Radiation Oncology: What's in a Name?

Effect of Terminology Used to Describe Medical Oncologists on Perceptions of Radiation Oncologists as Equal Partners in Cancer Care

Purpose

Our purpose was to assess the terminology used to describe the different oncologic subspecialties at academic institutions in the United States and determine whether the use of the term “oncologist” to describe a medical oncologist (MO) may affect the multidisciplinary care of patients with cancer.

Methods and Materials

An electronic survey was sent to chairs and program directors at all 94 academic radiation oncology departments in the United States. Questions assessed the terminology used to describe the oncologic subspecialties in their hospital’s electronic medical record system, their views on how that terminology may affect referral patterns, and the perception of radiation oncologists’ (ROs) role in patient care.

Results

Responses were received from 40 institutions (response rate, 42.6%). Fifteen percent of hospital electronic medical record systems used the term “oncology” instead of “medical oncology” (51%) or “hematology/oncology” (28%). Describing MOs simply as “oncologists” was thought to more likely affect patient views of MOs as the primary decision maker in their cancer care (mean Likert-type rating, 3.43) than it would affect the probability of up-front multidisciplinary referrals (mean Likert-type rating, 2.69). Patient perceptions of ROs as equal partners in care were thought to be less associated with the terminology used to describe MOs (mean Likert-type rating, 3.15) than the behavior of ROs in patient care (mean Likert-type rating, 4.65; P < .001), the attitude of MOs toward ROs (mean Likert-type rating, 4.59; P < .001), and the involvement of ROs in the initial new patient visits rather than a downstream referral (mean Likert-type rating, 3.95; P < .001).

Conclusions

The terminology used to describe MOs was thought to affect patient and provider perceptions of RO, but less so than other patient-provider interaction factors.

US Radiation Oncologists (Re)Defined: An American Society for Radiation Oncology Scope of Practice Study

PURPOSE

To assess US radiation oncologists' views on practice scope and the ideal role of the radiation oncologist (RO), the American Society for Radiation Oncology (ASTRO) conducted a scope of practice survey.

METHODS AND MATERIALS

In spring 2019, ASTRO distributed an online survey to 3822 US RO members. The survey generated 984 complete responses (26% response rate) for analysis. Face validity testing confirmed respondents were representative of ASTRO's RO membership.

RESULTS

Nearly all respondents agreed that "ROs should be leaders in oncologic care." Respondents indicated the ideal approach to patient care was to provide "an independent opinion on radiation therapy and other treatment options" (82.5%) or "an independent opinion on radiation therapy but not outside of it" (16.1%), with only 1.4% favoring provision of "radiation therapy at the request of the referring physician" as the ideal approach. Actual practice fully matched the ideal approach in 18.2% of respondents. For the remaining majority, actual practice did not always match the ideal and comprised a mix of approaches that included providing radiation at the referring physician's request 24.0% of the time on average. Reasons for the mismatch included fear of alienating referring physicians and concern for offering an unwelcome opinion. One-fifth of respondents expressed a desire to expand the scope of service though interspecialty politics and insufficient training were potential barriers. Respondents interested in expanding scope of practice were on average earlier in their career (average years in practice 13.3) than those who were not interested (average years in practice 17.2, P < .001). Radiopharmaceuticals administration, medical marijuana and anticancer medications prescribing, and RO inpatient service represented areas of interest for expansion but also knowledge gaps.

CONCLUSIONS

These results provide insight regarding US ROs' scope of practice and attitudes on the ideal role of the RO. For most ROs, to provide an independent opinion on treatment options represented the ideal approach to care, but barriers such as concern of alienating referring physicians prevented many from fully adhering to their ideal in practice. Actual practice commonly comprised a mixed approach, including the least favored scenario of delivering radiation at the referring physician's request one-quarter of the time, highlighting the influence of interspecialty politics on practice behavior. Advocacy for open communication and meaningful interdisciplinary collaboration presents an actionable solution toward a more balanced relationship with other specialties as ROs strive to better fulfill the vision of being leaders in oncologic care and being our best for our patients. The study also identified interest in expanding into nontraditional domains that offer opportunities to address unmet needs in the cancer patient's journey and elevate radiation oncology within the increasingly value-based US health care system.