,022. The size of residency training classes for the years 2014 to 2019 would have to double to 280 residents per year in order for growth in supply of radiation oncologists to equal expected growth in demand. Demand for radiation therapy is expected to grow 10 times faster than supply between 2010 and 2020. Research is needed to explore strategies to enhance capacity to deliver quality radiation therapy despite increased patient loads.

Japanese Structure Survey of Radiation Oncology in 2005 Based on Institutional Stratification of Patterns of Care Study

To evaluate the structure of radiation oncology in Japan in terms of equipment, personnel, patient load, and geographic distribution to identify and improve any deficiencies. A questionnaire-based national structure survey was conducted between March 2006 and February 2007 by the Japanese Society of Therapeutic Radiology and Oncology. These data were analyzed in terms of the institutional stratification of the Patterns of Care Study. The total numbers of new cancer patients and total cancer patients (new and repeat) treated with radiotherapy in 2005 were estimated at approximately 162,000 and 198,000, respectively. In actual use were 765 linear accelerators, 11 telecobalt machines, 48 GammaKnife machines, 64 60Co remote-controlled after-loading systems, and 119 192Ir remote-controlled after-loading systems. The linear accelerator systems used dual-energy function in 498 systems (65%), three-dimensional conformal radiotherapy in 462 (60%), and intensity-modulated radiotherapy in 170 (22%). There were 426 Japanese Society of Therapeutic Radiology and Oncology-certified radiation oncologists, 774 full-time equivalent radiation oncologists, 117 medical physicists, and 1,635 radiation therapists. Geographically, a significant variation was found in the use of radiotherapy, from 0.9 to 2.1 patients/1,000 population. The annual patient load/FTE radiation oncologist was 247, exceeding the Blue Book guidelines level. Patterns of Care Study stratification can clearly discriminate the maturity of structures according to their academic nature and caseload. The Japanese structure has clearly improved during the past 15 years in terms of equipment and its use, although the shortage of manpower and variations in maturity disclosed by this Patterns of Care Study stratification remain problematic. These constitute the targets for nationwide improvement in quality assurance and quality control.

Radical external beam radiotherapy for prostate cancer in Japan: preliminary results of the changing trends in the Patterns of Care process survey between 1996-1998 and 1999-2001.

To report the preliminary results of a study to delineate the changing trends in radical external beam radiotherapy usage for prostate cancer between the 1996-1998 and 1999-2001 survey periods in Japan. The 1996-1998 Patterns of Care Study (PCS) and the 1999-2001 PCS in Japan reviewed the detailed information on 694 patients with prostate cancer treated with radiotherapy. Of them, 298 patients with clinically localized prostate cancer treated with radical external beam radiotherapy in A1 and B1 institutions were selected for analysis (1996-1998 PCS, 117 patients; 1999-2001 PCS, 181 patients). High-risk prostate cancer (defined as T3-T4 tumors, a pretreatment prostate-specific antigen level >20 ng/ml, and/or poorly differentiated adenocarcinoma) was diagnosed in 82.1% of the patients in the 1996-1998 PCS and in significantly less (70.2%) of those in the 1999-2001 PCS (P = 0.021). Moreover, significantly earlier T stages (T1-T2: 49.7%) and more well-differentiated tumors (24.7%) were found between 1999 and 2001 than between 1996 and 1998 (T1-T2: 31.9%, well-differentiated tumors: 13.9%). Although only 6.1% of patients were treated with radiotherapy by patient's choice in 1996-1998, a larger proportion (32.2%) chose this treatment in 1999-2001. The median radiation dose was 65.0 Gy (range, 24-74 Gy) in 1996-1998 and increased to 69 Gy (range, 14-80 Gy) in 1999-2001. The percentage of radiation doses <60 Gy was 20.5% in 1996-1998 but only 2.2% in 1999-2001. Moreover, the incidence of treatment with total doses of > or =70 Gy was higher in 1999-2001 (43.9%) than in 1996-1998 (19.7%). These increased radiation doses were predominantly observed in B1 institutions. Although the usage of > or =10 MV was significantly increased in 1999-2001 (82.0%) compared with that in 1996-1998 (65.8%), conformal therapy administered to 52.1% of patients in 1996-1998 was almost the same (55.8%) in 1999-2001. The median number of full-time equivalent (FTE) radiation oncologists (2.4 in A1 institutions and only 0.6 in B1 institutions) in 1996-1998 increased slightly in 1999-2001 (2.7 in A1 institutions, 0.7 in B1 institutions), but remained low in B1 institutions. In Japan, there is a trend to fewer high-risk prostate cancer patients being treated with radical external beam radiotherapy. An increasing percentage of patients chose radiotherapy and also increased radiation doses, which might reflect the growing acceptance of radical external beam radiotherapy as a treatment of choice for prostate cancer in Japan. Therefore, to optimize delivery of radiotherapy, more advanced equipment and more FTE radiation oncologists are warranted.

Radiation oncology in Australia: workforce, workloads and equipment 1986-1999.

Regular national surveys of all public and private radiation oncology facilities in Australia have been carried out between 1986 and 1999. Workforce data recorded were numbers of radiation oncologists and trainees, radiation therapists, medical physicists and physics technicians, nursing staff, data managers, social workers and clerical staff. Workloads included treatments with megavoltage beams (linear accelerators, cobalt-60), orthovoltage/superficial X-rays, brachytherapy, total body irradiation and stereotactic radiosurgery. Major equipment recorded included numbers of megavoltage and orthovoltage/superficial X-ray machines, planning simulators, computerized dosimetry systems and brachytherapy equipment. The use of radiotherapy beds and the public-private mix of treatments were also documented. Data were assembled for Australia based on each individual state. Within Australia the number of public and private treatment facilities has increased by 44% from 18 in 1986 to 26 in 1999. The population has increased by 16.4%, cancer incidence by 51.8% and megavoltage workloads (fields) by 102%. The number of radiation therapists and physicists and the number of linear accelerators have, in general, increased with the growth in workloads. The number of radiation oncologists has increased by 60% from 4.5 full-time equivalent (FTE) radiation oncologists per million population in 1986 to 7.2 per million in 1999. There is currently a deficit of at least 40 radiation oncologists to be able to treat the 50% of newly diagnosed cancer patients requiring radiotherapy. In addition, a significant deficiency exists in numbers of radiation therapists, nursing staff, data managers, social workers and clerical staff. Clearly the demands for medical physicists has increased but the data are insufficient to comment on deficiencies. Despite the increases in workloads the proportion of patients with cancer receiving radiotherapy remains below 40%. A positive correlation has been shown between the proportion of newly diagnosed cancer patients treated and the number of FTE radiation oncologists, the number of megavoltage machines and number of radiation therapists. This was shown for Australia as a whole, for each state and for the years 1986 to 1999. This was also the case when total megavoltage fields was used as the dependent variable. Multiple regression analysis using the same independent variables confirmed these positive correlations. It is concluded that the low treatment rate with radiation oncology for cancer patients in Australia is due mainly to the lack of resource allocation. The stated commitment of governments and health departments to a 50% treatment rate can only become a reality if there is a concerted effort to increase the numbers of radiation oncologists, radiation therapists, megavoltage machines and support staff. Otherwise at least one in every 10 newly diagnosed cancer patients will continue to be denied adequate and equitable access to radiotherapy - in 1999 that total figure was 9400 persons.

The future demand for and structural problems of Japanese radiotherapy.

Recently, as the number of elderly people in Japan is growing, so is the number of new cancer cases. The number of patients treated with radiotherapy is therefore also on the increase, so that it is important to estimate the future demand for radiotherapy and to make preparations for it. All the surveys were conducted for 106 facilities selected randomly out of 556 radiotherapy facilities in Japan. To obtain trends in the number of new cancer patients treated with radiotherapy in Japan, we conducted a survey with a self-administered mail questionnaire designed to obtain the number of new patients treated with radiotherapy for each year of the past decade (1990-99). The future number of new patients treated with radiotherapy was estimated from the data thus obtained. To investigate structural problems of Japanese radiotherapy, surveys about the number of treatment machines and full-time equivalent (FTE) radiation oncologists were conducted according to data from the Japanese Society for Therapeutic Radiology and Oncology (JASTRO) structure survey and the Patterns of Care Study (PCS). We also compared the structure of Japanese radiotherapy with that in the USA. The number of patients treated with radiotherapy has increased for every institutional stratum, with an overall increase of 1.4-fold over the past 10 years in Japan. It is estimated that the number of cancer patients treated with radiotherapy will reach 190 000 in 2015. In Japanese non-academic institutions, less than one FTE radiation oncologist has been managing many of these patients. In both equipment and manpower, academic institutions exceed nonacademic institutions. The future demand for Japanese radiotherapy will grow substantially, so that it is of vital importance to prepare for it. Specifically, the number of FTE radiation oncologists must be increased.