By Laura Thevenot, ASTRO CEO
In the wake of the COVID-19 pandemic, we know that each ASTRO member has been impacted as you continue to provide world-class cancer treatment to your patients (and manage a host of new responsibilities like homeschooling children). Likewise, ASTRO has been impacted in many ways as we continue our work to provide high quality services to our members. As we launch registration for our virtual Annual Meeting on July 9, I want to explain how this meeting is coming about and why your participation is so important.
The ASTRO Annual Meeting is the primary income source for ASTRO, which is a 501(c)6 nonprofit. Unfortunately, ASTRO is not eligible to apply for any of the financial support available to many small businesses as a result of the pandemic. While membership dues produce roughly 15% of the organization’s overall budget, the Annual Meeting and income generated by the sponsorships, exhibitors and attendees is the revenue engine for ASTRO’s overall operations. This allows ASTRO to provide members with education and training for their practice, reimbursement and health policy expertise, advocacy work on Capitol Hill, clinical practice guidelines, safety resources and so much more.
Last year in anticipation that more than 11,000 radiation oncologists, residents, physicists and other health care professionals would descend on Miami in support of the Annual Meeting, ASTRO secured contracts with numerous entities including the Miami Convention & Visitors Bureau, 54 hotel properties, transportation service providers, audio/visual firms, and much more. While the ASTRO Board acted quickly to change course to a virtual Annual Meeting due to COVID-19, there are still many contracts and significant damages that we are contractually obligated to pay. We do hold event cancellation insurance, which will offset some of these expenses, but we are in line behind more than 170 other medical meetings that canceled before us.
With the cancellation of the in-person event and other revenue generators, ASTRO proactively looked to streamline day-to-day operations and adjust budgets. Like many of you, we suspended all business travel, cut professional development and other costs and implemented pay and benefit cuts for all staff in an effort to curtail spending given the extraordinary disruption and an uncertain future. We instituted these budget cuts to avoid staff layoffs and maintain our commitment to provide you with the support and educational content you need. For ASTRO to continue to play its role in supporting members, we also need to keep the ASTRO organization healthy and fiscally sound.
In an effort to produce an immersive and interactive virtual meeting, ASTRO then invested in an online platform that is being customized for our community’s unique needs, including networking and interview opportunities and an expansive exhibit hall. I promise you this will not be a hyped up Zoom call! This virtual meeting will be immersive and unlike anything you have ever experienced before. This transition to a virtual platform required us to negotiate and secure new contracts with a range of vendors including an online platform provider, videographers and audio technicians, digital designers to create online materials, support to produce trainings and onboarding for all presenters and exhibitors, and so much more. Everything we have done to produce this Annual Meeting was done to create a world-class, unforgettable learning experience for you.
We recognize that every member of the ASTRO community has been impacted in so many ways by the pandemic, including financially. Based on our COVID-19 practice survey, we know that your patient volumes have been negatively impacted and therefore you expect revenue declines this year. At the same time, we have seen the resilience of radiation oncology during the pandemic, and we marvel with pride in your ability to provide cancer patients with needed treatments and services without disruption. We also know that cancer doesn’t wait for a COVID-19 vaccine, and the need to get the latest science out to the global oncology community is more pressing than ever.
Because we understand that both your time and financial resources are precious, we are making the content available to all registered attendees for 30 days to allow you time to view materials at a pace that works best for you. One of the top complaints we get about our meeting is that there are too many competing sessions, so key content is missed, but not this year! This format and the 30-day window allow us to provide over 200 hours of CME credits — something that has never been possible, nor ever offered before during a four-day meeting. We hope that the financial savings from airfare, hotel and meals will make it possible for more members than ever to participate and learn at our Annual Meeting. In recognition of the fiscal impact our meeting cancellation will have on the Miami Beach area, a portion of all early-bird registration fees will be donated to two local cancer patient support organizations in the greater Miami area.
While everything is different for the 2020 Annual Meeting, we hope that our community will continue to gather to learn from each other, network and show our resilience as we continue to make our way through this unprecedented time. Thank you for all that you do for ASTRO and for your care and support of cancer patients.
Posted: July 2, 2020
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By ASTRO Journals Team
A recent Advances in Radiation Oncology article, Nutrition in Cancer: Evidence and Equality, examines the role of nutrition in cancer through the lens of social equity. Focusing on how diet affects cancer outcomes, particularly patients living in food priority areas (FPAs), the researchers sought to collect data at the human cellular level to advance understanding of the link between poor nutrition and cancer. Their research concentrated on four areas: nutritional intervention, synergy with definitive treatments, diet and long-term effects and how a lack of nutrient-dense foods contributes to outcomes. To learn more about this research, we reached out to the corresponding author Melissa A.L. Vyfhuis, MD, PhD, to answer a few questions.
Please summarize your study.
Our article attempts to answer the question: How does diet affect cancer outcomes? We tried to answer the question with as much data as possible, including human population level epidemiology down to cellular signaling. All in all, we found over 100 years of evidence that dietary intake can affect tumor development, may enhance treatment effects and may prevent symptoms associated with muscle wasting. Despite this, there are few clinical trials to demonstrate evidence-based recommendations. The highest-risk populations — those at high risk of nutritional deficits at baseline — may have the most to gain from such dietary interventions, but there are no studies to date.
What initially prompted you to pursue this study?
Historically, the primary focus of dietary intervention in oncology was caloric density. Understandably, oncologists are focused on the prevention of weight loss. Indeed, most clinical studies in humans aim to minimize treatment interruptions from manifestations of cachexia. However, if obesity, insulin resistance and metabolic syndrome account for major risk factors in tumorigenesis — and are major causes of death following completion of curative oncologic therapies — then perhaps the individual baseline should be taken into consideration. Our research demonstrates that nuance in dietary recommendations may be beneficial.
Looking at the bigger picture, how could your findings impact patient care? What do you see as the key practice-changing implications of the research?
Approximately one third of patients ask what they should eat prior to embarking on definitive cancer therapies. We see four separate and important questions that need further research to provide patients with the best answer. First, can nutritional intervention (micronutrient or macronutrient supplementation) mitigate or prevent cachexia and therefore help patients complete definitive therapies? Second, is there a possible treatment related effect whereby nutrition can synergize with definitive treatments to increase control or survival? Third, can a healthy diet mitigate the long-term side effects of definitive cancer therapies? Finally, to what extent are patients with the highest nutritional deficiencies at baseline adversely affected from their lack of access to nutrient dense foods?
Did anything about your findings surprise you?
We were surprised to find just how far back in time the original nutritional intervention studies go. Despite 100 years of animal data suggesting a treatment effect, we are still in need of large randomized trials across many disease sites and patient populations.
You point out that many studies have been published on the effects of living within an FPA and having higher incidences of various health issues like diabetes, hypertension, etc., but few studies have focused on cancer treatment and outcomes for patients living in FPAs. You then conclude that further research is needed to characterize the nutritional needs of cancer patients residing in FPAs and strategize how best to include them in future clinical trials. Why do you think this subject has not been studied as much as others regarding equity in health care, and what can cancer researchers do to include this population in future clinical trials?
I believe that this subject has not been studied as much because the prospective characterization of nutrition and its effect on cancer care is such a complicated, difficult task to begin unraveling, especially since other confounding factors can cloud the pictures such as access to care, social support and other psychosocial factors.
The recent addition of deregulated cellular energetics as an emerging hallmark of cancer highlights that the acceptance of the role in nutrition in cancer is also recent. We now hope to see this area of research grow rapidly.
What is the link between FPA and food deserts? Food deserts and poverty cannot be solved by health care practitioners alone, but what do you see as their role in decreasing the effects of living in these areas has on patients?
Patients living in FPAs (previously called food deserts) are at high risk of nutritional deficiencies because of lack of access; however, these zip codes can be very heterogenous. While community access to food cannot be solved by a health care professional, we hope to start a dialogue between oncology practitioners and patients. The end goal would be a discussion regarding the patient’s current diet, the recommended diet during and after a definitive cancer treatment and resources that can be used to bridge the gap. Hopefully, with these specific nutritional interventions, citizens at risk for poor eating habits can live longer, healthier lives after cancer care.
What steps can health care practitioners treating underserved populations living in FPAs take to improve nutrition, and therefore potentially improve outcomes, for patients?
We believe that asking patients about their current diet and access to nutritious foods is the best start.While future studies are needed, encouraging nutrient dense foods as opposed to calorically dense foods that are within each patient’s budget will likely be prudent. Also, having information on hand about resources available in the area (i.e. virtual pantry programs, church donations) to provide to patients can be helpful.
What are your next steps? Will you be pursuing further study?
Our next step is to better characterize our own patient population’s access to nutritious foods. In a prospective manner, we will gather data about our patient’s diets and economic means to determine how to best identify patients at the highest risk of nutritional deficits. We hope to begin to bridge the gap with those in the greatest need.
Read the full article, Nutrition in Cancer: Evidence and Equality in Advances in Radiation Oncology, ASTRO’s open-access journal.
Posted: July 1, 2020
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By Doriann Geller, ASTRO Communications
ASTRO staff continue to monitor the worldwide effect of the novel coronavirus. During this time, several program updates have been made ― or are in progress ― to APEx - Accreditation Program for Excellence®. These changes are reflected on the program’s webpages.
Visitors to APEx's webpage will find an updated message of support during the pandemic as well as information for practices regarding current applications. Specifically, facility visits continue to be on hold and will resume only when it is safe and permissible to do so. Meanwhile, APEx is offering extensions to practices that are awaiting facility visits and those whose accreditation expires during the public health emergency.
APEx recently announced a new payment option for practices thinking about starting the accreditation process. Through the end of this calendar year, ASTRO is offering a partial payment option to assist with the upfront fee. Practices that request the partial payment option will pay half of the total amount due upon submission of the application; the balance is due before finalizing the facility visit.
In June, notice was given of changes to two Evidence Indicators affecting all facilities starting July 7, 2020. The first, Evidence Indicator 1.6.1, addresses transferring previous radiation therapy and promotes the creation of a standard process for transfer of care documents to a new provider and in emergency situations. The second, new Evidence Indicator 2.4, separates the treatment plan from the treatment prescription (EI 2.3) to allow for more detailed evaluation of both criteria.
Last, an APEx FAQs page was added in May. Divided into sections, the FAQs cover all aspects of the accreditation process, including application, the Self-Assessment, facility visits, reaccreditation, program requirements and general questions. This informative section covers questions asked over the life of the program and gives answers and examples that clarify program policies.
As a reminder, the 2019 Annual Report, “APEx in Review: Five Years of Dedication to Quality Improvement,” posted to the website in January, is available to read and download. APEx was launched in 2014 to support quality improvement in radiation therapy practices. The accreditation process evaluates essential functions and steps that contribute to the delivery of safe, high-quality care. Learn more about APEx standards and dedication to patient safety and check back frequently for program updates and news. APEx is the right choice for radiation oncology practice accreditation.
Posted: June 24, 2020
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By David Beyer, MD, FASTRO
We all face many similar challenges in our practices, whether in an academic medical center or small private practice, an urban hospital or suburban clinic, a big city or rural site. However, there are also vast differences that come with each setting. Until recently, we had little understanding and even less data on the unique challenges faced by ASTRO members who practice in a rural setting, In October 2018, ASTRO's Board of Directors decided to pursue a Rural Radiation Oncology Initiative to support ASTRO members and radiation oncology facilities ensuring patient access to care in rural communities. In January 2019, the Board asked me to chair the ASTRO Rural Task Force. We selected members from across ASTRO councils, as many of our colleagues who work in rural areas across the country, to serve on the task force. In addition, the Board agreed with a broad set of potential rural strategies for the task force to explore.
In March 2019, task force members were asked to provide written responses on a series of questions to inform the project. In addition, I solicited input on the initiative from the ASTRO membership via ROhub. One of the most common themes submitted involved the challenges for rural radiation oncologists to access peer review from other rural practitioners and nationally recognized experts. Thus, the idea for a peer matching system was born.
After exploring different options, the task force and ASTRO ultimately decided on an out-of-the-box program that would be housed in ROhub. The aim is to match interested radiation oncologists (with a focus on those in rural settings) with others for the purpose of reviewing each other's cases by remote access on a recurring basis.
In January 2020, the customization of the program began. In the following months, many rounds of review by the task force members ensued, and now, today, I am happy to announce the Peer-to-Peer Match is live! In light of COVID-19, the need to create virtual connections to continue treating patients is greater than ever.
Peer-to-Peer Match is an online tool — including a searchable database — that facilitates the establishment of relationships for the purpose of peer review of patient cases. The platform is user-driven, allowing enrolled participants to search, using specified criteria, to find other interested individuals whose experience and expertise would assist them in evaluating patient cases and treatment plans. This platform may be used to find and establish an ongoing peer-to-peer relationship or a one-off case review with a specialist. Participants will communicate outside the platform using their own communication vehicles to establish the parameters of the relationship and review cases.
Members can enroll and find fellow peers in the program in four easy steps that only take a few minutes. Once enrolled, members can also specify the number of peer matches they desire at a time. For more information, see the Peer-to-Peer Match page on ASTRO.org or contact ROhub Community Manager Laura Hinely.
I am personally excited and have already signed up. I hope my rural colleagues and all radiation oncologists will find this new program beneficial. Peer-to-Peer Match is a free ASTRO member benefit, and I encourage you to explore it further.
Posted: June 2, 2020
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By Anthony Zietman, MD, FASTRO
Ten years ago, I was chosen to become the editor-in-chief (EIC) of the Red Journal and, on reflection, I cannot believe how naïve I was entering the position, and how little I understood the qualities required to lead the journal well. I had a dreamy and romantic view that it was about reviewing some papers, making some great choices, and voila, as if by magic, quality would just shine out. What I did not realize was the level of 24/7 commitment required, the necessity to develop a dynamic and like-minded editorial team, the diplomatic stresses and the ethical, and even legal, challenges. Even though I had been chair of ASTRO previously, this position eclipsed that for its unique challenges. As my term concludes in 2021 and the search for my successor begins, I’ve been reflecting a lot on what it has taken to haul the Red Journal to where it is today and on what it will take for my successor to bring it to the next level. If you are considering the position, these are my tips.
The incoming editor-in-chief should be:
- A time management marvel. This journal moves very fast. With 15 issues per year and hundreds of pages per issue, there is always work to be done. Often this work cannot wait more than a day or two. The journal occupies nights and weekends and pops up between patients in clinics…every day.
- Dedicated to the journal. Along the lines of the above, the new editor should have a proven commitment to the journal, likely through editorial responsibilities, reviewing and/or writing. Because of the volume of work, the personal investment and the especially nuanced judgment required of this role, you’ll need to love the Red Journal — well before you apply. You will “need to bleed Red.”
- Ethical, insightful and diplomatic. Serving as the EIC of the Red Journal amounts to leading and shaping our specialty’s premier record of published research. As such, emotions surrounding the journal’s decisions can run high. The successful EIC must have a keen moral compass, be able to carefully manage conflicts of interest and scientific misbehavior and have the diplomatic skills to swiftly and gracefully handle difficult situations. The intellectual safety of the journal and of ASTRO and the scientific community can depend on it. A thick skin is essential — remember, most of the papers that come to the journal are rejected!
- An excellent writer. It is very important to be able to write well and to write quickly. Editorials, issue highlights, podcasts and similar communications need to be composed with tight turnaround times. Publishing this journal is a rapid endeavor, and being comfortable with writing quickly and decisively will help the process run smoothly.
- Well-connected. Do you have a diverse web of contacts who can be called upon to act as resources? Networks of connections within radiation oncology and beyond (broader oncology, policy and even politics) will be tremendously helpful. Authors of opinion pieces and editorials, or tie-breaker reviews for tricky papers, are often needed in haste.
- Visionary. As the EIC, you will be responsible for the entirety of the journal, its content and its editorial board. How will you make the journal your own? What new, innovative ideas would you like to enact? What should the journal look like in five years, and why? Scientific publishing has changed a great deal in the last 10 years and will undoubtedly continue to evolve. The incoming EIC should understand the threats and opportunities presented by this time of great change.
For the right candidate, this will be the most rewarding experience of their professional career. It was an incredible honor for me to be chosen to lead the Red Journal after Dr. Jim Cox and an even greater honor to see it fortify its position as the premier forum for science and ideas in our specialty. I have thoroughly enjoyed the opportunity, and when I pass the baton next year, I would love to do so into an equally proud set of hands. For those of you interested, view the job posting and details on how to apply at www.astro.org/RedJournalEIC.
Posted: May 5, 2020
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