US Radiation Oncology Research Articles

First Author Publications of US Radiation Oncology Residents Graduating Between 2015 and 2019

Scholarly work is seen as an increasingly important component of radiation oncology (RO) residency. In fact, most programs now provide residents with dedicated research time and support to augment clinical training. In this study, we sought to describe scholarly work among graduating RO residents nationwide in the modern era. Using publicly available information from the ARRO directory, residency program and hospital websites, we identified RO residents who graduated from ACGME-accredited residency programs in the United States between 2015 and 2019. We then queried PubMed to identify first-author peer-reviewed publications completed by each resident during residency. To account for publication lag after completing residency, articles published between January 1st of PGY-2 and December 31st of the year of graduation were included. Publications were downloaded and manually checked. We extracted meta-data, including journal name, impact factor, and articles citing the publication. Publications were classified into original articles, reviews, or commentary; original articles were further classified by type. Results were aggregated by individual and by residency program. This project was determined to be exempt human research by our IRB (19-02888). We identified 882 RO residents from 87 programs who produced 2683 first author publications (median 2; range 0-59; interquartile range (IQR) 1-4). 78% of residents authored ≥1 publication. The articles were published in 394 distinct peer-reviewed journals. The median 2018 impact factor was 3.13 (range 0-70.7, IQR 2.3-6.1), with the two most common journals being IJROBP (14%) and PRO (7%). 76% of publications were original scientific articles, 13.5% - reviews, and 10.5% - commentaries. Grant support was identified in 25% of original research publications. Within original research, 70% of studies were retrospective, of which 27% of data originated from a national database (e.g. NCDB/SEER). Additionally, 8% of publications were classified as case reports, 6% as physics/dosimetry, 4% as clinical trials, 4% as basic/translational science, 3% as surveys, 2% as economic analyses, and 1% as meta-analyses. We then grouped residency programs into quartiles of productivity. Residents from programs in the top quartile published a median of 3 publications per resident, while those from programs in the lowest quartile published a median of 1 publication per resident. The most productive program had a median of 7.5 publications per resident, while 13% of programs had a median of 0 publications per resident. Programs with higher average residency productivity tended to publish in journals with a higher impact factor (r = 0.41, p<0.001). Substantial variability exists in resident research productivity nationwide, both in terms of publication numbers and study design. These data serve as an important benchmark for first-author publications in RO residency.

Cross-Sectional Gender Analysis of US Radiation Oncology Residency Programs in 2019: More Than a Pipeline Issue?

PurposeThe purpose of this study is to assess the current status of gender disparities in academic radiation oncology departments in the United States and the associated factors. Methods and MaterialsThe data were collected from publicly available resources, including websites of individual radiation oncology programs, the Fellowship and Residency Electronic Interactive Database, the Accreditation Council for Graduate Medical Education, and the Association of American Medical Colleges. We collected data on the gender information of residents in each year (postgraduate years 2-5) and of the faculty (attendings, program director, and chair) during the academic year 2018 to 2019. Spearman’s rho test, Pearson’s chi-squared test, and Fisher exact tests were used for evaluating the correlation among variables using SPSS version 24. ResultsWomen constituted 30.8% of radiation oncology residents in the United States in 2019. Eight programs (12.5%) did not have any female residents in their programs, whereas 6 programs (9%) had women constituting more than half of their resident class. The fraction of female medical students applying to radiation oncology over the last 7 years varied between 27% and 33%. Female attending physicians accounted for 30.5% of all the attending physicians in the academic programs. In the leadership positions of the department, the gender gap was wider where only 19 (20%) and 11 (12%) of programs had female program director or chair, respectively. There was a positive correlation between the number of attending physicians and the number of female residents in programs (P = .01). ConclusionsA significant gender disparity continues to exist among the residents and physicians in the academic radiation oncology departments in the US. This disparity is pronounced in the leadership positions. The results of this study could be used as a benchmark to evaluate the progress that has been made by the efforts to improve gender disparities in radiation oncology.

I Can’t Breathe: The Continued Disproportionate Exclusion of Black Physicians in the United States Radiation Oncology Workforce

PurposeBlack physicians remain disproportionately underrepresented in certain medical specialties, yet comprehensive assessments in radiation oncology (RO) are lacking. Our purpose was to report current and historical representation trends for Black physicians in the US RO workforce.Methods and MaterialsPublic registries were used to assess significant differences in 2016 representation for US vs RO Black academic full-time faculty, residents, and applicants. Historical changes from 1970 to 2016 were reported descriptively. Linear regression was used to assess significant changes for Black residents and faculty from 1995 to 2016.ResultsIn 2016, Black people represented 3.2% vs 1.5% (P < .001), 5.6% vs 3.2% (P = .005), and 6.5% vs 5.4% (P = .352) of US vs RO faculty, residents, and applicants, respectively. Although RO residents nearly doubled from 374 (1974) to 720 (2016), Black residents peaked at 31 in 1984 (5.9%; 31 of 522) and fell to 23 (3.2%; 23 of 720) in 2016 across 91 accredited programs; Black US graduate medical education trainees nearly doubled over the same period: 3506 (1984) to 6905 (2016). From 1995 to 2016, Black US resident representation significantly increased by 0.03%/y, but decreased significantly in RO by –0.20%/y before 2006 and did not change significantly thereafter. Over the same period, Black US faculty representation significantly increased by 0.02%/y, whereas Black RO faculty significantly increased by 0.07%/y before 2006, then decreased significantly by –0.16%/y thereafter. The number of Black RO faculty peaked at 37 in 2006 (3.1%; 37 of 1203) and was 27 (1.5%; 27 of 1769) in 2016, despite the nearly 1.5-fold increase in the number of both RO faculty and Black US faculty overall (4169 in 2006 and 6047 in 2016) during that period.ConclusionsBlack physicians remain disproportionately underrepresented in RO despite an increasing available pipeline in the US physician workforce. Deliberate efforts to understand barriers to specialty training and inclusion, along with evidence-based targeted interventions to overcome them, are needed to ensure diversification of the RO physician workforce.

National Quality Improvement Participation Among US Radiation Oncology Facilities: Compliance with Guideline-Concordant Palliative Radiation Therapy for Bone Metastases

To characterize the participation of radiation oncology (RO) in reporting quality metrics through the Centers for Medicare and Medicaid Services' (CMS) Hospital Compare database and to describe the association of hospital characteristics with RO-specific quality metrics. Data from the CMS Hospital Compare, International Atomic Energy Agency's Directory of Radiotherapy Centre, 2010 US Census, and CMS Inpatient Prospective Payment System were linked to create an integrated data set of geographic information, facility characteristics, and quality measures, focusing on the use of external beam radiation therapy (EBRT) for bony metastases. Of 4829 hospitals in the Hospital Compare database, 2030 had access to radiation therapy. Among these, 814 (40%) reported on the rate of guideline-concordant EBRT for bony metastases, a RO-specific quality measure. A total of 33,614 eligible cases of bony metastases treated with EBRT were sampled. Participation in quality reporting varied significantly by geography, population type, teaching status, hospital ownership, hospital type, and hospital size. The median rate of guideline-concordant palliative EBRT utilization was 89%. Nine percent of 814 centers had a compliance rate of less than 50%. On multivariable analysis, increasing number of cases sampled (odds ratio 0.93, P = .028), increasing hospital star-rating, and above-average patient experience rating (odds ratio 0.58, P = .024) remained significantly associated with decreased odds of falling into the lowest quartile of guideline-concordant EBRT utilization. RO participation in a large, national quality improvement effort is nascent and reveals potential quality gaps between hospitals offering palliative EBRT for bone metastases. More robust RO-specific quality measures are needed.

Comfort Level of US Radiation Oncology Graduates: Assessment of Transition to Independent Clinical Practice.

Radiation training programs are designed to prepare graduates for independent practice, with metrics in place to assess appropriateness of clinical decision-making. Here, we investigated the self-assessed preparedness of US graduates during the transition to independent practice.An anonymous, Internet-based survey was distributed to recent graduates of radiation oncology residencies (2016-2017). A Likert scale was used to assess comfort with various aspects of practice, as well as "time" to development of comfort in independent practice.Responses were obtained from 70/210 (33%), the majority reported training in programs with 5-8 residents (n = 35). Most (77%) reported designing between 500 and 900 treatment plans during training (n = 54). Only 41% of respondents reported the opportunity to review treatment plans and make decisions about safety/adequacy without attending input > 50% of the time (n = 29). Thirty percent of residents reported being responsible for seeing/managing on-treatment visits (OTVs) ≤ 75% of the time. Aspects with which practitioners reported the least comfort were understanding of billing/application to practice (2.43, IQR 2-3), orthovoltage (superficial radiation) setup and field design (2.57, IQR 1-4), and planning/delivery of prostate implants (2.82, IQR 2-4). Increased mean comfort levels were reported by those designing > 700 treatment plans in training as well as those reporting an opportunity to evaluate plans and make clinical decisions prior to attending input > 50% of the time during residency. Comfort with the delivery of stereotactic body radiation (SBRT) correlated with caseload for liver, spine, prostate, and CNS disease sites but not lung.Variations in training experiences exist across institutions. Here, a lower than expected number of residents reported seeing/managing OTVs as well as reviewing treatment plans prior to attending input during training. Overall comfort was correlated with case volume and opportunities to independently review treatment plans prior to attending input. These data highlight areas of opportunity for improving resident education with implications for ease of transition to independent clinical practice.

Perceptions and Patterns in Academic Publishing: A Survey of United States Residents in Radiation Oncology

PurposeWe aimed to assess perceptions of, and training regarding, the publishing process among US radiation oncology (RO) residents, focusing on awareness and understanding of criteria for selecting appropriate and legitimate peer-reviewed journals for academic publishing. The growing challenge of predatory publication in the broader scientific realm and its relevancy to resident training is also briefly discussed. Methods and MaterialsA survey was opened to residents of all Accreditation Council for Graduate Medical Education–accredited RO programs in the United States, focusing on 3 categories: (1) demographics; (2) submission, peer review, and publication of academic research; and (3) subjective ranking of factors for choosing an appropriate publisher/journal. Results were stratified by level of training and number of publications. ResultsOverall, 150 of 690 residents (19.8%) responded, with a 98% (147 of 150) completion rate. Twenty of 150 residents (13.3%) reported formal training in manuscript preparation and choosing academic journals. Only 3.4% of residents reported departmental guidelines regarding publication in “predatory” journals; 57.7% were unsure. The 3 most important factors influencing publisher and journal choice were impact factor (ranked first for 59.0%), whether a journal is found in a major index (ranked first for 18.0%), and association with a reputable organization (ranked first for 17.0%). Importance of impact factor increased with number of publications (50% with 0 publications, 48.3% with 1-5, 63.9% with 5-10, 76.2% with 10-15, and 70.6% with >15). Cost considerations influenced journal choice at least once for 79 (52.7%) residents. ConclusionsImpact factor was the most important consideration for residents when choosing an appropriate publisher, with increased emphasis with increasing number of publications. A minority had formal training in choosing appropriate academic journals and knowing how to identify so-called predatory journals or were aware if their department has proscriptions regarding publication in such journals. Additional emphasis on formal training for RO residents in manuscript preparation and choosing academic journals is warranted.

Assessment of the Medical Schools Radiation Oncology Residents Come fom Suggests A Reasonable Approach for Diversifying the Workforce

The US radiation oncology (RO) workforce has significant underrepresentation of women, African Americans, and Latinos compared to the US population and medical school (MS) graduates. Our hypothesis is that this reflects inadequate RO exposure and mentoring for these students. Our objective was to better understand how MS and RO department demographics correlate with MS-specific residency match rates in RO. The ASTRO directory was used to search all RO physicians that self-identified as a “resident” and listed their MS. This included 507 residents, of which 36 who attended osteopathic or international schools were excluded. Demographic information for all 147 allopathic US medical schools and any on-site affiliated RO department and residency program was also collected from other freely accessible web resources. Spearman’s rank-order and Wilcoxon signed-rank tests were used for correlative analyses. A total of 100 schools (68%) had an affiliated RO department and 81 (55%) had a RO residency program. There was a median of 9 faculty members (interquartile range (IQR) 5 - 15) per RO department, with a median of 2 female faculty (IQR 1 - 5) and 0 African American or Latino faculty per department (IQR 0 - 1). In total, 26.5% of all US RO academic faculty were women and 4.4% African American or Latino. The median percentage of students per MS that matched in a RO residency was 0.4% (IQR 0.2 - 0.7%), and the median percentage of all US RO residents that came from each MS was 0.6% (IQR 0.2 - 1.1%). Both of these percentages were significantly higher when there was an affiliated RO department (p < 0.01) or RO residency program (p < 0.01), and for RO departments with more faculty members (rs = 0.45 and 0.43, p < 0.01), but there was no significant association with any MS factors assessed (percentages of women or underrepresented minority students, or average matriculating student MCAT scores or GPA). RO residents’ ethnicity could not be determined for analysis, however, the number of female RO faculty in a department predicted for significantly more female RO residents graduating from that MS (rs = 0.35, p<0.01), and the top quartile of RO departments with the most female faculty were affiliated with schools that graduated 49% of all female RO residents. Only 57 US RO residents (12%) graduated from the 47 schools without an affiliated RO department, whereas the 25 schools that graduated the highest percentage of US RO residents accounted for 46% of all RO residents. The proportion of students at a given MS that match into RO is strongly associated with affiliation to a larger RO department and residency program. As such, the majority of RO residents come from a select number of schools. Targeted education and mentoring outreach initiatives for schools with fewer affiliated RO faculty should be considered in order to help diversify the workforce.

Non-Clinical Time in Radiation Oncology Residency Programs: A National Survey of Program Structure and Resident Perspectives

Data regarding the amount and use of non-clinical time (NCT) in radiation oncology residency programs are scarce. We surveyed every US Radiation Oncology residency program to obtain benchmark data to inform decisions about optimal program structure. An anonymous, internet-based survey was distributed to all PGY5 residents at ACGME-accredited radiation oncology training programs. The survey consisted of 33 yes/no, Likert-scale, and free-response questions. Up to 2 reminder emails were sent to any resident who did not complete the survey. Program data were analyzed for all programs; those considered “top 10” per Doximity and those not considered “top 10.” Likert-scale responses were dichotomized as “not as satisfied” (1, 2, 3) or “very satisfied” (4, 5). 123 residents completed the survey (response rate 68%). Program specific data were obtained for 100% of programs (n=82). The vast majority of training programs (98%) provide residents with protected NCT. The median NCT was 10 months, 12 months, and 9 months in all 82 programs, “top 10” programs, and not “top 10” programs, respectively (p=0.03). Most (68%) of programs reported having more than 6 months of NCT. The median number of publications resulting from NCT did not differ significantly between residents who had 9 or fewer months compared to 10 or more months of NCT (p=0.07). The proportion of residents who reported wanting more NCT increased as the amount of time decreased (100%, 73%, 52%, and 19% for 1-3, 4-6, 7-9, and 10-12 months, respectively; p=0.01). The proportion of residents who reported being very satisfied with NCT flexibility increased with more NCT (50%, 58%, 79%, and 94% for 1-3 , 4-6 , 7-9 , and 10-12 months, respectively; p=0.04) as did proportion of residents very satisfied with accomplishment during NCT (0%, 35%, 53%, and 73% for 1-3, 4-6, 7-9, and 10-12 months, respectively; p=.03). When asked whether residents would theoretically want to give up their NCT to shorten their residencies, the proportion of residents willing to shorten their residencies decreased as amount of NCT increased (100%, 57%, 47%, and 33% for 1-3, 4-6, 7-9, and 10-12 months respectively; p=0.02) Residents with more NCT reported placing more importance on amount of NCT while making rank lists (0%, 37%, 51%, and 73% for 1-3, 4-6, 7-9, and 10-12 months, respectively; p=0.04) and less frequently desired to change the importance of this factor in their rank list decision retrospectively (100%, 50%, 41%, and 25% for 1-3, 4-6, 7-9, and 10-12 months, respectively; p=0.03). Most residency programs dedicate > 6 months of non-clinical time to residents. In addition, > 50% of residents value the experience from their non-clinical time such that they would not trade it to shorten their residency if given the option. Programs should maintain an emphasis on such time and implement measures to ensure meaningful resident experiences.

Representation Trends of Underrepresented Minority Physicians in the US Radiation Oncology (RO) Workforce

Representation Trends of Underrepresented Minority Physicians in the US Radiation Oncology (RO) Workforce

A Growing Specialty: A 15-year Profile of US Radiation Oncology Residency Growth and Implications for Workforce Imbalances

The radiation oncology (RO) community is concerned about geographic maldistribution and a future oversupply of physicians, driven in part by a sustained growth in residency programs and positions. This growth has previously only been reported in absolute numbers of positions over time. Therefore, the aim of this project is characterize RO residency growth, in both number of programs and number of positions, as it relates to geographic region, major urban centers, and program size. A database of all RO programs & positions from 2003 to 2018 was created using publicly available data from the National Resident Matching Program (NRMP). Programs were categorized by geography (US Census Bureau region designations: Northeast [NE], South [SO], Midwest [MW], and West [WT]), location in a 2018 top metropolitan region (top 10 Combined Statistical Area [CSA] by population vs. all others), and program size (large [>6 trainees] vs. small [≤6 trainees]. Program size definition (large vs. small) was dynamic by year and thus defined as the cumulative number of positions over the prior four years. Linear regression with interaction terms was used to determine the effect of region, metro size, and program size on RO program & positions growth over time. An increase in the number of RO programs (54 to 91, 69%) & annual positions (106 to 193, 82%) was observed during the studied time frame. In decreasing regional order, 2018 programs & positions, respectively, are located in the SO (31.9% & 29.9%), NE (25.3% & 28.5%), MW (23.1% & 25.0%) and WT (19.8% & 16.7%). There is a statistically significant difference in regional RO program & position annual growth rate. Specifically, programs & positions in the NE (0.44 programs/year & 1.48 positions/year), SO (0.70 & 2.28), and WT (0.62 & 1.44) are increasing at faster annual rates relative to the MW (0.16 & 0.84) (all p<0.05). 41.7% of all programs and 48.0% of all positions are in a top metropolitan location. Annual growth rates in RO programs (0.86 vs. 1.04) & positions (2.73 vs. 3.31) were not statistically different between top metropolitan areas vs. all others (p >0.18). Larger programs (change in annual growth rate: 0.23 positions/year) are growing faster than smaller programs (change in annual growth rate: -1.89), p=0.01. In this study of US RO residency growth, we found steady and unequal growth rates among residency programs & positions over the past 15 years. This growth may worsen already existing imbalances in the workforce, including (1) Geographic: MW growing at rates slower than other more saturated regions, 2) Urban: the top urban areas are growing at equal rates as elsewhere, and 3) Size: larger, established programs are growing more rapidly than smaller programs. Further discussion regarding the implications of these imbalances is warranted.

P62 - Current and Historical Representation Trends of Black Physicians in the US Radiation Oncology (RO) Workforce

P62 - Current and Historical Representation Trends of Black Physicians in the US Radiation Oncology (RO) Workforce

The Employment Experience of Recent Graduates From US Radiation Oncology Training Programs: The Practice Entry Survey Results From 2012 to 2017

PurposeThe Practice Entry Survey presentation is a highly anticipated session for the radiation oncology (RO) resident at the American Society for Radiation Oncology annual meeting. Each year the senior author reports the employment outcomes and job market experiences for the most recently graduated RO residents. MethodsThe Practice Entry Survey has been continuously administered annually to graduated RO residents since 1984 via the Association of Residents in Radiation Oncology directory. Six years of individual-level data, from 2012 to 2017, were readily available for analysis. The questionnaire queries the workforce placement experience and collects debt, salary, and benefits information. Respondents were subgrouped by practice type (academic vs private practice), and results were tested for trends over time. ResultsSurvey data were collected from 302 recently graduated residents. There were 7 in fellowship and 1 practicing internationally, leaving 294 eligible for analysis. They identified themselves as working in either an academic setting (n = 150 [51%]) or private practice (n = 144 [49%]). First-year salaries for those in private practice were more than those in academics ($303,000; [interquartile range, $270,000-$375,000] versus $280,000 [interquartile range, $260,000-$325,000]; P < .01). With regard to the job search, 21.8% of respondents found their jobs through the online American Society for Radiation Oncology Career Center, while most respondents, 77.2%, found their jobs through other means. Respondents also ranked the items they found to be most helpful during the interview process. ConclusionsThese data can help gauge the competitiveness of an offer as well as what to expect during the job hunt and interview process.

Survey results of US radiation oncology providers' contextual engagement of watch-and-wait beliefs after a complete clinical response to chemoradiation in patients with local rectal cancer.

Watchful waiting in rectal cancer patients with a complete clinical response (cCR) to chemoradiation therapy (CRT) forgo upfront resection has been proposed. Growing evidence suggests that a watch-and-wait approach using resection for salvage of local recurrence may improve quality of life without jeopardizing outcomes. The current acceptance of watch-and-wait by US radiation oncologists (ROs) is unknown. US ROs completed our IRB-approved anonymous e-survey regarding non-surgical management of patients who achieved a cCR to neoadjuvant CRT. Self-ranked knowledge of the OnCoRe Project-UK prospective observational study of watch-and-wait-was tested for its association with ROs' attitudes using the Chi-squared or Fisher's test, as indicated. Supporters of observation are self-identified. Of the 220 respondents, 48% (n=106) of respondents support watchful waiting and 48% claimed familiarity with the OnCoRe Project. Respondents supporting observation were more likely to be familiar with the publication (P=0.029). Among watch-and-wait supporters, 59% (n=62) felt comfortable discussing this approach and 41% preferred the conversation be initiated by other specialists. There was no association between comfort level in discussing watch-and-wait and familiarity with the OnCoRe Project. ROs treating more than 10 locally advanced rectal cancer (LARC) patients annually felt more comfortable discussing watch-and-wait (P=0.015) compared to ROs seeing fewer patients. Almost half of surveyed US ROs support watch-and-wait, though many do not feel comfortable discussing this paradigm with patients. Knowledge of the OnCoRe Project is associated with support of watch-and-wait, yet not comfort level in leading the discussion. These results inform provider attitudes toward future clinical study participation.

Brachytherapy Training Survey of Radiation Oncology Residents

As brachytherapy utilization rates decline, we sought to evaluate the state of brachytherapy training during radiation oncology residency. US radiation oncology residents in the Association of Residents in Radiation Oncology database were sent an online questionnaire regarding brachytherapy training. Survey questions addressed a wide array of topics, and responses were often given on a 1 to 5 Likert-type scale that reflected strength of opinion. Postgraduate year (PGY) 4/5 respondents' answers were analyzed. Descriptive statistics were generated, and rank correlation analyses (Kendall's τ coefficient and Wilcoxon signed-rank test) were used for comparisons. The survey was completed by 145 of 567 residents (62% being PGY4/5). Of PGY4/5 respondents, 96% (86 of 90) believed learning brachytherapy during residency was important, and 72% (65 of 90) felt their program valued brachytherapy training. Resident brachytherapy comfort varied by site, decreasing as follows: gynecologic, prostate, breast, skin. The current intracavitary 15-case minimum was believed adequate by most, but only a minority believed the 5-case interstitial minimum was adequate. Most respondents (59%) believed that caseload was the greatest barrier to achieving independence in brachytherapy. Significant support exists for American Brachytherapy Society training courses and on-the-job education to enhance training, but enthusiasm about pursuing brachytherapy fellowship training was low. Most respondents expressed confidence in developing a brachytherapy practice (54%); however, this was significantly lower than the rate of those confident in developing a stereotactic body radiation therapy/stereotactic radiosurgery program (97%) (P<.001). Furthermore, there was an association between aggregate number of brachytherapy cases performed and resident confidence in starting a brachytherapy practice (τ=0.37; P<.001). Brachytherapy is an important component of residency training that is valued by residents and programs. Because caseload was the greatest perceived barrier in brachytherapy training, with confidence correlated with case volume, attempts should be made to expand opportunities for training experiences that are feasible to complete during residency.

Attitudes Toward Pre-Operative Short-Course Radiation Therapy for Rectal Cancer among US Radiation Oncologists

Several landmark studies revealed short-course preoperative radiotherapy (SC-RT, 25 Gy in 5 fractions) followed by chemotherapy to be non-inferior to conventionally fractionated long-course chemoradiation therapy (CF-CRT). The current attitude towards these treatment modalities among US practicing radiation oncologists (ROs) is unknown. We surveyed US ROs via an anonymous online institutional review board-approved survey. Questions pertained to management preferences, knowledge of landmark randomized trials and hypothetical approach within the frame of an alternative reimbursement system. We received 220 responses. Fifty-eight percent of respondents (n=128) support SC-RT. Approximately 81% of respondents were familiar with the results of the randomized Trans-Tasman Radiation Group Trial 0104 and 51% with results of the randomized Polish Colorectal Study Group. There was no association between the knowledge of these studies and support for SC-RT (p-value = 0.726). The majority of respondents (72%) prefer to manage their patients with CF-CRT. The reasons cited for this preference were to achieve higher pathological complete response rate, to decrease toxicity and to achieve a better rate of sphincter preservation. If patient insisted on receiving SC-RT, 92% would feel comfortable. In a hypothetical situation where reimbursement would not be based on the number of fractions, 72% of respondents would still continue to prefer CF-CRT. Most ROs who would preferentially use SC-RT if insurance reimbursed at the same rate as CF-CRT also indicated they supported SC-RT compared to those who did not support SC-RT (85.2% vs 14.8%, p-value < 0.001). Despite several randomized trials showing SC-RT to be comparable to CF-CRT, 42% of US radiation oncologists do not support SC-RT and 72% prefer to manage their localized rectal cancer patients with CF-CRT. This does not appear to be influenced by the US radiation oncology reimbursement system.Abstract TU_6_2947; Table 1Reasons stated by survey respondents (n=220) leading to preferred utilization of CF-CRT over SC-RT.Stated Reasons for choosing CF-CRT over SC-RTn (%)*Better overall survival14 (8.9%)Better local control30 (19.0%)Higher pCR rate64 (40.5%)Better sphincter preservation64 (40.5%)Fewer acute toxicities29 (18.4%)Fewer long-term toxicities62 (39.2%)*Percentages do not add up to 100% as multiple reasons could be selected by respondents. Open table in a new tab

Enhancing the Reporting of Radiation Oncology Treatment Details to Central Cancer Registries and the SEER Program: A Report of Pilot Studies in Progress

Reporting cancer treatment data to state cancer registries provides a framework for assessing national treatment and outcome trends and the foundation for health services and epidemiologic research. All cancer treatments are reportable to state cancer registries; however, radiation oncology details are generally limited to whether radiation was administered or not, without any details. By establishing standardized, scalable, and easy-to-adopt methods to acquire data derived from commercial radiation oncology information systems (ROIS) we hope to demonstrate that details of radiation oncology treatments can be successfully imported into central registries, thus facilitating new research on radiation treatments and outcomes at the population level. To assess the feasibility and requirements of enhancing and automating detailed reporting from ROIS to registries, we are facilitating the acquisition of radiation oncology data from two leading commercial systems that – combined – represent greater than 90% of US radiation oncology clinics. Independently, the systems will establish a secure interface to export data directly to one central cancer registry. Upon receipt, the central cancer registry will perform a linkage between the ROIS data and the registry data. A set of desired data elements was developed in collaboration with the National Cancer Institute (NCI) Surveillance, Epidemiology and End Results (SEER) program and the project team of radiation oncology experts. The elements include patient demographics, diagnosis code, diagnosis date, treatment site, date of service, primary oncologist, facility, dose per fraction, total radiation dose, total number of fractions, number of sessions, dates of treatment, course dose delivered, frequency, and technique. The pilots will run at least 6 months at one large health system with multiple radiation oncology departments using ROIS from both venders. The two pilot projects will capture the data elements and export them to state registries. Exportable reports are being designed to account for industry standards of the data elements that currently exist in each ROIS. We anticipate presenting results separately after testing, but the goal is to make this process feasible regardless of site ROIS customization. To our knowledge, this is the first effort with collaboration from industry to develop a rich dataset of radiation treatment information to contribute to state and SEER registries. If feasible and scalable, these pilots will enable broad use of standard and efficient ways of reporting detailed radiation treatment data to registries. This reporting would fulfill radiation oncology reporting requirements and capture both initial and subsequent therapy. This enhanced data may be used for research to assess the utilization and outcomes of cancer treatments and improve the lives of cancer patients.

Importance of First and Second Authorship in Assessing Citation-Based Scholarly Activity of US Radiation Oncology Residents and Subsequent Choice of Academic Versus Private Practice Career

PurposeThe Hirsch index (h-index) has been shown to correlate with radiation oncology residents’ having a first job in academics versus private practice, but it is limited by its inability to distinguish between the differing significance of coauthor roles in articles. MethodsA list of 2016 radiation oncology resident graduates and their postresidency career choices was compiled. The Scopus bibliometric citation database was then searched to collect h-index data for articles limited to first author only (hf) and first or second-author only (hs) for each resident. ResultsMean hf was 2.06 for all resident graduates, and mean hs was 2.77. Residents with PhDs had significantly higher hf (3.11 versus 1.76, P < .01) and hs (4.50 versus 2.28, P < .01). There was no statistically significant difference between male and female residents for hf (2.19 versus 1.61, P = .11) or hs (2.91 versus 2.25, P = .15). Residents choosing academia had higher hf (2.72 versus 1.44, P < .01) and hs (3.57 versus 2.01, P < 0.01) than those in private practice. Fewer than 20% of graduates with hf = 0 and only 10% of graduates with hs = 0 secured academic jobs. ConclusionThe average radiation oncology resident graduate has published a minimum of two first- and/or second-author articles cited at least twice. Graduates with PhDs and/or choosing academic careers were more likely to have higher hf and hs scores; there was no significant score difference by gender. Only 10% of graduates without any first- and/or second-author articles cited at least once secured academic jobs. These findings indicate that stratifying publications by first or second authorship when developing benchmarks for evaluating resident productivity and postresidency career type may be useful.

Survey results of US radiation oncology providers' contextual engagement of watch-and-wait beliefs after complete clinical response to chemoradiation in patients with local rectal cancer.

e22120Background: Current multimodality treatment of locally advanced rectal cancer (RC) includes chemotherapy, chemoradiation (CRT) and surgery. Growing clinical data suggest omitting resection (w...

Introductory Radiation Oncology Curriculum: Report of a National Needs Assessment and Multi-institutional Pilot Implementation

To assess the optimal structure of an introductory curriculum (IC) for radiation oncology residents, including the perceived utility of a 2-day off-site "boot camp," and evaluate the success of a pilot introductory radiation oncology curriculum (IROC) based on these initial data. In the first phase, anonymous, web-based surveys were sent to US radiation oncology program directors and residents. Likert-type scores (1, not at all; 5, extremely) are reported as the median and interquartile range. Using the phase 1 results, IROC was developed, piloted, and evaluated. Of the 89 program directors and 697 residents, 47 (53%) and 165 (24%) responded, respectively. Of the 89 program directors, 37 (79%) reported offering a formal IC. However, only 83 residents (50%) reported having a formal IC. Program directors reported resident preparation for clinical training as "moderate" (median 3, interquartile range 2-3) on entering residency and "moderate" (median 3, interquartile range 3-4) after IC completion (P=.03). However, residents only believed they were "slightly" prepared (median 2, interquartile range 1-2) on entering residency and "moderately" (median 3, interquartile range 2-3) prepared after IC completion (P<.01). Program directors believed an off-site boot camp would be of "moderate" utility (median 3, interquartile range 3-4) with participation limited by funding (57%). Residents without an IC reported that having an IC would be "quite" beneficial (median 4, interquartile range 3-5). Residents preferred instruction before the clinical training (49%) and over 1week (40%). Both program directors and residents rated lectures on radiation emergencies and simulation highly. Using these data, IROC was developed and piloted with incoming residents at 4 institutions. After IROC, residents reported improvement in overall preparedness for clinical training (before: median 1, interquartile range 1-2; vs after: median 3, interquartile range 2-3; P<.01) and among specific practice domains. Beginning radiation oncology residents frequently lack structured introductory curricula but desire instruction before the clinical training with a focus on practical aspects (emergency management, contouring). Program directors recognize the value of both off-site and on-site boot camps. An on-site IC could mitigate funding barriers. A standardized IC, IROC, piloted at 4 programs, showed promising outcomes.

A Survey of Program Directors’ Experience With Patient Safety Training Programs for Medical and Physics Radiation Oncology Residents

Current ACGME and CAMPEP guidelines expect physicians and physicists to teach quality improvement (QI) as a core element of residency curriculum in radiation oncology (RO). However, a recent national study found that most residents did not feel they had adequate safety and QI training during their residency, and the type of training most desired by the residents were practical workshops. We surveyed program directors (PDs) in RO and therapy medical physics to understand current conditions and potential ways to address this educational gap. PDs of accredited US RO and medical physics therapy programs were surveyed via email. Questions inquired about demographics, curricular elements, perceived barriers to development/improvement of safety training, and attitudes regarding training using a 5-point Likert scale. Differences in proportions of responses between medical and physics PDs were tested using chi-square. Responses were collected from 56 of 175 PDs (32%); 45% identified as medical faculty and 55% as physics faculty. Most medical (88%) and physics PDs (94%) felt that safety and QI training are an important part of resident education. More physics than medical PDs felt residents were enthusiastic about safety training (77% physics, 48% medical, P < 0.05). Likewise, more physics than medical PDs agreed that residents were well exposed (83% physics, 64% medical, P = 0.18) to safety and QI concepts and adequately prepared to meet the safety expectations of clinical practice (90% physics, 60% medical, P = 0.07), but these did not reach significance. Likewise, more physics PDs (90%) agreed that residents were adequately prepared to meet the patient safety expectations of clinical practice than medical PDs (60%) (P = 0.07). PDs most often used safety/QI publications (53%), curriculum templates (38%), and online modules/guides (36%) to create the safety training experience for residents. Common curricular elements included web-based modules (66%), patient safety rotations (61%), and clinical projects (37%, e.g., root cause analysis). The most common reported barriers to improving resident safety education were lack of resident time (38%), faculty time (27%), and faculty expertise (27%). Only a small minority (3%) felt that institutional safety culture was a barrier to improving resident safety education. The most common modes of assessing the effectiveness of a safety curriculum were resident feedback (56%), faculty feedback (37%), and assessments of resident knowledge and/or attitudes (27%). The results show that the majority of PDs feel their residents are adequately prepared for the patient safety and QI expectations of clinical practice, which is different than the results of a prior survey of residents in training. While residents most desire practical workshops, none of the programs appeared to offer this opportunity. National guidelines and resources would help PDs efficiently improve patient safety curricula in their programs.