By Sabin B. Motwani, MD
Communications Committee Chair
November has arrived, signaling Fall, and the one-year anniversary of the new and improved ROhub! ASTRO’s official online community continues to serve as a place for collaboration and networking. During the summer of 2018, ROhub was moved to a more user-friendly platform and relaunched in November 2018 welcoming the Open Forum, ASTRO’s all member community, ASTRO event communities and specialty communities such as Locum Tenens.
To celebrate its one-year anniversary, ASTRO is conducting an online scavenger hunt on ROhub during the month of November. At the beginning of each week, a new activity will be posted in the Open Forum for members to complete. Those who complete all posted activities will be entered into a drawing and five individuals will win $50 each in ASTRO cash, which can be used toward ASTRO products.
Let’s take a moment to look back at this invaluable resource. When ROhub launched last year, expectations were open and benchmarks were not set. Looking back over the course of a year, ROhub has received overwhelmingly positive feedback from members and other committees. The Communications Committee was particularly excited with what ROhub brought to the table as a resource that we were missing at ASTRO. Over the course of the year, ROhub has totaled 231,000 pageviews, 8,500 unique logins, 300 plus unique contributors and more than 900 discussion posts generated by ASTRO members.
The Open Forum has served as an inaugural place for members to discuss a wide range of topics and allows members to interact with staff on a more personal and private level compared to other platforms. This discussion forum has also given the Communications Committee and ASTRO staff invaluable feedback on areas to focus on or what ASTRO can do to better serve its members. From topics like prior authorization, RO-APM and rural practices, discussion has spurred on and encouraged a number of members to jump in and participate in these timely topics. The Communications Committee posted a discussion about the changes we were making to the patient education material and found the feedback extremely valuable. We will continue to do this to help our members shape the work we do.
What’s next for ROhub?
Additional features and large initiatives have been going on behind the scenes for some time now in ROhub. At this very moment the Communications Committee and I are testing a document versioning system similar to Google Docs that will be hosted on ROhub called WorkSpace. WorkSpace will greatly enhance the efficiency of ASTRO committee work and will eliminate the need for so many emails flooding our inboxes or several users at once making changes on a document. Workspace, for example, has features that will allow users to “lock” documents as they are making edits in draft mode. We are confident that this will bring a much-needed reprieve from Google Docs.
Working with the ASTRO Rural Task Force, we will soon launch a peer-to-peer matching system. This new platform will match interested radiation oncologists for the purpose of virtual physician to physician peer review of patient cases.
With the growing expansion, I can’t wait to see what emerging ideas, points of discussion and progress will be accomplished by the 2nd anniversary of ROhub! To those of you who may have wanted to jump in on a thread or have had a question you wanted to pose to the rest of the membership, I encourage you now to go online to rohub.astro.org and post those questions in the Open Forum.
I encourage you to feel comfortable to voice your opinions and ask your questions in this members only environment. Don’t forget to upload your headshot! It’s always appreciated to associate a post with a friendly face so others can introduce themselves to you at maybe…#ASTRO20. It’s never too late to start a conversation or create a new connection today on ROhub. Learn more about how to post in the ROhub.
Posted: November 6, 2019
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By Anna Lee, MD, MPH, and Valerie Powell, RT Patient
Social media provides a platform for people and organizations to share information, opinions and expertise. It also serves as a news source, a networking tool and a pivotal communications channel for millions of people around the world. As radiation oncology experts, it’s important that we share our voice and raise the profile of our field and one area of focus for ASTRO is social media. For this year’s Annual Meeting, ASTRO asked nine attendees to serve as Social Champions, including, for the first time, the voice of an RT patient. Here, two #ASTRO19 Social Champions share their experiences from the meeting.
Anna: Last year I created a Twitter account in preparation for ASTRO’s Advocacy Day in Washington, D.C. While I participated in social media through Facebook and Instagram, these were primarily for personal use and I found the public platform of Twitter to be daunting. Why would people even care what I thought? What would be the purpose of having a professional account? These sentiments were alleviated after watching the social media webinar prior to Advocacy Day. I quickly learned different ways to increase visibility and how to use the platform to put my voice out there and get people’s attention.
Once I joined the #SoMe (social media) community, I was floored to see so many radiation oncologists on Twitter! I immediately felt welcomed and learned so much from discussions (some can be intense) and hot-off-the-press papers. I quickly developed new friendships that have crossed over #IRL (in real life) and have been offered opportunities to collaborate on projects including to be one of the nine #ASTRO19 Social Champions.
The #ASTRO19 meeting in Chicago this year was one of the busiest but most exciting I’ve attended. I felt more engaged because I wanted to synthesize information from the talks and share it on #SoMe. As a current trainee in proton therapy, I wanted to share my perspective as someone still early in her career and excited about the increased utilization of protons for our patients. Even though my task was to interact and engage through tweets, I met and spoke #IRL with so many dedicated ASTRO members. I came home exhausted but grateful to have had an enriched conference experience and to be part of a larger network that helped me to better understand both the field and the people in the field.
Valerie: I was giddy to get to Chicago. The opportunity to attend such an influential and informative conference with the opportunity to be an #ASTRO19 Social Champion and stand in for other RT patients was something I never imagined I would do. So, I assigned myself a few goals: Be present. Be professional. Be transparent. And, be myself.
As a non-clinician and former RT patient attending #ASTRO19 for the first time, my initial steps into the main ballroom made me nervous. My face had been promoted all over Twitter and was published throughout the convention center. Whether anyone recognized me or not was one thing, but the idea of potentially being way out of my realm of understanding was a whole different thing.
I arranged my conference schedule to include topics I was interested in but also topics that I had some familiarity with. While I am not clinical in my marketing and communications work at University of Alabama, Birmingham’s (UAB) radiation oncology department, I tend to poke my head in as many different areas of our department that I am allowed. Of course, going through treatment for head and neck cancer in 2017 taught me quite a bit about radiation oncology too.
During each #ASTRO19 session I attended, I kept the overall topic in mind and listened closely. If something struck a particular chord in me, I quickly wrote it into my phone and gave myself a few seconds to process why it impacted me. Sometimes it came from a past experience. Other times it might have come from clinical perspective that I learned while working in research at UAB and more recently in marketing and communications.
At that point, I had to make a decision about how what I had to say was going to come across to a very practical and data-driven audience. It was crucial for me to stay relevant in this venue and provide quick and valid thoughts or I would inevitably fall behind the other Social Champions.
Overall, being a Social Champion definitely gave me a feeling of inclusiveness, especially coming in as a total outsider and not knowing what to expect. I came with purpose and a story and ASTRO gave me a platform to share those things and hopefully improve care for future patients being treated with radiation therapy.
Even though the Annual Meeting is behind us, there are many opportunities to use social media in radiation oncology. If you are not currently on social media, you can start with a Twitter account. There’s an easy how-to video on ASTRO.org. If you don’t want to start posting right away, you can follow the conversations until something strikes your interest.
Anna Lee, MD, MPH, graduated from residency at SUNY Downstate Medical Center and is currently completing a one-year proton therapy fellowship at Memorial Sloan Kettering Cancer Center.
Valerie Powell is a radiation oncology marketing professional at the University of Alabama at Birmingham and a previous head and neck cancer patient. She is married to her husband of five years, K.T. Powell, and they have two dogs, Fox and Stella.
Posted: October 30, 2019
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By Gita Suneja, MD, MS, and Malika Siker, MD
As the field of radiation oncology continues to make tremendous biomedical advancements in patient care, we know that these breakthroughs are not reaching all patients equally. We are aware of the outstanding research documenting the disparities that exist in the field, both in terms of patient care and the composition of our work force. It is critical that we focus on improving health equity to devise new and innovative solutions to bring change to the field. To this end, the ROI has issued a new request for proposals (RFP), “Improving Diversity and Inclusion in Radiation Oncology,” to award research grants focused on developing and testing practical applications that will help change the current state of affairs for radiation oncology professionals and their patients.
This new funding opportunity from the ROI will support innovative ideas to:
- Reduce disparities in patient care.
- Increase participation of underrepresented groups in clinical trials.
- Improve diversity in the radiation oncology workforce.
The proposed research must also focus on one or more of the topics that make up the ROI’s research agenda: communication, quality and safety, toxicity management, comparative effectiveness and value of radiation therapy. The grants typically will be approximately $50,000 to be paid over two years, but budgets of up to $100,000 will be considered for projects with a large scope of work. We encourage all interested, eligible applicants to submit a Letter of Intent (LOI) by 5:00 p.m. Eastern time, October 28, 2019, on the ROI portal on proposalCENTRAL. Full proposals will be due at the end of January for invited applicants only.
The ROI and ASTRO’s Committee on Health Equity, Diversity and Inclusion (CHEDI) are excited to be partnering on this new grant opportunity to ensure that the ROI is supporting the highest priority research that will address some of the most pressing challenges to improve equity, diversity and inclusion in radiation oncology. Our collaboration began with the development of the RFP and will continue through the review of the LOIs and proposals, when members of CHEDI will serve as guest reviewers. We are hoping to see many proposals for groundbreaking initiatives to improve recruitment and inclusion of underrepresented minorities into cancer clinical trials, one of CHEDI’s top priorities for the year, in response to this RFP.
We are proud to support this new funding opportunity that could help transform the field. We invite all members of the radiation oncology community to review the complete RFP and propose your best ideas for how to improve health equity and ensure that all patients have access to the lifesaving and quality-of-life benefits of radiation therapy.
Gita Suneja, MD, MS, is chair of the ROI Research Committee and vice-chair of CHEDI, and Malika Siker, MD, is chair of CHEDI, a member of the ROI Development Committee and chair of its Communications Subcommittee.
Posted: September 25, 2019
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By Manisha Palta, MD, and Albert Koong, MD, PhD
The role of radiation therapy (RT) in pancreatic cancer is rapidly evolving. Until recently, 3-D conformal RT was the primary technique for treating patients. However, the emergence of intensity-modulated radiation therapy (IMRT) has allowed greater dose conformality, resulting in reduced dose to organs at risk. Together with advancements in simulation and image guidance, these developments have facilitated the use of hypofractionated RT, including stereotactic body RT. Simultaneously, more effective systemic therapies have also been developed. As these systemic therapies improve overall survival, local regional treatments like RT and surgery have become more important.
To address the questions surrounding RT for patients with pancreatic cancer, ASTRO launched a guideline on this topic, published online in Practical Radiation Oncology on August 29. The guideline task force comprised of not only radiation oncologists, including those working in community practice and Veterans Affairs and a resident representative, but also members from medical and surgical oncology, medical physics and the patient community. The guideline considered indications for RT in the adjuvant, neoadjuvant and definitive settings, along with doses, target volumes and sequencing with systemic therapies. It also made recommendations on simulation and treatment planning, technique and use of prophylactic medications to mitigate toxicity. Recommendations are rated as either strong or conditional, and the quality of the evidence is also graded for each recommendation.
For conventionally fractionated RT, the task force made a conditional recommendation supporting its use in the adjuvant setting if patients have high-risk features such as positive lymph nodes and margins. It conditionally recommended neoadjuvant RT in patients with borderline resectable tumors following chemotherapy, as well as RT as an option for definitive therapy in those with locally advanced disease. In addition, for borderline and locally advanced pancreatic cancer, SBRT is conditionally recommended. However, the task force recognized that ongoing clinical trials, including the Alliance for Clinical Trials in Oncology study, may provide new data for patients with borderline pancreatic cancer.
For RT simulation, the guideline recommends that patient-specific motion assessment should be utilized along with image guidance. Use of IMRT is recommended for treatment delivery.
Finally, there was strong consensus, even with limited clinical data, that patients undergoing RT for pancreatic cancer should receive prophylactic anti-nausea medications and agreement that patients may benefit from anti-acid or acid-reducing drugs.
Throughout the guideline, the task force sought to promote a patient-centered approach that integrates the patient's values, preferences and ability to tolerate short and late toxicities, and how those considerations are balanced against outcomes like local control. Given the many controversies and nuances of RT, it is especially important that every patient who might be appropriate for RT have a nuanced discussion with a radiation oncologist about the risks and benefits of RT, ideally in a multidisciplinary setting that also includes a surgeon and a medical oncologist.
Although many of the current guideline recommendations are conditional recommendations, reflecting limitations in the available data, ongoing and recently completed trials continue to add to the evidence available to make decisions on RT for pancreatic cancer and may alter the guideline in future years.
Posted: September 3, 2019
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By Fumiko Chino, MD
ASTRO's Committee on Health Equity, Diversity and Inclusion (CHEDI) has made recruitment and inclusion of underrepresented minorities into cancer clinical trials a top priority for the upcoming year.
Clinical trials are the mainstay in the development and validation of new cancer therapies and treatment options. Despite the potential for access to novel new treatments and technologies, less than one in 20 adult patients with cancer participate in a clinical trial.1 This disparity is even starker for racial and ethnic minorities1 with data showing that the clinical trial enrollment of racial/ethnic minorities has actually decreased over the past 14 years.2 In 2012, only 17% of patients enrolled in industry-sponsored clinical trials were of a racial or ethnic minority, despite these groups making up about one-third of the population.3 One evaluation found that black participation reached 10% for only two of the 31 cancer drugs studied.4 Clinical trial participants are disproportionately non-Hispanic white men with higher education levels and household incomes.1,5
With skewed enrollment and participation, conclusions of clinical trials may be questioned for how generalizable they may be to patients not fully represented in the trial cohort.6 As racial/ethnic minorities carry some of the highest cancer burdens in the United States, equitable participation in clinical trials becomes an important tool in the fight against health care disparities. Adequate representation in cancer research is essential in the development of therapies that are both effective and tolerable to patients from diverse backgrounds. Recurring themes in the assessment of barriers to clinical trial enrollment for racial/ethnic minorities include trust, costs and access/knowledge:
- Trust in medical providers and the health care establishment is a known obstacle for minority engagement. From infamous historical outrages like the Tuskegee Syphilis Study and forced sterilization in segregated hospitals, distrust has been a valid protective measure for many patients for centuries. One study looking at barriers to cancer research found that almost one-third of the black women surveyed agreed that scientists “cannot be trusted” (compared to 4% of white women).7 Trust concerns can be exacerbated by the lack of minority investigators,8 making workforce diversity9,10 an essential target action to improve trust.
- Costs remain a consistent barrier to clinical trial participation, particularly among racial/ethnic minorities.12 Lower income patients are much less likely to participate across all subgroups5 and increased out-of-pocket costs were consistently stated as a concern limiting enrollment.13 Although the costs of study drugs, tests and procedures are typically covered under protocol, there are many “hidden costs” including gas, hotels and missed work.14 Extra costs are in part due to more frequent clinic visits and travel as most comprehensive cancer centers leading clinical trials are in major metropolitan centers. Although there are fears that financial incentives may create a type of economic pressure for patients with lower socioeconomic status to participate, the additive costs of participation are often exclusionary for those with fewer resources.
- Access/knowledge continues to limit many patients who may be otherwise willing and eligible for clinical trial participation. Black/African American patients are less likely to be aware of clinical trials17 and provider referral may also be limited. In one study of black women, almost all participants stated their doctor had “never talked to them” about participating in a clinical trial.18
- Workforce: In addition to improving diversity in physician workforce, which is a long-term process, greater community involvement and use of culturally concordant staff (for example, Hispanic staff and Spanish language-based education materials) have led to improved enrollment in certain target populations.11
- Cost: One intervention of graded financial assistance demonstrated the ability to improve clinical trial equity with successful increased enrollment for those patients typically underrepresented in trials.15 Expanding trials into community cancer centers may also decrease travel costs and increase participation.16
- Access/Knowledge: Targeting enrollment toward specific cultural background and literacy levels may improve recruitment of underrepresented populations.12 Patient navigation programs also hold unique promise to help recruit and retain racial and ethnic minority populations in clinical trials. One study found that black/African American enrollment increased from 9% to 16% after initiating an education and tailored support program.19
CHEDI has highlighted ways that equity, diversity and inclusion can be improved within radiation oncology since its creation as a committee. By focusing this year on underrepresented minority clinical trial enrollment, we hope to raise awareness of this crucial issue and ultimately increase access and outcomes for our patients. Share your suggestions for how to encourage minorities to enroll in clinical trials in the comments below.
Fumiko Chino is transitioning from chief resident in Radiation Oncology at Duke Cancer Institute and the Teaching Value in Health Care Learning Network Fellow for the Costs of Care, a global NGO. She will join the faculty at Memorial Sloan Kettering Cancer Center in August 2019.
- Murthy VH, Krumholz HM, Gross CP: Participation in cancer clinical trials: race-, sex-, and age-based disparities. JAMA. 291:2720-6,2004.
- Duma N, Vera Aguilera J, Paludo J, et al: Representation of Minorities and Women in Oncology Clinical Trials: Review of the Past 14 Years. J Oncol Pract. 14:e1-e10,2018.
- Proportion of Study Volunteers by Race and Ethnicity in Clinical Research Studies, 2012. JNCI: Journal of the National Cancer Institute. 109, 2017.
- Propublica. "Black Patients Miss Out On Promising Cancer Drugs" Published September 19, 2018, accessed June 23, 2019 at https://www.propublica.org/article/black-patients-miss-out-on-promising-cancer-drugs.
- Unger JM, Gralow JR, Albain KS, et al: Patient Income Level and Cancer Clinical Trial Participation: A Prospective Survey Study. JAMA Oncol. 2:137-9, 2016.
- Rothwell PM: External validity of randomised controlled trials: "to whom do the results of this trial apply?". Lancet. 365:82-93, 2005.
- Mouton CP, Harris S, Rovi S, et al: Barriers to black women's participation in cancer clinical trials. J Natl Med Assoc. 89:721-7, 1997.
- McCaskill-Stevens W, Pinto H, Marcus AC, et al: Recruiting minority cancer patients into cancer clinical trials: a pilot project involving the Eastern Cooperative Oncology Group and the National Medical Association. J Clin Oncol. 17:1029-39, 1999.
- Winkfield KM, Flowers CR, Patel JD, et al: American Society of Clinical Oncology Strategic Plan for Increasing Racial and Ethnic Diversity in the Oncology Workforce. J Clin Oncol. 35:2576-2579, 2017.
- Winkfield KM, Gabeau D: Why workforce diversity in oncology matters. Int J Radiat Oncol Biol Phys. 85:900-1, 2013.
- Symonds RP, Lord K, Mitchell AJ, et al: Recruitment of ethnic minorities into cancer clinical trials: experience from the front lines. Br J Cancer. 107:1017-21, 2012.
- Ford JG, Howerton MW, Lai GY, et al: Barriers to recruiting underrepresented populations to cancer clinical trials: a systematic review. Cancer. 112:228-42, 2008.
- Unger JM, Hershman DL, Albain KS, et al: Patient income level and cancer clinical trial participation. J Clin Oncol. 31:536-42, 2013.
- Chino F, Zafar SY: Financial Toxicity and Equitable Access to Clinical Trials. Am Soc Clin Oncol Educ Book. 39:11-18, 2019.
- Nipp RD, Lee H, Powell E, et al: Financial Burden of Cancer Clinical Trial Participation and the Impact of a Cancer Care Equity Program. Oncologist. 21:467-74, 2016.
- Copur MS, Ramaekers R, Gonen M, et al: Impact of the National Cancer Institute Community Cancer Centers Program on Clinical Trial and Related Activities at a Community Cancer Center in Rural Nebraska. J Oncol Pract. 12:67-8, e44-51, 2016.
- Lara PN, Jr., Paterniti DA, Chiechi C, et al: Evaluation of factors affecting awareness of and willingness to participate in cancer clinical trials. J Clin Oncol. 23:9282-9, 2005.
- Trauth JM, Jernigan JC, Siminoff LA, et al: Factors affecting older African American women's decisions to join the PLCO Cancer Screening Trial. J Clin Oncol. 23:8730-8, 2005.
- Fouad MN, Acemgil A, Bae S, et al: Patient Navigation As a Model to Increase Participation of African Americans in Cancer Clinical Trials. J Oncol Pract. 12:556-63, 2016.
Posted: August 21, 2019
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