Posted on behalf of the Soft Tissue Sarcoma Guideline Task Force
ASTRO’s latest clinical practice guideline, Radiation Therapy for Treatment of Soft Tissue Sarcoma in Adults, was published on July 26, 2021, in Practical Radiation Oncology. ASTRO’s first guideline on soft tissue sarcoma (STS) provides guidance on the use of radiation therapy to treat adult patients. Recommendations outline optimal radiation dosing, techniques and treatment planning for patients with localized, operable STS of the trunk and extremities, with a focus on preserving long-term functionality through individualized care. The guideline additionally addresses the role for radiation therapy for retroperitoneal sarcoma.
The guideline was developed through a systematic literature review of articles published from January 1980 through September 2020. The multidisciplinary task force included radiation, medical, orthopedic and surgical oncologists, a radiation oncology resident, a pathologist, a medical physicist and a patient representative. And, new to ASTRO guidelines, this guideline includes an appendix of reflections written by the patient representative that provides guidance to current patients and recommendations for oncology providers.
We encourage you to read the full guideline in PRO and listen to the podcast. And here, we specifically spotlight the recommendations written by the task force patient representative, Maria Voermans, BS, to oncology providers. These valuable insights serve as a reminder that patient-centered care should always lead our work.
Patient to Provider Recommendations
Excerpt from Radiation Therapy for Treatment of Soft Tissue Sarcoma in Adults: An ASTRO Clinical Practice Guideline
- Do not make assumptions about a patient based on what you see in terms of current life situation. This is particularly crucial in conversations surrounding long term effects on fertility as a result of treatment. A patient may be married with children but to assume that he or she does not want the opportunity to explore fertility preservation methods is erroneous.
- Encourage your patients to bring with them a support person or two to help listen and take notes at important visits. No matter how medically savvy a patient seems, absorbing personal medical information once a cancer diagnosis is received can be extremely overwhelming, and having at least one additional set of ears to take in and take down the information presented by the medical team is vital to information retention.
- Be supportive if your patient wants to pursue a second opinion. After all, the treatment of their cancer could have significant long-term impact on the rest of their life. The last thing a patient should deal with when navigating the treatment decision making process is feeling guilty that they may offend their medical team by exploring a second opinion. A second opinion is not indicative of mistrust or lack of respect for your medical abilities, rather it is a chance for patients to feel that they have some control over their own situation, and in many cases it is an opportunity for patients to get confirmation that they are making the best decision for themselves.
- Engage your patients as part of the team by including them in the decision-making process.
- Be cautious when throwing around medical jargon. Although you may be used to saying these terms dozens of times per day, patients are not always used to hearing it, especially in the beginning, and it can provoke anxiety.
- Encourage your patients to seek out psych-oncology support. Regardless of a patient’s seemingly firm grasp on their mental health, receiving a cancer diagnosis is devastating. Often, patients do not realize the extent of their own anxiety until they talk to a professional trained to deal with the emotions surrounding cancer.
- Recognize and respect the unique needs of the adolescent and young adult (AYA) patient population and learn about the myriad of resources available to this group.
- If you would like your patients to stay off the internet, provide reputable online resources if they want to research their diagnosis/treatment plan. They will feel empowered.
- Do not be afraid to talk about sexual side effects. Your patients may be afraid to ask, but they want to know what to expect and how to manage it.
Access the full guideline, published in Practical Radiation Oncology.
Read ASTRO’s news release.
Listen to the podcast.
Posted: July 26, 2021
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By Candice Johnstone, MD, MPH, Lindsay Puckett, MD, Hina Saeed, MD
The importance of mentoring for a successful carrier cannot be denied. Effective mentoring contributes to wellness, career growth and satisfaction throughout a lifetime. Leveraging mentorship to promote growth necessitates being aware of when to look for a new mentor for a new stage in your career and taking steps to build a mentor network. A mentor network is a group of individuals that can provide specialization in different areas you are seeking guidance in and can access their wealth of knowledge when needed. Let’s examine what makes a successful mentoring relationship:
- Trust between both individuals.
- Both the mentor and mentee should be prepared for each meeting.
- Set and document appropriate goals for the mentee, with the mentee creating their own goals before the meeting.
- Track progress toward goals.
- Consider existing skills and continuously assess and reassess.
- Acknowledging real and assumed differences can help develop the relationship and deal with crises that come up for mentee.
- Recognize that mentoring is subject to the same social forces and interpersonal dynamics that make all human relationships complex; not all relationships will continue.
Best Practices for Mentors and Mentees
There are many lessons learned as a mentor, as a mentee and from developing or overseeing mentorship programs. Here is some advice we would like to share based on those experiences.
Advice For Mentors
What makes a good mentor?
- Altruism and generosity, including time and accessibility.
- Creative and forward thinking.
- Recognition of mentee’s abilities.
- Recognition of the mentee’s goals and changes in those goals.
- Advocating for your mentee.
- Good communication.
What is a mentor’s role?
- Create a safe space that invites trust and openness.
- Be comfortable addressing perceived and real differences between the mentor and the mentee, such as gender, race or background, and embrace them.
- Be aware of implicit and explicit bias that may affect relationships.
- Acknowledge one’s own identity and experiences.
- Explore, rather than make assumptions.
- Expand experience and knowledge of the mentee.
- Work with the mentee to expand their skills.
Advice for Mentees
What makes a good mentee?
- Enthusiasm and receptivity.
- Initiation and carry through skills.
- Attention to detail and work ethic.
- Awareness of specific goals.
- Respect for the mentor’s time.
What is the mentee’s role?
- Taking initiative with goals and bringing to the table ideas.
- Follow through on steps to achieve goals.
- Good communication.
- Being receptive to advice and constructive criticism.
Missteps and Remedies
Sometimes missteps happen in the mentor-mentee relationship, but there are plenty of remedies to each type of situation. In the JAMA essay Mentee Missteps: Tales From the Academic Trenches, the authors break down six situations stemming from conflict averse and confidence lacking issues. Here are two examples of mentee missteps ― being an overcommitter or a vampire ― and how to remedy them.
This individual lacks the power of no and ends up overcommitting and stretching themself thin. A sign of this might be a résumé that is jam packed with volunteer roles and committee work, and yet few of these positions have resulted in academic products, such as publications.
As a potential solution, the mentee could lean on the mentor as a reason to say “no.” Before committing to a project, determine which current projects you should withdraw from to refocus your efforts. A mentor in this case could add new items to the mentee’s list only after previous goals or projects have been completed.
The mentee requires constant attention and supervision, leaving mentors drained of time and energy. The mentee seeks approval or clarification for every step of a project regardless of similar or past discussions. They may jump from mentor to mentor.
A remedy in this case would be for the mentor to help the mentee recognize their behavior and speak to them about their feelings of insecurity. The mentee should look to their peers and how they handle or cope when struggling. Once these issues are addressed, a mentor could set clear goals and boundaries including what scope of questions are appropriate and what are not.
These guidelines may act as a blueprint for a strong foundation. To view the original charts and other situations, access them on the JAMA network. We hope you can apply these mentoring pearls to your existing or future mentor-mentee relationships.
Do you have any advice for mentors and mentees you have picked up from experience? Please comment below. And to view additional mentoring resources, check out the Mentor Match page on ASTRO.org and read the latest issue of ASTROnews, focused on mentorship.
Vaughn V, Saint S, Chopra V. Mentee Missteps: Tales From the Academic Trenches. JAMA. 2017;317(5):475–476. doi:10.1001/jama.2016.12384
Posted: July 12, 2021
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By Dawn Owen, MD, PhD, and Megan Daly, MD, co-chairs of the Continuum of Care of Non-resectable NSCLC Planning Committee
ASTRO is excited to present a live, interactive webinar series on non-resectable, locally advanced non-small cell lung cancer (NSCLC). The Continuum of Care of Non-resectable NSCLC series is a three-part webinar supported by an independent medical education grant from AstraZeneca and is free to registered participants.
There is a wide gap between the near-universal expert recommendation for multidisciplinary care and the penetration of this model of care delivery into real world clinical care environments. Most examples of multidisciplinary care programs exist in academic or managed care environments, but over 70% of lung cancer care in the United States is delivered outside such settings (Little, 2007). Even within environments with multidisciplinary care programs, close examination reveals no consistent model structure or function and little evidence to support the impact (Osarogiagbon, 2016). It becomes imperative to increase awareness and understanding for the diagnosis and treatment of lung cancer.
This webinar series provides a case-based approach to the diagnosis, workup and treatment of NSCLC with a specific focus on the paradigm of chemoradiation and adjuvant durvalumab. The webinar series offers continuing education credits and SA-CME credits.
The first webinar, scheduled for Thursday, July 15, at 6:00 p.m. Eastern time and titled “Overcoming Barriers to Care,” features a multi-institutional multidisciplinary tumor board comprising a radiation oncologist, medical oncologist, thoracic surgeon and pulmonologist. This panel will take you through the process for the staging of lung cancer and the multidisciplinary discussion that follows for deciding if a patient is unresectable.
The second webinar is scheduled for Wednesday, July 21, at 6:00 p.m. Eastern time and titled “Best Practices for the Continuum of Care.” This session will take you through the interdisciplinary coordination of chemotherapy and radiation. You will hear about the steps that a medical oncologist and radiation oncologist take to decide on type of chemotherapy, whether a patient is a radiation candidate, and the identification and management of pneumonitis in the durvalumab era.
The third and final installation in this series (in August, date TBD), will focus on challenging unresectable cases with a multidisciplinary panel that includes radiation oncology, medical oncology, medical physics, pulmonology and dosimetry. Topics, such as the controversial role of proton therapy for lung cancer, management of patients with cardiac/lung/autoimmune comorbidities and the role of induction systemic therapy, will be broached.
The three webinars in this series are designed to actively engage the audience, and the audience is invited to proffer questions in the comment section of this blog or in real time. Review the agenda and register today for these forum case discussions in order to participate in a multidisciplinary lung tumor board-style review.
Posted: July 6, 2021
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By Doriann Geller, ASTRO Communications staff
The COVID-19 pandemic has changed the way business is conducted in many sectors around the world. Medicine, hard hit in operational activities, embraced telemedicine for patient visits, as well as peer-to-peer consultation, to a greater extent than ever before. ASTRO’s APEx - Accreditation Program for Excellence® curtailed facility site visits in March 2020, when the public health emergency declaration brought travel to a halt and closed many workplaces throughout the United States. In December 2020, after strategic and logistical planning sessions, ASTRO pivoted to offering virtual facility visits, the final step toward APEx accreditation.
“ASTRO decided to offer virtual facility visits when on-site surveys are not possible because of visitor or travel restrictions related to the public health emergency,” said Samantha Dawes, ASTRO director of Quality Improvement. “Baptist MD Anderson staff were willing participants with APEx’s first virtual format, which enabled ASTRO staff to assess the remote processes at both a main site and satellite facility simultaneously.” As a result, Baptist MD Anderson Cancer Center, in Jacksonville, Florida, was the first facility to successfully complete the accreditation process virtually.
Baptist MD Anderson’s Michael Olson, MD, PhD, interim division head of Radiation Oncology, and Ann-Marie Grietens, MSN, RN, NE-BC, director of Radiation/Neuro Oncology and Social Services, discussed their accreditation journey and the virtual facility site visit by video conference earlier this year, in April.
The Baptist MD Anderson mission is to provide “care that surrounds our patient and families with everything they need, physically, spiritually, and emotionally.” Ms. Grietens, who was involved in the process from start to finish, said that the accreditation process directly supports that model. To fulfill their missions, they take all aspects of the patient’s journey into consideration and utilize many patient-centered resources, including chaplain and social work support, both of which are in Ms. Grietens’ area of responsibility, she explained. The accreditation process gave them the opportunity to “go back and explore those resources,” she said. “I didn't realize going through it, but the biggest benefit is just pulling the team together and focusing them around these ideas of quality and safety and reminding them that the patient really is at the center of everything.”
Baptist MD Anderson operates two clinics, a main clinic and the South satellite clinic, both of which went through the accreditation process simultaneously. Ms. Greitens remarked that the surveyors “were gracious enough to split out our medical records [review] on different days and times, and the physics interview on different days and times, as well. Because we share resources at both clinics, that allowed my medical records team to be able to do the medical records review for both areas.” She added, “I feel the virtual aspect really was beneficial ― they could do it in [the] virtual app from either location. And Dr. Olson, with the team interview for South [the satellite clinic], was able to call in to participate. I thoroughly enjoyed the virtual aspect of the survey.”
Dr. Olson concurred: “I'm the physician that did [the survey] downtown. Especially for the policy reviews, because it’s electronic and our information is electronic, the virtual format does facilitate some of that information sharing. Everyone's looking at the same screen. I think this process, at least part of it, really lends itself to the to the virtual environment very well.”
Ms. Dawes remarked that the staff at Baptist MD Anderson were “well prepared and enthusiastic throughout the entire accreditation process, which contributed to how smoothly it went, and provided great feedback for ASTRO to learn from.” That feedback included comments from Ms. Grietens, who suggested that facilities undergoing the virtual visit talk to their IT departments to make sure that they are able to upload contiguous, large documents to the platform to ensure that the videos and documentation stay together.
“When I was at South with our physicist, we walked through and did [the video] with my phone,” Ms. Grietens explained. “And then he and I actually came in and did the same thing on a weekend in our downtown clinic. Making sure that we labeled everything appropriately on the website when we were uploading everything was key.”
“It was made very straightforward,” observed Dr. Olson. “Having a virtual [site visit] allowed us to continue normal operations, to work in the meeting with the rest of our day. It was painless. We sat there, it was a conversation, it felt natural. We worked through all the survey questions together, and then we were done. I honestly couldn't believe, when it was all completed, how efficient and easy it really was.”
Ms. Grietens continued, “This was a very positive experience for my team, and I think that we gained a lot out of the preparation ― as much as the actual survey. I highly encourage anyone to follow in our footsteps and take the same journey because they won't regret it.”
Dr. Olson agreed. “I think this is a fabulous process. I honestly believe every center should seek accreditation. Whether they get it or not is not the point. It’s going through the process, that they think about the right questions, because these are the things that we should be focusing on for taking the best care of patients.”
To learn more about APEx, visit the APEx webpages, where you can also request a virtual information session for your team.
Posted: June 15, 2021
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By Robert C. Miller, MD, MBA, FASTRO, and Faustin Laurentiu Roman, MsC
In the weeks leading up to the U.S. national elections in November 2020, while much of our nation’s attention was focused on political issues, there was a series of cyberattacks on U.S. health care institutions. The U.S Department of Health and Human Services (HHS) Office of the Assistant Secretary for Preparedness and Response, along with the Federal Bureau of Investigation (FBI) and the Cybersecurity and Infrastructure Safety Agency (CISA), issued an advisory on October 28, 2020, noting that “CISA, FBI and HHS have credible information of an increased and imminent cybercrime threat to U.S. hospitals and health care providers.”1
In a recent letter to the editor in ASTRO’s Advances in Radiation Oncology, Nelson and colleagues detail the challenges they faced when the University of Vermont Health Network was attacked on October 28 in a ransomware incident.2 The resulting IT outage lasted more than 40 days and was estimated to have cost more than $63 million to resolve.3 Delivery of radiation therapy was delayed for as many as 13 days for some patients due to the loss of the radiation oncology department’s information management system.
This incident was unique in the severity of the impact of the attack but hardly a unique occurrence. It does illustrate the trend away from broad-based attacks and toward persistent attempts to compromise high-value targets that have a high financial yield. The following challenges in cybersecurity and cybercrime will rise in importance throughout 20214:
- Social engineering attacks, such as email phishing and business email compromise.
- Increased attempts to exploit internet-facing vulnerabilities of organizations.
- Exploitation of system administration tools.
- Ineffective monitoring of critical IT systems.
- Human-operated ransomware risks.
The very technical and complex nature of radiation oncology5, combined with the escalation of cyber-attacks and changes of tactics from malicious actors, may influence the risk profile of service providers,6 especially when the delay in receiving treatments may prove to be fatal.7
Radiation oncology, reliant on connected technology, is particularly vulnerable.8 The inherent top threats to health care9, (e.g., communication errors, lost and stolen devices, insider threats), or more sophisticated cyber espionage threats,10 add up to a wide range of threat actors and risks that demands better collaboration, (e.g. threat intelligence sharing),11 meaningful action beyond compliance “tick-box” exercises, and appropriate funding to respond adequately and become resilient to the rising cybersecurity risks.
ASTRO’s Advances welcomes the submissions of scientific manuscripts, commentary and firsthand accounts of how providers and institutions are meeting these challenges. Our deadline for manuscript submission is October 31, 2021. To submit, send papers through the journal’s submission system and select “Cybersecurity” as the article type. Please reach out to the editorial office with any questions at email@example.com.
- Cybersecurity and Infrastructure Security Agency. “Alert (AA20-302A) Ransomware Activity Targeting the Healthcare and Public Health Sector.” Accessed online February 1, 2021: https://us-cert.cisa.gov/ncas/alerts/aa20-302a.
- Nelson, C. J., Lester-Coll, N. H., Li, P. C., Gagne, H., Anker, C. J., Deeley, M. A., & Wallace, H. J. (2020). Development of Rapid Response Plan for Radiation Oncology in Response to Cyberattack. Advances in radiation oncology, 6(1), 100613. https://doi.org/10.1016/j.adro.2020.11.001
- Becker’s Healthcare, “The 5 most significant cyberattacks in healthcare for 2020.” Accessed online February 1, 2021: https://www.beckershospitalreview.com/cybersecurity/the-5-most-significant-cyberattacks-in-healthcare-for-2020.html
- Thibodeaux, B. Five cyber threats to watch in 2021. Security. January 2021. Accessed online February 1, 2021: https://www.securitymagazine.com/articles/94343-five-cyber-threats-to-watch-in-2021
- The impact of cybersecurity in radiation oncology: Logistics and challenges (appliedradiationoncology.com)
- CISA Launches Campaign to Reduce the Risk of Ransomware | CISA
- Ralston, W. Wired magazine, Accessed online February 4, 2021 at: The untold story of a cyberattack, a hospital and a dying woman | WIRED UK
- Impact of Ripple20 Vulnerabilities on Healthcare IoT, Connected Devices (healthitsecurity.com)
- Healthcare Data Breaches & Security | Verizon Enterprise Solutions
- Beyond Compliance: Cyber Threats and Healthcare (fireeye.com)
- H-ISAC Information Sharing Best Practices - (h-isac.org)
Posted: June 8, 2021
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