Number Of Radiation Oncologists Research Articles

Stereotactic Radiotherapy Deserts are Under-Represented among Radiation Oncology Alternative Payment Model Sites

In bundled payment models including the proposed Radiation Oncology Alternative Payment Model (RO-APM), reimbursement favors shorter treatment paradigms like stereotactic radiotherapy (SRT). However, SRT requires specialized equipment, staff, and quality assurance procedures not available across the US. To understand the geospatial distribution of SRT and its impact on bundled payment models, we investigated the interplay between SRT resources with sociodemographic characteristics and oncologic outcomes for an index site of prostate cancer (PC). We constructed an ecologic study model using data from the HRSA Area Health Resources, AMA Physician Masterfile, USDA Agriculture Economic Research Service, Medicare Provider and Service Files, and NIH Cancer State Profiles. SRT use was operationalized as the presence of Medicare SRT billing codes. Sociodemographic variables included county racial distributions, %poverty, and rural vs. urban classification. Provider to patient at risk density (PPRD) was defined as number of radiation oncologists per 100,000 males ≥65 years. PC incidence and death rates were evaluated. Uni- and multivariable logistic regressions examined links between SRT use, proposed RO-APM status, PPRD, sociodemographic variables, and PC oncologic outcomes at the US county level. All listed statistics demonstrated p <0.05. SRT use was identified in 13% of all 3140 counties and in 49% of counties with documented RO providers. In univariable analyses, odds of SRT use was higher in counties that were metro [odds ratio (OR) 19.9] and with higher %Black constituents (OR 6.95); odds decreased with higher %poverty (OR 0.92). Among counties with RO providers, odds of SRT use increased with higher PPRD (OR 1.01). Odds of SRT use was associated with higher PC incidence (1.01) but lower death rates (OR 0.99). SRT use was more common in participating RO-APM counties (OR 2.66); moreover, magnitude and direction of associations between sociodemographic variables and RO-APM participation were similar to those for SRT use. In multivariable analysis, SRT use remained significantly associated with metro status, %Black constituents, PPRD, and PC death rates. Both SRT use and proposed RO-APM participation were most prevalent in metro counties with higher PPRD and %Black populations, likely reflecting presence of densely populated cities with high health resources. If SRT is incentivized in future reimbursement models, then rural, lower resource communities without SRT may be disadvantaged. Lack of association between SRT and PC incidence indicates the presence of "SRT deserts"-counties with high oncologic need but no SRT. To enable visualization of SRT deserts and encourage interventions aimed at reducing disparities in SRT access, our results will be included in an interactive web platform (bit.ly/density maps).

Recent Trends of Medical Expenses Associated with Radiation Therapy in Korea Based on HIRA Big Data.

We aimed to determine the trends in the use of radiotherapy (RT) and the expenses associated with it in South Korea. The statistical data of the claims and reimbursement records provided on the Health and Insurance Review and Assessment Service website were utilized. This included information such as the number of patients, fractions, medical expenses according to treatment codes, in/outpatient, sex, age, and regions of hospitals. We analyzed data from 2016 to 2020. With a growing RT infrastructure and an increase in the number of radiation oncologists, the expenses for RT were 605.5 million USD in 2020, which had increased 1.5 times from 394.7 million USD in 2016. This growth was mainly because of the increased usage of advanced RT techniques. Furthermore, the proportion of intensity-modulated radiation therapy (IMRT) expenses in the total expenses increased by 1.6 times from 48.8% in 2016 to 76.9% in 2020. Advanced techniques were used more commonly in older individuals or children. However, the proportion of IMRT expenses increased mostly in young women. Additionally, geographical differences in RT use and expense were observed, although the gap in the IMRT fractions decreased among the regions. Recent medical expenses associated with RT in Korea have increased in tandem with technological advances and changes in demographics.

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.

Quantitative Analysis of Practice Size Consolidation in Radiation Oncology: A Trend Toward Bigger and Fewer Practices

PurposeThere is evidence of practice consolidation in US health care in recent years. To our knowledge, a detailed quantitative study of recent changes in radiation oncology practice size has not been performed. We aim to evaluate radiation oncology practice size changes between 2012 and 2020 in the United States. Materials and MethodsUsing the Medicare Physician Compare Database, we identified practices employing radiation oncologists using their taxpayer identification number and individual radiation oncologists using their national provider identifier. We grouped individual radiation oncologists into categories by practice size (which includes the number of physicians of all specialties) and compared the number of radiation oncologists in each category between 2012 and 2020. Further analyses by US geographic census region, single-specialty practice, academic practice, and high- and low-population density areas were performed. ResultsBetween 2012 and 2020, the total number of practicing radiation oncologists increased by 9%, and the number of practices employing radiation oncologists decreased by 11.5%. The number of radiation oncologists in practices of size 1 to 2, 3 to 9, 10 to 24, and 25 to 49 decreased by 3.7%, 4.7%, 4.9%, and 2%, respectively, and the number of radiation oncologists in practices of size 50 to 99, 100 to 499, and 500+ increased by 1.4%, 2.1%, and 11.8%, respectively (all 500+ practices are multispecialty groups). The increase in practice size was significant in all regions, for single-specialty and multispecialty practices, academic and nonacademic practices, and for practices in high-, middle-, and low-population density areas (P < .05 for all comparisons). The proportion of single-specialty practices has decreased significantly (P < .001), and the proportion of academic practices increased significantly (P = .004). Additionally, the proportion of practices and physicians in high- and low-population density regions remained stable during this period (P > .05). ConclusionsOur analysis suggests that practice size consolidation has occurred within the US radiation oncology workforce from 2012 to 2020. The impact of this consolidation on quality, cost, and patient access deserves further attention.

Fostering Radiation Oncology Physician Scientist Trainees Within a Diverse Workforce: The Radiation Oncology Research Scholar Track

There is a need to foster future generations of radiation oncology physician scientists, but the number of radiation oncologists with sufficient education, training, and funding to make transformative discoveries is relatively small. A large number of MD/PhD graduates have entered he field of radiation oncology over the past 2 decades, but this has not led to a significant cohort of externally funded physician scientists. Because radiation oncologists leading independent research labs have the potential to make transformative discoveries that advance our field and positively affect patients with cancer, we created the Duke Radiation Oncology Research Scholar (RORS) Program. In crafting this program, we sought to eliminate barriers preventing radiation oncology trainees from becoming independent physician scientists. The RORS program integrates the existing American Board of Radiology Holman Pathway with a 2-year post-graduate medical education instructor position with 80% research effort at the same institution. We use a separate match for RORS and traditional residency pathways, which we hope will increase the diversity of our residency program. Since the inception of the RORS program, we have matched 2 trainees into our program. We encourage other radiation oncology residency programs at peer institutions to consider this training pathway as a means to foster the development of independent physician scientists and a diverse workforce in radiation oncology.

The Evaluation of Oncological Hyperthermia Centers and Turkey Modeling Oncological Hyperthermia Centers and Turkey Modeling

Introduction and Objectives: The latest technology and current treatments are used in the treatment of cancer in Turkey; however, oncological hyperthermia devices are currently not available. This study aimed to demonstrate the necessity of oncological hyperthermia devices in Turkey where cancer treatment is performed effectively. In this direction, some important oncological hyperthermia centers have been examined to what kind of planning can be developed in this country. Materials and Methods: The data were collected regarding the number of patients who had undergone hyperthermia during the treatment of cancer and the distribution of oncological diagnoses, devices per population, and rate of hyperthermia use. Subsequently, a model was prepared for Turkey, and an evaluation was performed on the number of cancer patients that can be applied to this treatment and the need for the number of oncological hyperthermia devices. Results: According to the data obtained, an average of 375 patients are treated annually per hyperthermia device in relevant centers. When a similar projection is applied for Turkey, hyperthermia treatment can be applied to an average of 400 patients annually with 0.18 hyperthermia devices per one million population. According to this result, considering the population and the annual cancer diagnosis rates, it is predicted that 13 deep regional hyperthermia devices are required across the country. Conclusion: The presence of deep regional hyperthermia devices in comprehensive oncology centers plays an effective role in oncological treatment with modern radiotherapy devices. This condition along with the sufficient number of radiation oncologists will significantly benefit the capacity to provide oncological treatment options holistically.

Radiotherapy in the Caribbean: a spotlight on the human resource and equipment challenges among CARICOM nations

BackgroundThere is limited data on access to radiotherapy services for CARICOM nations.MethodsThis was a descriptive mixed-methods observational study which used data collected via survey from staff working in Radiation Oncology in 14 CARICOM countries. Benchmark recommendations from the International Atomic Energy Agency were compared to existing numbers. The Directory of Radiotherapy Centers, World Bank, and Global Cancer Observatory databases were all accessed to provide information on radiotherapy machines in the region, population statistics, and cancer incidence data respectively. Both population and cancer incidence-based analyses were undertaken to facilitate an exhaustive review.ResultsRadiotherapy machines were present in only 50% of the countries. Brachytherapy services were performed in only six countries (42.9%).There were a total of 15 external beam machines, 22 radiation oncologists, 22 medical physicists, and 60 radiation therapists across all nations.Utilizing patient-based data, the requirement for machines, radiation oncologists, medical physicists, and radiation therapists was 40, 66, 44, and 106, respectively. Only four (28.6%) countries had sufficient radiation oncologists. Five (35.7%) countries had enough medical physicists and radiation therapists.Utilizing population-based data, the necessary number of machines, radiation oncologists, and medical physicists was 105, 186, and 96 respectively. Only one county (7.1%) had an adequate number of radiation oncologists. The number of medical physicists was sufficient in just three countries (21.4%). There were no International Atomic Energy Agency population guidelines for assessing radiation therapists.A lower economic index was associated with a larger patient/population to machine ratio. Consequentially, Haiti had the most significant challenge with staffing and equipment requirements, when compared to all other countries, regardless of the evaluative criteria. Depending on the mode of assessment, Haiti’s individual needs accounted for 37.5% (patient-based) to 59.0% (population-based) of required machines, 40.1% (patient-based) to 59.7% (population-based) of needed radiation oncologists, 38.6% (patient-based) to 58.3% (population-based) of medical physicists, and 42.5% (patient-based) of radiation therapists.ConclusionThere are severe deficiencies in radiotherapy services among CARICOM nations. Regardless of the method of comparative analysis, the current allocation of equipment and staffing scarcely meets 50% of regional requirements.

Current radiologist workload and the shortages in Japan: how many full-time radiologists are required?

To clarify the workload of certified radiologists and to estimate the current manpower shortages in Japan. We conducted a questionnaire survey for accredited training institutions. The contents included the radiologist employment pattern (full vs. part time), the number of computed tomography (CT) and magnetic resonance imaging (MRI) examinations and their radiology reports, the number of radiation therapy planning sessions, and the time per week spent for each work activity. We also used the hospital survey reports of Japan's Ministry of Health, Labor, and Welfare in our analyses. The estimated numbers of CT and MRI interpretation reports and radiation treatment plans that one full-time radiologist could complete within 1 hospital day (8h) were 19.9 and 1.22, respectively. To complete all CT and MRI reports, at least 2.09 times more full-time diagnostic radiologists are needed in Japan. For radiation therapy, at least 1.23 times more full-time radiation oncologists are necessary at large- and medium-scale hospitals, although the number of radiation oncologists needed in Japan is balanced to the current number. The number of full-time certified diagnostic radiologists for CT and MRI interpretation in Japan is insufficient. Centralized radiation therapy facilities may be more efficient for meeting the increasing demand.

Survey of Advanced Radiation Technologies Used at Designated Cancer Care Hospitals in Japan

Our survey assessed the use of advanced radiotherapy technologies at the designated cancer care hospitals in Japan, and we identified several issues to be addressed. We collected the data of 397 designated cancer care hospitals, including information on staffing in the department of radiation oncology (e.g. radiation oncologists, medical physicists and radiation therapists), the number of linear accelerators and the implementation of advanced radiotherapy technologies from the Center for Cancer Control and Information Services of the National Cancer Center, Japan. Only 53% prefectural designated cancer care hospitals and 16% regional designated cancer care hospitals have implemented intensity-modulated radiotherapy for head and neck cancers, and 62% prefectural designated cancer care hospitals and 23% regional designated cancer care hospitals use intensity-modulated radiotherapy for prostate cancer. Seventy-four percent prefectural designated cancer care hospitals and 40% regional designated cancer care hospitals employ stereotactic body radiotherapy for lung cancer. Our multivariate analysis of prefectural designated cancer care hospitals which satisfy the institute's qualifications for advanced technologies revealed the number of radiation oncologists (P = 0.01) and that of radiation therapists (P = 0.003) were significantly correlated with the implementation of intensity-modulated radiotherapy for prostate cancer, and the number of radiation oncologists (P = 0.02) was correlated with the implementation of stereotactic body radiotherapy. There was a trend to correlate the number of medical physicists with the implementation of stereotactic body radiotherapy (P = 0.07). Only 175 (51%) regional designated cancer care hospitals satisfy the institute's qualification of stereotactic body radiotherapy and 76 (22%) satisfy that of intensity-modulated radiotherapy. Seventeen percent prefectural designated cancer care hospitals and 13% regional designated cancer care hospitals had a quality assurance committee. The numbers of radiation oncologists and other operating staff might be essential factors in the implementation of advanced radiotherapy technologies. Small proportions of regional designated cancer care hospitals satisfy the institute's qualifications of advanced technologies.

Observatoire national de la radiothérapie : rapport de l’enquête conduite en 2008 sur l’année 2007

For the second year, the French Radiotherapy Database presents information from French radiation oncology centers. Among 179 centers, 159 have participated (90 %). The number of accelerators increased from 371 to 384 between 2006 and 2007, 11 % of these machines are more than 15 years old. On average, centers are open 50 hours per week for treatment and 9.5 % more for maintenance. The lack of dedicated CT remains a difficulty: 158 from 159 centers have an access to a CT, but only 50 % have a dedicated scanner. There is no progress compared to 2006. The proportion of centers having a MU double calculation system has increased from 51 to 58 %. Two thirds of centers do not implement in vivo dosimetry. The activity is stable around 190 000 treatments per year. Three-dimension conformal radiotherapy is used for more than half of treatments in 77.2 % of private centers and 50 % of public hospitals. Intensity modulated radiotherapy remains rarely used. The number of radiation oncologists and technologists remains stable. The number of radiophysicists has increased from 7.6 %. Despite some progress, the difficulties of this speciality persist in France and are equally distributed across all regions, and between private and public centers. In 2009, the French Society for Radiation Oncology and the associated partners will continue this survey, which interest is recognized by both professionals and health administrations.

Number of Radiation Oncologists in Korea, Adequate or Surplus?

The purpose of this research is to discern and address the issues related to the radiation oncology manpower supply and its distribution. The statistical data of the Annual Report of the Korea Central Cancer Registry (KCCR) from 1997 to 2002 and the Annual Report of the Korean Society of Radiation Oncology (KOSTRO) from 1997 to 2004 were used to predict the status of the human resources in 2015. The estimated demand and supply were calculated with the Microsoft Excel program (Microsoft, Redmond, WA). The demand for radiation oncologists is estimated to be 161 in 2015 and about 4.9 radiation oncologists will be in demand annually. In contrast, an average of 15 new radiation oncologists will be supplied annually so that the accumulated surplus of radiation oncologists until 2015 is estimated to be 74.1. The main reason for the surplus comes from the discrepancy between the increased number of radiation therapy patients and the need for radiation oncologists. When there is an increase of 1,000 radiation therapy patients, the demand for radiation oncologists increases only by 2.4. This phenomenon is especially evident in the top 10 hospitals where the average number of radiation therapy patients per radiation oncologist is 341, which is 58% higher than the average number (215) of other 46 hospitals. To prevent a surplus and to maintain the quality of management, the number of radiation therapy patients per radiation oncologist should be limited. Furthermore, coordinate control of the number of residency positions should be seriously considered.

Variations in treatment for ductal carcinoma in situ in elderly women.

The objective of this study is to quantify variation and variability in treatment of ductal carcinoma in situ (DCIS) over time and across registries of the Surveillance, Epidemiology, and End Results (SEER) program; to assess diffusion of treatments (breast-conserving surgery [BCS], BCS with radiotherapy, and mastectomy); and to identify correlates of treatment choice. The linked SEER-Medicare database from 1991 to 1996 includes 2701 women aged 65 and older diagnosed with unilateral DCIS. 1990 census data provide socioeconomic variables at the zip-code level, and the 1999 Dartmouth Atlas of Health Care provides number of radiation oncologists. Bivariate and multivariate analyses of retrospective cohort data assess factors that explain treatment choice. The multivariate model includes controls for comorbidity, marital status, age, race, education, poverty, rural, and radiation oncologists per 100,000 population. Chi-squared tests assess differences in treatment rates by registry and by year. Diffusion of treatments is analyzed by predicting yearly mean treatment rates and yearly variation in treatment rates across geographic areas and over time. There are significant geographic and temporal differences in treatment rates for DCIS with increasing use of BCS alone. Treatment choice is explained by SEER registry, diagnosis year, marital status, race, age, urban/rural status, educational attainment, and number of radiation oncologists. Variability in treatment of DCIS is increasing during the study period. Findings indicate that diagnosis year and socioeconomic factors explain treatment choice for DCIS, but unexplained variation at the geographic-region level remains. Increasing variability in treatment implies continued uncertainty about optimal treatment of DCIS.

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.

Projected requirements for radiation oncologists and trainees in Australia and New Zealand to 2007

Workloads in radiation oncology facilities in Australia and New Zealand have been increasing steadily for many years and it is anticipated that this trend will continue. In the present paper the projected number of radiation oncologists required to meet this demand to the year 2007 are estimated, along with the number of trainees required. The estimates are based on data from regular surveys by the Royal Australian and New Zealand College of Radiologists (RANZCR) for the years 1988-97 (inclusive). From these surveys profiles of numbers, age and gender of specialists and trainees are documented together with increases from the training programme and losses from retirement. It is concluded that if the current trainee numbers are increased by 12 in Australia and two in New Zealand, there will be approximately 10 radiation oncologists per million of population by the year 2007. This number is considered appropriate considering the anticipated increase in demands and complexity of treatment. Because projections too far forward are unreliable, careful monitoring of progress is essential to obtain the appropriate balance between requirement and supply. Comparisons are made with other estimates of needs including the 1998 Australian Medical Workforce Advisory Committee (AMWAC) Report and the New Zealand Clinical Agency Workforce Project Report in 1997.

The manpower crisis facing radiation oncology

Data from several sources document that the number of radiation oncologists being trained is substantially above the number projected as recently as 1983. This paper addresses the manpower crisis facing radiation oncology and includes information on the supply of and need for specialists, as well as possible courses of action given current circumstances.