Canadian Radiation Oncologists Research Articles

Pan-Canadian Survey of Radiation Oncology Professional Involvement in Global Oncology Initiatives in Low- and Middle-Income Countries.

Canadian radiation oncology professionals have a strong history of involvement in global oncology initiatives worldwide. This pan-Canadian survey-based study was conducted to determine the current level of engagement of Canadian radiation oncologists (ROs) and medical physicists (MPs) in global oncology initiatives and broaden the development of these activities. This was a cross-sectional study. The survey was designed to characterize current levels of engagement of Canadian ROs and MPs in global oncology initiatives. The survey was open from March 2019 to April 2020. It was disseminated to all Canadian Association of Radiation Oncology and Canadian Organization of Medical Physicists members with two subsequent email reminders. Survey responses were received from 40 (93%) of the 43 Canadian cancer treatment centers that offer radiotherapy. At least one RO responded at 34 centers (79%) and one MP from 34 centers (79%) with some overlap. A response was received from a total of 93 participants, 47 ROs and 46 MPs. Of all survey participants, 58% reported some experience with global oncology. Nineteen percent of the participants surveyed were currently directly involved in short- or long-term projects, more than half of which have opportunity for additional staff involvement. The projects spanned 26 countries in South America, Africa, and Asia. Quality improvement and capacity building accounted for 27% and 20% of initiatives, respectively. The most common area of engagement was in direct treatment care, accounting for 56% of the projects. This study demonstrates the landscape of involvement of Canadian ROs and MPs in global oncology initiatives. The study also highlights areas of opportunity for broadening international participation and collaboration as it relates to global oncology for Canadian radiation oncology professionals.

Continuing Professional Development for Radiation Oncologists: Where are the Gaps and Barriers?

Continuing professional development (CPD) involves continuing medical education (CME), as well as educational activities to enhance research, teaching and leadership skills. Although CPD has been well explored in other specialties, the literature pertaining to radiation oncology is lacking. We sought to evaluate current CPD practices of radiation oncologists (RO) and identify unmet needs and barriers. An online survey on CPD was developed in English and French, approved by ethics board, and emailed to all RO departments across Canada. Respondents' current practices, preferences, barriers, and needs were explored across the CPD domains of CME, research, teaching and administrative skills. One-hundred twenty-four radiation oncologists completed the survey with representation across all listed disease sites and provinces. Respondents had an average 13.6 years of experience as staff (6 months to 38 years) and 96% were affiliated with a university. ROs indicated the most helpful resources for CME were reading journal articles (27%), attending tumor boards (25%), conferences (19%), informal discussion with colleagues (11%), free online websites (e.g., NCCN) (4%) and Twitter (3.5%). Lack of time was unanimously regarded as a barrier for CME. Other barriers included growing clinical workloads, expanding literature, and a lack of renumeration for CME. The mean score was 3.5/5, between "neutral" and "satisfied" for "satisfaction that CME needs are met" on a 5-point Likert scale. Seventy-six percent of respondents are currently engaged in research, with 46% involved as a research supervisor. However, only 35% had protected time for research (ranging from 10-80% FTE). Time (89%), funding (63%) and human resources (63%) were cited as barriers. Respondents wanted to improve skills in statistical analysis, clinical trial design and grant writing. Most researchers (78%) were comfortable with quantitative methodologies. Conversely, only 35% were comfortable with qualitative methods. Nearly all respondents (98%) were involved with clinical teaching. While the majority of respondents were satisfied with their teaching ability, many wanted to improve skills in coaching, providing feedback and delivering lectures. The preferred learning formats for improving these skills were either workshops at conferences or online. Half of the respondents are currently in an administrative/leadership role, and of those that are not, only 30% were interested in pursuing future leadership positions. The main barriers cited were time and the experience required. Overall satisfaction scores for current CME practices were mediocre amongst Canadian radiation oncologists - a group that is mostly in university-affiliated/academic practices with 98% involved in clinical teaching. There are notable barriers and unmet needs in research, teaching and administration - highlighting potential areas for future CPD initiatives in radiation oncology.

Patient engagement in CPD in radiation oncology and radiation therapy across Canada: A national survey

BackgroundThe aim of this study was to investigate patient engagement (PE) in the development and delivery of Continuing Professional Development (CPD) programs for health care providers within radiation oncology, radiation therapy and medical physics across Canada. This study looked at the current state of PE in CPD programs across Canada and how to address the benefits and barriers to PE to advance these programs. MethodsA quantitative, exploratory survey was conducted among radiation oncologists, radiation therapists and medical physicists across Canada. The questionnaire was developed by a multi-disciplinary team and piloted among interprofessional (IP) faculty with a special interest in patient education. The survey was web-based and disseminated through the Canadian Association of Medical Radiation Technologists (CAMRT) and Canadian Radiation Oncologists (CARO) professional associations. ResultsA total of 97 responses were obtained, 43.3% (n = 41) were radiation oncologists 64% (n = 54) were radiation therapists and 2(2%) were medical physicists. There was representation from all provinces, except Newfoundland, with the majority 36% (n = 35) from Ontario. 57% (n = 46) of participants agreed that patients should be involved in CPD, and 11% (n = 9) disagreed. The most agreed-upon barriers are financial costs for patients and clinician bias when selecting patients. The most agreed-upon solutions were improving patient resources and creating training programs for patients. Radiation therapists agreed significantly more (p<0.05) with the potential benefits of PE in CPD, compared to radiation oncologists. DiscussionPE in CPD programs is a novel and controversial topic but is still highly rated and important. We intend to advocate for patients to take an active role in our CPD programs. Further research is warranted.

221 Survey on the Structure of Inpatient Care Provided by Radiation Oncologists in Canada

221 Survey on the Structure of Inpatient Care Provided by Radiation Oncologists in Canada

Supply and Demand for Radiation Oncologists in Canada: Workforce Planning Projections From 2020 to 2040

The number of Canadians diagnosed with cancer, and subsequent demand for radiation therapy, are expected to increase over time. This study aimed to update our needs-based workforce planning model to ensure appropriate staffing levels in the future. The supply of radiation oncologists, by age group, sex, and full-time equivalent status, was projected from 2020 to 2040 using a recursive-aging, input-output model developed with seeding parameters derived from national sources. The demand for radiation oncologists until 2040 was estimated using referral patterns for radiation therapy and consultation workload metrics applied to projected annual cancer incident cases to calculate required full-time equivalent positions. Baseline model parameters were also applied to the 2005-2019 workforce and incident case data to evaluate preprojection supply and demand trends. Preprojection trends for 2005 to 2019 revealed accelerated staffing growth that transitioned from a workforce shortage to a surplus state in 2014 followed by substantial growth slowdown in 2016. The model predicts a transient surplus of radiation oncologists until 2026 followed by a projected deficit in subsequent years. Sensitivity analyses using the plausible range for each parameter continued to favor an undersupply, suggesting a trainee shortage unable to meet workforce expansion needs. Considering possible future declining trends in radiotherapy utilization and workload, calculations to inform corrective efforts in resident numbers resulted in 25 entry positions per year, up from 21 per year currently. Geographic distribution of trainees, relative to workforce and cancer incidence distributions, could be improved with more residency positions in Canadian regions outside Ontario. Demand for radiation therapy and radiation oncologists in Canada are expected to grow more quickly than future expansion in staffing levels. Our workforce planning model provides evidence for more trainee requirements to inform stakeholders of possible corrective actions to training programs and recruitment. Further research is needed to explore additional strategies to expand capacity and high-quality delivery of radiation therapy to meet the foreseeable increase in Canadian patients with cancer.

Perceptions of Canadian Radiation Oncologists, Medical Physicists, and Radiation Trainees about the Feasibility and Need of Boron Neutron Capture Therapy (BNCT) in Canada: A National Survey.

Boron Neutron Capture Therapy (BNCT) is an emerging radiotherapy. There are ongoing efforts to develop a Canadian accelerator-based BNCT center. However, it remains unclear how Canadian radiation oncologists (RO), medical physicists (MP), and their trainees perceive BNCT and its impact on radiation oncology as a discipline. A survey was created to explore the knowledge of BNCT, its clinical role, and the support for Canadian research. It was distributed through the Canadian Association of Radiation Oncology (CARO) and the Canadian Organization of Medical Physicists (COMP). We received 118 valid responses from all 10 provinces, from 70 RO (59.3%) and 48 MP (40.7%), including 9 residents. Most knew of BNCT and its indications (60.2%). Although many were unaware of the reasons behind early failures (44.1%), common reasons were a lack of clinical trials and an inaccessibility of neutron sources (42.4%) as well as reactor unsuitability (34.7%). Additionally, 90.6% showed definite (66.9%) or possible (23.7%) support for Canadian BNCT research, while 89% indicated a definite (56.8%) or possible (32.2%) willingness for BNCT referrals. Most ROs and MPs supported Canadian BNCT research and would refer patients. However, limited awareness and a lack of experiences remain a challenge. Educational sessions are needed to realize this innovative cancer treatment in Canada.

The Impact of Parent and Family Caregiver Roles Among Canadian Radiation Oncologists

Working parents, and a rising number of adults delivering care for aging relatives, experience numerous challenges in their personal, family, professional, and financial lives owing to multiple responsibilities. This study describes the experiences of Canadian radiation oncologist (RO) parents and family caregivers, reporting challenges that may exist in providing family care with clinical and academic work commitments. Canadian ROs, via RO heads of departments in cancer centers across Canada, and physician members of the Canadian Association of Radiation Oncology were invited to participate in an anonymous online survey between November 2021 and January 2022. The survey focused on demographics, experiences of pregnancy and leave, parenting and adult caregiving responsibilities, and self-care. A total of 103 staff ROs (38%) completed the survey and 78 (75.7%) identified as having a parental (76 [89.7%]) and/or other family caregiver (8 [10.3%]) role; 41% were female and 59% were male, with no difference between genders in the number of children (median, 2; interquartile range, 1-3; P=.17). More female respondents took parental leave for their first child compared with male respondents (mean, 29 vs 6 weeks; P < .001). Of male respondents who started caring for their first child during residency, 27% took parental leave, compared with 77% who started caring for their first child as a staff member (P=.003). The majority of respondents described "always/usually" having collegial support for each pregnancy and parental leave. Both genders described parental responsibilities as negatively affecting attendance at conferences (male, 65%; female, 77%; P=.31) and early or late work-related meetings (male, 76%; female, 79%; P=1.0). More female respondents described parental responsibilities as negatively affecting their career (50% vs 29%; P=.085). Of female respondents, 52% (vs 26% of male respondents; P=.044) identified a physician mentor or positive role model around parenting issues. Parental and other family caregiving responsibilities are not gender unique in Canadian ROs, but competing work and family roles may affect genders differently.

Exploring Caregiver and Parental Roles as Radiation Oncologists in Canada

<h3>Purpose/Objective(s)</h3> Caregiving and parental responsibilities present multiple challenges for physicians including personal, family, professional, and financial. Our objective was to describe the experiences of Canadian radiation oncologists (RO) with caregiving/parental roles and to illustrate challenges that exist, whilst dealing with professional work. <h3>Materials/Methods</h3> An online survey was administered (November – January 2022) to registered staff RO members of the Canadian Association of Radiation Oncology (CARO). The survey consisted of 57 multiple choice and 7 open-ended questions on demographics, parental and other family caregiver roles. Descriptive statistics summarized survey responses and thematic analysis was used to analyze open-ended questions. Qualitative data was analyzed using SAS with Chi-square and Wilcoxon rank sum tests, a two-sided p-value of <0.05 was deemed statistically significant (SS). <h3>Results</h3> Of the 271 CARO members, 103 staff RO responded (38%): 45% female and 55% male. Most participants were <50 years old (78, 76%), Canadian MD graduates (75, 73%) with <15-years of practice (76, 74%). The majority (76%) of respondents identified as having a parental and/or non-parental caregiving role (8%). There was no difference between respondents' gender and number of children (median 2 (range: 1-4), p=0.5). A SS higher proportion of females compared to males took parental leave for each pregnancy, with more females (71%) receiving financial support (employment insurance, employer contribution and/or paid vacation) compared to males (44%) for the 1^st and 2^nd parental leave only. Median duration of parental leave by female's vs males for 1^st and 2^nd child was 26 vs 4 weeks and 22 vs 4 weeks. Half of female respondents (52%) identified as having a positive parent mentor at work compared to 26% of male respondents (p=0.02). A higher proportion of females described having a child negatively impacted their career (50% vs 28%, p=0.06) with similar gender proportions describing attendance at conferences (77% vs 65%, p=0.3) and early/late work meetings (79% vs 76%, p=0.7) affected by having children. Respondents described balancing work-life, dealing with sudden illness of children and bringing children to pre- and post-school activities as examples of daily challenges experienced. Few respondents (8%; 4 females, 4 male) identified having a non-parental caregiving role, with 6 (75%) having both dependent child and adult caregiving roles. Challenges identified in caring for an older adult included taking time off during work hours to attend medical appointments, older adult being unable to drive, and ongoing medical concerns. <h3>Conclusion</h3> Caregiving and parental responsibilities are not gender unique, but competing work and family roles may impact genders differently. Further studies to understand the gender differences and to determine strategies to support and address ongoing challenges of RO's balancing career and family caregiving demands are required.

Canadian Radiation Oncology 2020, Work Engagement and Burnout Survey

<h3>Purpose/Objective(s)</h3> In 2018, the Canadian Medical Association acknowledged that physician health remains a significant threat to the viability of Canada's health care system. The prevalence of burnout among American oncologists was 44% in a 2014 survey. The purpose of this survey was to determine the national prevalence of burnout indicators and report work engagement among Canadian radiation oncologists. <h3>Materials/Methods</h3> Between November 2019 and March 2020 (pre-COVID pandemic), an online questionnaire was distributed electronically to 333 Canadian radiation oncologists across 49 centers through the Stadt lander Canadian Association of Radiation Oncology mailing list. The survey included 62 questions assessing work engagement, and the validated Maslach Burnout Inventory (MBI) burnout scale (22 questions). <h3>Results</h3> 241 of the 333 surveyed Canadian radiation oncologists (72%) completed the questionnaire and were included in this analysis. Responses to the MBI showed that 15% of radiation oncologists met the strict criteria for burnout (i.e., negative scores in all 3 domains: exhaustion, depersonalization, and low accomplishment). Another 60% scored negative in at least one of the three burnout domains. Using the more commonly reported definition of burnout (negative scores in either exhaustion and/or depersonalization), 44% of Canadian radiation oncologists were burnt out. Only 25% had positive scores in all 3 domains and were fully engaged in their work. The full burnout syndrome varied between provinces and was the highest in British Columbia (22%) and lowest in Quebec (3%). The responses to work engagement questions revealed significant concerns regarding inefficiency in workflow (50%), heavy workloads (> 50%), poor work life balance (68%), lack of control over the work environment (47%) and lack of recognition from administrators (45%). 48% perceive the atmosphere at their primary work area as "chaotic and hectic". Within the last 3 years, 41% had considered leaving their institution to work elsewhere and 51% were considering reducing their full-time equivalent (FTE). Reassuringly, 80% reported a sense of overall ability to provide high quality care and a 59% feel they have a supportive network of colleagues and 80% are willing to try something new. The top 4 strategies identified by respondents aimed to improve work-life quality were (1) more support staff at work, (2) more efficient care models, (3) more resources for patients, and (4) lighter workloads for physicians. <h3>Conclusion</h3> Our survey showed that only 25% of Canadian radiation oncologists are fully engaged in their work, whereas 15% met the strict criteria for burnout and 44% met the commonly used burnout criteria. With the rising incidence of cancer and complexity of care, there is an urgent need for system change, leverage enthusiasm to "try something new", and develop appropriate strategies to improve the well-being of the Canadian radiation oncologist workforce

MSOR07 Presentation Time: 10:30 AM: The Canadian Association of Radiation Oncology 2020 Radiation Oncologist Burnout and Work Engagement Survey

Background: The Canadian Medical Association recently acknowledged that physician health remains a significant threat to the viability of Canada's health care system. A 2014 survey reported a 44% prevalence of burnout among American oncologists. The purpose of this survey was to determine the national prevalence of burnout and document work engagement among Canadian radiation oncologists.

Partial Breast Irradiation and Surgical Clip Usage for Tumor Bed Delineation After Breast-Conserving Surgery in Canada: A Radiation Oncology Perspective

PurposeOur purpose was to evaluate the usage and perceived benefit of surgical clips for breast radiation therapy planning in Canada, focusing on partial breast irradiation (PBI) after breast-conserving surgery. Methods and MaterialsA retrospective institutional review identified patients eligible for PBI based on clinicopathologic criteria, and tumor bed visualization was determined from computed tomography-planning scans. An online survey was subsequently distributed to Canadian radiation oncologists addressing the usage and added value of surgical clips for breast radiation therapy planning purposes. The survey also evaluated PBI usage and regimens. Responses were collected over a 4-week period. PBI regimen usage at our institution was also reviewed from May 1 to December 18, 2020. ResultsBased on clinicopathologic criteria, 306 patients were identified between 2013 and 2018 who were eligible for PBI. However, only 24% (72/306) of cases were noted to have surgical clips, of which over 50% did not assist in tumor bed localization due to inconsistent clip positioning. Similarly, nearly two-thirds (28/43) of survey respondents indicated that surgical clips are placed in the tumor bed in less than 50% of cases. Almost all respondents (42/43) indicated that surgical clips facilitate breast radiation therapy planning and favor the development of guidelines to increase the consistent placement of surgical clips in the tumor bed after breast-conserving surgery. Approximately two-thirds of respondents (28/43) offer PBI to eligible patients as routine treatment, with moderate hypofractionated regimens most commonly recommended. However, the 1-week daily regimen of 26 Gy in 5 fractions is now offered to the majority (77%) of patients at our institution. ConclusionsThere was strong agreement among Canadian radiation oncologists that surgical clip placement facilitates breast radiation therapy planning, and most favor the development of surgical guidelines for the consistent placement of surgical clips in this setting. With the growing use of PBI, accurate localization of the tumor bed is extremely important.

Perceptions of Canadian radiation oncologists, radiation physicists, radiation therapists and radiation trainees about the impact of artificial intelligence in radiation oncology – national survey

ContexteL'intelligence artificielle (IA) est en progression constante dans le domaine de la radio-oncologie au Canada et dans le monde. Bien que ce domaine continue d'évoluer, on ne comprend pas bien comment les radio-oncologues, les radiothérapeutes, les physiciens médicaux et les stagiaires en radiothérapie perçoivent l'IA et son impact sur la radio-oncologie en tant que discipline. L'objectif de cette étude était d'étudier la perception de ces quatre groupes professionnels canadiens sur l'IA et la manière dont l'IA affectera la radio-oncologie en tant que spécialité. MéthodologieAprès un examen scientifique approfondi de la littérature existante, un questionnaire à échelle de Likert de 29 questions a été élaboré à l'aide de Google Survey. Le questionnaire a été testé et distribué par des organisations nationales, notamment l'Association canadienne de radio-oncologie (ACRO), l'Association canadienne de radiothérapie médicale (ACTRM) et l'Organisation canadienne des physiciens médicaux (OCPM), d'abord en février, puis entre mars et juin 2020. Les résultats ont été analysés à l'aide de statistiques descriptives. Résultats159 réponses ont été reçues de 10 provinces canadiennes. Les connaissances sur l'IA étaient modérées avec une moyenne de 5/10, mais 91% ont répondu qu'ils étaient intéressés à en savoir plus. Les implications négatives de l'IA étaient liées à la crainte de perdre son emploi et à des changements dans la pratique. La majorité des participants ont convenu que l'IA aurait un impact positif sur le traitement des patients. ConclusionLes professionnels en radio-oncologie estiment que l'IA constituera une part importante du traitement des patients dans leur pratique future. Les craintes relatives à l'IA peuvent être atténuées par des programmes de formation continue sur l'IA, afin d'augmenter le degré de confiance des professionnels et leur acceptation de l'IA.

Behavioral Determinants of Canadian Radiation Oncologists’ Use of Single Fraction Palliative Radiation Therapy for Uncomplicated Bone Metastases

A mainstay therapy for pain relief from uncomplicated bone metastases is external beam radiation therapy. Single fraction radiation therapy (SFRT) is more convenient and cost-effective, causes fewer acute side effects, and is equivalent to multiple fraction radiation therapy for pain relief. Despite these advantages, radiation oncologists seldom prescribe SFRT. To identify the behavioral determinants to Canadian radiation oncologists' use of SFRT for uncomplicated bone metastases. Semistructured interviews were conducted with 38 radiation oncologists from all 10 Canadian provinces. The interview guide and analysis were guided by the Theoretical Domains Framework (TDF). Transcripts were analyzed using a 5-phase thematic content analysis process: coding, generation of belief statements, generation of themes within TDF domains, generation of overarching themes, and classification of themes as barriers or facilitators to SFRT use, or as divergent (a barrier or facilitator depending on the participant). Thirteen overarching themes were identified of which 2 were barriers, 7 were facilitators, and 4 were divergent. The most commonly identified theme was the facilitator "most radiation oncologists are aware of evidence and guidelines on the use SFRT" (n = 38, 100%). The 3 next most reported themes (n = 37, 97.4% ) were (1) "radiation oncologists' use of SFRT can influence their colleagues" use of it (divergent), (2) experience with SFRT can increase its use (facilitator), and (3) SFRT is convenient for patients (facilitator). The most commonly identified barrier (n = 31, 81.6%) was "SFRT is associated with a higher risk of retreatment." Our use of the TDF to explore the behavioral determinants of Canadian radiation oncologists' use of SFRT for uncomplicated bone metastases identified a range of factors that are perceived to encourage and discourage its use. Our results will inform the design of future interventions to increase the use of SFRT.

172: Towards Gender Equality and Equity in Radiation Oncology: Gender Representation Trends in Canadian Trainees and Radiation Oncologists From 1994 to 2019

172: Towards Gender Equality and Equity in Radiation Oncology: Gender Representation Trends in Canadian Trainees and Radiation Oncologists From 1994 to 2019

Re: Do Canadian Radiation Oncologists Consider Geriatric Assessment in the Decision-Making Process for Treatment of Patients 80 Years and Older with Non-Metastatic Prostate Cancer? National Survey.

Re: Do Canadian Radiation Oncologists Consider Geriatric Assessment in the Decision-Making Process for Treatment of Patients 80 Years and Older with Non-Metastatic Prostate Cancer? National Survey.

Real-world management of advanced prostate cancer: A Canadian comparison of academic specialists and community-based prostate cancer physicians.

29 Background: The Canadian GU Research Consortium recently conducted a consensus development conference with 27 academic prostate cancer (PC) specialists leading to 31 consensus recommendations. We conducted a survey to compare community-based practice with the consensus recommendations on the management of metastatic castration sensitive prostate cancer (mCSPC), metastatic castration resistant prostate cancer (mCRPC) and non-metastatic castration resistant prostate cancer (nmCRPC). Methods: An 87-item online questionnaire was sent to 600 Canadian community urologists, medical oncologists, radiation oncologists, and general practitioner oncologists involved in the treatment of PC. Results: Seventy-two physicians responded to the questionnaire (12% response). A discordance of &gt;25% was observed in 15 of 31 recommendations (48%). Among the areas of discordance were treatment approach for patients with nmCRPC and PSADT &lt; 10 months who are negative for metastases on conventional imaging but metastatic on PET-based imaging. Of the academic physicians, 89% indicated treating with agents approved for nmCRPC compared to 50% of community physicians (p=0.0005). Important discrepancies were also observed across academic and community physicians for radiation to the prostate for low-volume mCSPC which was 74% vs 27%, (p&lt;0.0001) respectively; criteria for stopping therapy in mCRPC in which 78% of academic physicians favored continuation of therapy in the event of PSA progression only, compared to 24% of community physicians. Sequencing of therapy after prior apalutamide for nmCRPC using subsequent docetaxel treatment was observed in 81% of academic physicians vs 35% of community physicians, (p&lt;0.0001), and use of genetic testing was favored by 74% of academics vs 36% of community physicians, (p&lt;0.0001) for newly diagnosed metastatic prostate cancer. Conclusions: The areas of discordance between a national sample of community-based PC physicians and academic consensus recommendations represent potential areas for education, practice tools and future research.

189 Bone Scans in the Management of Metastatic Castrate-Resistant Prostate Cancer: Survey of Patterns of Practice in Canadian Radiation Oncologists, Medical Oncologists and Urologists

189 Bone Scans in the Management of Metastatic Castrate-Resistant Prostate Cancer: Survey of Patterns of Practice in Canadian Radiation Oncologists, Medical Oncologists and Urologists

End-of-life discussions in practice: survey among Canadian radiation oncologists.

Early end-of-life (EOL) discussions improve patient satisfaction, quality of care, and the cost-effectiveness of care. However, some US studies show that radiation oncologists (ROs) are unlikely to discuss EOL issues until the patients develop significant symptoms or the families initiate the discussion. There have been no prior studies describing the patterns of EOL discussions among Canadian ROs. The objectives of this study were: (I) to describe the patterns of EOL discussions among Canadian ROs; (II) to identify the barriers to EOL conversation among Canadian ROs; (III) to assess the attitudes of Canadian ROs toward Medical Assistance in Dying (MAiD). The 22-question online survey was distributed to the members of Canadian Association of Radiation Oncologists (CARO). Demographics, EOL discussion patterns, perception of EOL discussions, barriers, and the impact of MAiD were evaluated. Sixty ROs responded out of 326. Prognosis (57%) and goals of care (58%) were routinely discussed, while advanced directive (40%) and planned site of death (12%) were not. More than 90% felt that early EOL discussions with palliative patients were important. The amount of palliative discussion training was correlated with confidence in EOL discussion (P <0.01), perceived importance of RO role in EOL (P=0.006), and the frequency of planned site of death discussion (P=0.041). The most frequently identified barriers were lack of time, uncertainty about prognosis, and concern for patient disappointment. Many ROs provided MAiD information upon request or case-by-case, but only 3% provided the information routinely. Canadian ROs recognize the importance of EOL discussions, but they do not routinely incorporate advanced directive or site of death in their discussions. ROs with more palliative discussion training were more confident in EOL discussion and likely to engage in them earlier. Short structured training may improve the confidence and quality of EOL discussion. Time constraint is the number one barrier that may be alleviated by delegation of tasks and patient education tools. Discussion about MAiD is supported but not routine among Canadian ROs.

P.096 Practice patterns in the management of residual/recurrent non-functioning pituitary adenomas: results from a Canada-wide survey

Background: Postoperative follow-up of non-functioning pituitary adenomas (NFAs) occasionally detects residual or recurrent disease. Subsequent treatment options range from continued follow-up, to re-resection or radiotherapy. To better understand current practice patterns on this topic, we surveyed neurosurgeons and radiation oncologists in Canada. Methods: Skull-base neurosurgeons and radiation oncologists across Canada were invited to complete a 25-item online questionnaire. Summary statistics were computed and 2-tailed t-tests were performed to assess significance. Results: 33 participants returned completed questionnaires: neurosurgeons (n=20, 61%) and radiation oncologists (ROs; n=13, 39%). When treating giant (&amp;gt;3cm) tumours, 92% of neurosurgeons in practice for less than 15 years use an endoscopic approach, as compared to only 57% of neurosurgeons in practice for 15 years or more. Additionally, younger neurosurgeons have a greater tendency to advocate for stereotactic radiosurgery (SRS) or re-resection (54% and 38%, respectively), as compared to older surgeons who show a higher propensity (29%) to advocate for observation. The presence of cavernous sinus extension appears to encourage neurosurgeons (40%) to offer radiotherapy sooner, as compared to 62% of ROs. Conclusions: Our results identify both variations and commonalities in practice amongst Canadian neurosurgeons. Approaches deviate in the setting of residual tumors based on years of practice.

Do Canadian Radiation Oncologists Consider Geriatric Assessment in the Decision-Making Process for Treatment of Patients 80 years and Older with Non-Metastatic Prostate Cancer? - National Survey.

Clinical judgement may not be sufficient to detect relevant problems in older cancer patients. We investigated what Geriatric Assessment tools (GA) are used by Canadian radiation oncologists (CROs) to treat non-metastatic prostate cancer patients aged 80 years and older. A 27-item cross-sectional survey was developed with input from a multidisciplinary team and distributed electronically to Genitourinary (GU) CROs via LimeSurvey. Survey contents included: demographics, treatment choice based on components of GA, and how GA tools are used in clinic. Descriptive statistics were used to analyze multiple-choice data, with Open-ended question being coded and analyzed for emerging themes. 154 GU CRO's were contacted, 44 responded (29%). Active surveillance was the choice of therapy in older low risk prostate cancer patients regardless of factors used in a GA assessment (97%). Results in intermediate and high-risk older prostate cancer patients were more heterogenous. Functional status and comorbidities were the most important factor in the decision-making-process (94%, 91%). Sixty-six percent of CROs did not use any GA tools; yet 77% felt comfortable to very comfortable treating older patients. Eighty-eight percent felt there were some to very few guidelines in helping them to treat older patients. Barriers to using GA included lack of knowledge, time, support, and resources. GAs are not commonly utilized by CROs. Majority of CROs felt comfortable treating older patients with prostate cancer, regardless of guidelines/evidence in this population. This may have negative implications on patient care. CROs are however open to referring patients for a formal GA.