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Coleman CN, Wong R, Petereit DG, Maguire PD, Heron DE, Steinberg M, Bains Y, Vikram B, Angelis P, Livinski AA, Roach M, Govern FS. The National Cancer Institute's Cancer Disparities Research Partnership Program: a unique funding model 20 years later. J Natl Cancer Inst 2023; 115:1465-1474. [PMID: 37707545 PMCID: PMC10699796 DOI: 10.1093/jnci/djad173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Revised: 06/29/2023] [Accepted: 08/22/2023] [Indexed: 09/15/2023] Open
Abstract
The burden of cancer and access to effective treatment are not experienced equally by all in the United States. For underserved populations that often access the health-care system when their cancers are in advanced disease stages, radiation oncology services are essential. In 2001, the National Cancer Institute's (NCI's) Radiation Research Program created and implemented the Cancer Disparities Research Partnership Program (CDRP). CDRP was a pioneering funding model whose goal was to increase participation of medically underserved populations in NCI clinical trials. CDRP's Cooperative Agreement funding supported for awardees the planning, development, and conduct of radiation oncology clinical research in institutions not traditionally involved in NCI-sponsored research and cared for a disproportionate number of medically underserved, health-disparities populations. The awardee secured and provided support for mentorship from 1 of 2 NCI comprehensive cancer centers named in its application. Six CDRP awards were made over two 5-year funding periods ending in 2013, with the end-of-program accomplishments previously reported. With the current focus on addressing equity, diversity, and inclusion, the 6 principal investigators were surveyed, 5 of whom responded about the impact of CDRP on their institutions, communities, and personal career paths. The survey that was emailed included 10 questions on a 5-point Likert scale. It was not possible to collect patient data this long after completion of the program. This article provides a 20-year retrospective of the experiences and observations from those principal investigators that can inform those now planning, building, and implementing equity, diversity, and inclusion programs.
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Affiliation(s)
- C Norman Coleman
- Radiation Research Program, Division of Cancer Treatment and Diagnosis, National Cancer Institute, National Institutes of Health, Rockville, MD, USA
| | - Rosemary Wong
- Radiation Research Program, Division of Cancer Treatment and Diagnosis, National Cancer Institute, National Institutes of Health, Rockville, MD, USA
| | | | - Patrick D Maguire
- Coastal Carolina Radiation Oncology (Novant-New Hanover Regional Medical Center Radiation Oncology), Wilmington, NC, USA
| | | | - Michael Steinberg
- Department of Radiation Oncology, David Geffen School of Medicine at the University of California Los Angeles, Los Angeles, CA, USA
| | | | - Bhadrasain Vikram
- Radiation Research Program, Division of Cancer Treatment and Diagnosis, National Cancer Institute, National Institutes of Health, Rockville, MD, USA
| | - Patricia Angelis
- Radiation Research Program, Division of Cancer Treatment and Diagnosis, National Cancer Institute, National Institutes of Health, Rockville, MD, USA
| | - Alicia A Livinski
- National Institutes of Health Library, Office of Research Services, Office of the Director, National Institutes of Health, Bethesda, MD, USA
| | - Mack Roach
- Radiation Research Program, Division of Cancer Treatment and Diagnosis, National Cancer Institute, National Institutes of Health, Rockville, MD, USA
- Departments of Radiation Oncology and Urology, University of California San Francisco, San Francisco, CA, USA
| | - Frank S Govern
- Radiation Research Program, Division of Cancer Treatment and Diagnosis, National Cancer Institute, National Institutes of Health, Rockville, MD, USA
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McPhee NJ, Nightingale CE, Harris SJ, Segelov E, Ristevski E. Barriers and enablers to cancer clinical trial participation and initiatives to improve opportunities for rural cancer patients: A scoping review. Clin Trials 2022; 19:464-476. [PMID: 35586873 DOI: 10.1177/17407745221090733] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
| | - Claire E Nightingale
- Monash Rural Health, Monash University, Bendigo, VIC, Australia.,Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia
| | - Samuel J Harris
- Department of Medical Oncology, Bendigo Health, Bendigo, VIC, Australia
| | - Eva Segelov
- Department of Medicine, School of Clinical Sciences, Faculty of Medicine, Monash University, Clayton, VIC, Australia.,Department of Oncology, Monash Health, Clayton, VIC, Australia
| | - Eli Ristevski
- Monash Rural Health, Monash University, Warragul, VIC, Australia
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Antunez AG, Kanters AE, Regenbogen SE. Evaluation of Access to Hospitals Most Ready to Achieve National Accreditation for Rectal Cancer Treatment. JAMA Surg 2020; 154:516-523. [PMID: 30785616 DOI: 10.1001/jamasurg.2018.5521] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Importance The American College of Surgeons National Accreditation Program for Rectal Cancer (NAPRC) promotes multidisciplinary care to improve oncologic outcomes in rectal cancer. However, accreditation requirements may be difficult to achieve for the lowest-performing institutions. Thus, it is unknown whether the NAPRC will motivate care improvement in these settings or widen disparities. Objectives To characterize hospitals' readiness for accreditation and identify differences in the patients cared for in hospitals most and least prepared for accreditation. Design, Setting, and Participants A total of 1315 American College of Surgeons Commission on Cancer-accredited hospitals in the National Cancer Database from January 1, 2011, to December 31, 2015, were sorted into 4 cohorts, organized by high vs low volume and adherence to process standards, and patient and hospital characteristics and oncologic outcomes were compared. The patients included those who underwent surgical resection with curative intent for rectal adenocarcinoma, mucinous adenocarcinoma, or signet ring cell carcinoma. Data analysis was performed from November 2017 to January 2018. Exposures Hospitals' readiness for accreditation, as determined by their annual resection volume and adherence to 5 available NAPRC process standards. Main Outcomes and Measures Hospital characteristics, patient sociodemographic characteristics, and 5-year survival by hospital. Results Among the 1315 included hospitals, 38 (2.9%) met proposed thresholds for all 5 NAPRC process standards and 220 (16.7%) met the threshold on 4 standards. High-volume hospitals (≥20 resections per year) tended to be academic institutions (67 of 104 [64.4%] vs 159 of 1211 [13.1%]; P = .001), whereas low-volume hospitals (<20 resections per year) tended to be comprehensive community cancer programs (530 of 1211 [43.8%] vs 28 of 104 [26.9%]; P = .001). Patients in low-volume hospitals were more likely to be older (11 429 of 28 076 [40.7%] vs 4339 of 12 148 [35.7%]; P < .001) and have public insurance (13 054 of 28 076 [46.5%] vs 4905 of 12 148 [40.4%]; P < .001). Low-adherence hospitals were more likely to care for black and Hispanic patients (1980 of 19 577 [17.2%] vs 3554 of 20 647 [10.1%]; P < .001). On multivariable Cox proportional hazards model regression, high-volume hospitals had better 5-year survival outcomes than low-volume hospitals (hazard ratio, 0.99; 95% CI, 0.99-1.00; P < .001), but there was no significant survival difference by hospital process standard adherence. Conclusions and Relevance Hospitals least likely to receive NAPRC accreditation tended to be community institutions with worse survival outcomes, serving patients at a lower socioeconomic position. To possibly avoid exacerbating disparities in access to high-quality rectal cancer care, the NAPRC study findings suggest enabling access for patients with socioeconomic disadvantage or engaging in quality improvement for hospitals not yet achieving accreditation benchmarks.
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Affiliation(s)
- Alexis G Antunez
- University of Michigan Medical School, Ann Arbor.,Center for Healthcare Outcomes and Policy, University of Michigan, Ann Arbor
| | - Arielle E Kanters
- Center for Healthcare Outcomes and Policy, University of Michigan, Ann Arbor.,Department of Surgery, University of Michigan, Ann Arbor
| | - Scott E Regenbogen
- Center for Healthcare Outcomes and Policy, University of Michigan, Ann Arbor.,Department of Surgery, University of Michigan, Ann Arbor
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Vapiwala N, Thomas CR, Grover S, Yap ML, Mitin T, Shulman LN, Gospodarowicz MK, Longo J, Petereit DG, Ennis RD, Hayman JA, Rodin D, Buchsbaum JC, Vikram B, Abdel-Wahab M, Epstein AH, Okunieff P, Goldwein J, Kupelian P, Weidhaas JB, Tucker MA, Boice JD, Fuller CD, Thompson RF, Trister AD, Formenti SC, Barcellos-Hoff MH, Jones J, Dharmarajan KV, Zietman AL, Coleman CN. Enhancing Career Paths for Tomorrow's Radiation Oncologists. Int J Radiat Oncol Biol Phys 2019; 105:52-63. [PMID: 31128144 PMCID: PMC7084166 DOI: 10.1016/j.ijrobp.2019.05.025] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2018] [Revised: 05/03/2019] [Accepted: 05/08/2019] [Indexed: 02/07/2023]
Affiliation(s)
- Neha Vapiwala
- Department of Radiation Oncology, Abramson Cancer Center, University of Pennsylvania, Philadelphia, Pennsylvania.
| | - Charles R Thomas
- Department of Radiation Medicine, Oregon Health and Science University, Portland, Oregon
| | - Surbhi Grover
- Department of Radiation Oncology, Abramson Cancer Center, University of Pennsylvania, Philadelphia, Pennsylvania; University of Botswana, Gaborone, Botswana
| | - Mei Ling Yap
- Collaboration for Cancer Outcomes Research and Evaluation, Ingham Institute, University of New South Wales, Sydney, Australia; Liverpool and Macarthur Cancer Therapy Centre, Western Sydney University, Campbelltown, Australia; School of Public Health, University of Sydney, Camperdown, Australia
| | - Timur Mitin
- Department of Radiation Medicine Director, Program in Global Radiation Medicine, Knight Cancer Institute, Oregon Health and Science University, Portland, Oregon
| | - Lawrence N Shulman
- Department of Radiation Oncology, Abramson Cancer Center, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Mary K Gospodarowicz
- Department of Radiation Oncology, University of Toronto, Cancer Clinical Research Unit, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - John Longo
- Department of Radiation Oncology Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Daniel G Petereit
- Department of Radiation Oncology, Rapid City Regional Cancer Care Institute, Rapid City, South Dakota
| | - Ronald D Ennis
- Clinical Network for Radiation Oncology, Rutgers and Cancer Institute of New Jersey, New Brunswick, New Jersey
| | - James A Hayman
- Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan
| | - Danielle Rodin
- Department of Radiation Oncology, University of Toronto, Toronto, Ontario, Canada; Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - Jeffrey C Buchsbaum
- Radiation Research Program, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Bhadrasain Vikram
- Clinical Radiation Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - May Abdel-Wahab
- Department of Nuclear Sciences and Applications, International Atomic Energy Agency, Vienna, Austria
| | - Alan H Epstein
- Uniformed Service University of the Health Sciences, Bethesda, Maryland
| | - Paul Okunieff
- Department of Radiation Oncology, University of Florida Health Cancer Center, Gainesville, Florida
| | - Joel Goldwein
- Department of Radiation Oncology, Abramson Cancer Center, University of Pennsylvania, Philadelphia, Pennsylvania; Elekta AB, Stockholm, Sweden
| | - Patrick Kupelian
- Department of Radiation Oncology, University of California Los Angeles, Los Angeles, California; Varian Medical Systems, Palo Alto, California
| | - Joanne B Weidhaas
- Department of Radiation Oncology, University of California Los Angeles, Los Angeles, California; MiraDx, Los Angeles, California
| | - Margaret A Tucker
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - John D Boice
- National Council on Radiation Protection and Measurements, Bethesda, Maryland; Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Clifton David Fuller
- Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Reid F Thompson
- Department of Radiation Medicine, Oregon Health and Science University, Portland, Oregon; VA Portland Health Care System, Portland, Oregon
| | - Andrew D Trister
- Department of Radiation Medicine, Oregon Health and Science University, Portland, Oregon
| | - Silvia C Formenti
- Department of Radiation Oncology, Weill Cornell Medicine, New York City, New York
| | | | - Joshua Jones
- Department of Radiation Oncology, Abramson Cancer Center, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Kavita V Dharmarajan
- Department of Radiation Oncology, Mount Sinai Hospital, Icahn School of Medicine at Mount Sinai, New York City, New York
| | - Anthony L Zietman
- Department of Radiation Oncology, Massachusetts General Hospital, Boston, Massachusetts
| | - C Norman Coleman
- National Cancer Institute, National Institutes of Health, Bethesda, Maryland
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Simon MA, Malin EL, Hitsman BL, Ciecierski CC, Victorson DE, Banas JR, Stuart M, Luedke T, Nu-Neighbors Advisory Committees, Cella D. Institutional Alliances to Reduce Cancer Disparities in Chicago. J Health Care Poor Underserved 2018; 27:97-113. [PMID: 27763461 DOI: 10.1353/hpu.2016.0007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
A partnership formed between Northeastern Illinois University (NEIU) and the Robert H. Lurie Comprehensive Cancer Center of Northwestern University sought to address well-documented cancer health disparities in Chicago by developing a collaborative research, training, and educational infrastructure between a minority-serving institution and a National Cancer Institute designated comprehensive cancer center. With a critical examination of partnership documentation and outputs, we describe the partnership's community-engaged approaches, challenges, and lessons learned. Northeastern Illinois University and the Lurie Cancer Center engaged in a yearlong partnership-building phase, identified interdisciplinary research teams, formed a governance structure, and identified collective aims. Partnership outcomes included funded inter-institutional research projects, new curriculum, and an annual research trainee program. Significant challenges faced included uncertain fiscal climate, widespread turnover, and dissimilar institutional demands. Lessons learned from this minority serving institution and comprehensive cancer center partnership may be useful for bridging distinct academic communities in the pursuit of ameliorating health disparities.
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McClelland S, Leberknight J, Guadagnolo BA, Coleman CN, Petereit DG. The pervasive crisis of diminishing radiation therapy access for vulnerable populations in the United States, part 2: American Indian patients. Adv Radiat Oncol 2018; 3:3-7. [PMID: 29556572 PMCID: PMC5856975 DOI: 10.1016/j.adro.2017.08.010] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2017] [Revised: 08/14/2017] [Accepted: 08/15/2017] [Indexed: 12/20/2022] Open
Abstract
INTRODUCTION American Indian/Alaska Native (AI/AN) patients with cancer disproportionally present with more advanced stages of disease and have the worst cancer-specific survival rates of any racial/ethnic group in the United States. The presence of disparities in radiation therapy (RT) access for AI/AN patients has rarely been examined. METHODS AND MATERIALS National Cancer Institute (NCI) initiatives toward addressing AI/AN disparities were examined. Additionally, an extensive PubMed literature search for studies investigating RT access disparities in AI/AN patients was performed. RESULTS Literature describing RT access disparities for the AI/AN patient population is sparse, revealing only 3 studies, each of which described initiatives from the Walking Forward program, the NCI Cancer Disparity Research Partnership initiative to address barriers to cancer screening among AI populations in the Northern Plains region (eg, geographic remoteness and mistrust of health care providers). This program has used patient navigation, community education, and access to clinical trials for more than 4000 AI/AN patients to combat high cancer mortality rates. Over the course of its 15-year existence, the program has resulted in patients presenting with earlier stages of disease and experiencing higher cure rates. Lung cancer, the most common cause of cancer-related mortality in AI/AN patients, is the most recent and ongoing focus of the program. CONCLUSION The amount of information regarding RT access in AI/AN patients is limited, with nearly all peer-reviewed published progress in this area being associated with the Walking Forward program. Further initiatives from this program will hopefully inspire similar initiatives throughout the country to reduce the barriers to optimized cancer care that these patients face. Given the similarities with cancer disparities of populations worldwide, the AI/AN experience should be included within the broad issue of a global shortage of cancer care among underserved populations.
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Affiliation(s)
- Shearwood McClelland
- Department of Radiation Medicine, Oregon Health & Science University, Portland, Oregon
| | | | - B. Ashleigh Guadagnolo
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | | | - Daniel G. Petereit
- Walking Forward Program, Rapid City, South Dakota
- International Cancer Expert Corps, Washington, DC
- Rapid City Regional Cancer Care Institute, Rapid City, South Dakota
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Williams TR, Coleman CN. Implementing Cancer Care for the Undeserved Globally: From the "5 R's" of Radiobiology to the "7 P's" of Global Cancer Care. Semin Radiat Oncol 2017; 27:95-97. [PMID: 28325247 DOI: 10.1016/j.semradonc.2016.11.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Tim R Williams
- International Cancer Expert Corps, New York, NY; Boca Raton Regional Hospital, Lynn Cancer Institute, Boca Raton, FL
| | - C Norman Coleman
- International Cancer Expert Corps, New York, NY; Radiation Research Program, Division of Cancer Treatment and Diagnosis, National Cancer Institute, Bethesda, MD.
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Coleman CN. Masters of Our Destiny: From Jazz Quartet to Symphony Orchestra. Int J Radiat Oncol Biol Phys 2016; 96:511-3. [PMID: 27681746 DOI: 10.1016/j.ijrobp.2016.07.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2016] [Revised: 07/05/2016] [Accepted: 07/11/2016] [Indexed: 11/16/2022]
Affiliation(s)
- C Norman Coleman
- Radiation Research Program, Division of Cancer Treatment and Diagnosis, National Cancer Institute, Bethesda, Maryland.
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Coleman CN, Minsky BD. The verdict is in: the time for effective solutions to the global cancer burden is now. Lancet Oncol 2015; 16:1146-7. [DOI: 10.1016/s1470-2045(15)00276-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2015] [Accepted: 08/26/2015] [Indexed: 11/25/2022]
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Coleman CN, Formenti SC, Williams TR, Petereit DG, Soo KC, Wong J, Chao N, Shulman LN, Grover S, Magrath I, Hahn S, Liu FF, DeWeese T, Khleif SN, Steinberg M, Roth L, Pistenmaa DA, Love RR, Mohiuddin M, Vikram B. The international cancer expert corps: a unique approach for sustainable cancer care in low and lower-middle income countries. Front Oncol 2014; 4:333. [PMID: 25478326 PMCID: PMC4237042 DOI: 10.3389/fonc.2014.00333] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2014] [Accepted: 11/01/2014] [Indexed: 11/13/2022] Open
Abstract
The growing burden of non-communicable diseases including cancer in low- and lower-middle income countries (LMICs) and in geographic-access limited settings within resource-rich countries requires effective and sustainable solutions. The International Cancer Expert Corps (ICEC) is pioneering a novel global mentorship-partnership model to address workforce capability and capacity within cancer disparities regions built on the requirement for local investment in personnel and infrastructure. Radiation oncology will be a key component given its efficacy for cure even for the advanced stages of disease often encountered and for palliation. The goal for an ICEC Center within these health disparities settings is to develop and retain a high-quality sustainable workforce who can provide the best possible cancer care, conduct research, and become a regional center of excellence. The ICEC Center can also serve as a focal point for economic, social, and healthcare system improvement. ICEC is establishing teams of Experts with expertise to mentor in the broad range of subjects required to establish and sustain cancer care programs. The Hubs are cancer centers or other groups and professional societies in resource-rich settings that will comprise the global infrastructure coordinated by ICEC Central. A transformational tenet of ICEC is that altruistic, human-service activity should be an integral part of a healthcare career. To achieve a critical mass of mentors ICEC is working with three groups: academia, private practice, and senior mentors/retirees. While in-kind support will be important, ICEC seeks support for the career time dedicated to this activity through grants, government support, industry, and philanthropy. Providing care for people with cancer in LMICs has been a recalcitrant problem. The alarming increase in the global burden of cancer in LMICs underscores the urgency and makes this an opportune time fornovel and sustainable solutions to transform cancer care globally.
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Affiliation(s)
| | | | - Tim R Williams
- Lynn Cancer Institute at Boca Raton Regional Hospital , Boca Raton, FL , USA
| | | | - Khee C Soo
- National Cancer Center , Singapore , Singapore
| | - John Wong
- National University Cancer Institute, National University of Singapore , Singapore , Singapore
| | - Nelson Chao
- Division of Hematologic Malignancies and Cellular Therapy, BMT and Global Cancer, Duke Cancer Institute, Duke University , Durham, NC , USA
| | | | - Surbhi Grover
- Department of Radiation Oncology, Abramson Cancer Center, University of Pennsylvania , Philadelphia, PA , USA
| | - Ian Magrath
- International Network for Cancer Treatment and Research , Brussels , Belgium
| | - Stephen Hahn
- Department of Radiation Oncology, Abramson Cancer Center, University of Pennsylvania , Philadelphia, PA , USA
| | - Fei-Fei Liu
- Department of Radiation Oncology, Radiation Medicine Program, Princess Margaret Cancer Centre, University of Toronto , Toronto, ON , Canada
| | - Theodore DeWeese
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University , Baltimore, MD , USA
| | - Samir N Khleif
- Cancer Center, Georgia Regents University , Augusta, GA , USA
| | - Michael Steinberg
- Department of Radiation Oncology, University of California Los Angeles , Los Angeles, CA , USA
| | - Lawrence Roth
- International Cancer Expert Corps , Chevy Chase, MD , USA
| | | | - Richard R Love
- International Cancer Expert Corps , Chevy Chase, MD , USA ; International Breast Cancer Research Foundation , Madison, WI , USA
| | | | - Bhadrasain Vikram
- Radiation Research Program, National Cancer Institute , Bethesda, MD , USA
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