Continuing Professional Development for Radiation Oncologists: Where are the Gaps and Barriers?

PURPOSE/OBJECTIVE(S)

Continuing professional development (CPD) involves continuing medical education (CME), as well as educational activities to enhance research, teaching and leadership skills. Although CPD has been well explored in other specialties, the literature pertaining to radiation oncology is lacking. We sought to evaluate current CPD practices of radiation oncologists (RO) and identify unmet needs and barriers.

MATERIALS/METHODS

An online survey on CPD was developed in English and French, approved by ethics board, and emailed to all RO departments across Canada. Respondents' current practices, preferences, barriers, and needs were explored across the CPD domains of CME, research, teaching and administrative skills.

RESULTS

One-hundred twenty-four radiation oncologists completed the survey with representation across all listed disease sites and provinces. Respondents had an average 13.6 years of experience as staff (6 months to 38 years) and 96% were affiliated with a university. ROs indicated the most helpful resources for CME were reading journal articles (27%), attending tumor boards (25%), conferences (19%), informal discussion with colleagues (11%), free online websites (e.g., NCCN) (4%) and Twitter (3.5%). Lack of time was unanimously regarded as a barrier for CME. Other barriers included growing clinical workloads, expanding literature, and a lack of renumeration for CME. The mean score was 3.5/5, between "neutral" and "satisfied" for "satisfaction that CME needs are met" on a 5-point Likert scale. Seventy-six percent of respondents are currently engaged in research, with 46% involved as a research supervisor. However, only 35% had protected time for research (ranging from 10-80% FTE). Time (89%), funding (63%) and human resources (63%) were cited as barriers. Respondents wanted to improve skills in statistical analysis, clinical trial design and grant writing. Most researchers (78%) were comfortable with quantitative methodologies. Conversely, only 35% were comfortable with qualitative methods. Nearly all respondents (98%) were involved with clinical teaching. While the majority of respondents were satisfied with their teaching ability, many wanted to improve skills in coaching, providing feedback and delivering lectures. The preferred learning formats for improving these skills were either workshops at conferences or online. Half of the respondents are currently in an administrative/leadership role, and of those that are not, only 30% were interested in pursuing future leadership positions. The main barriers cited were time and the experience required.

CONCLUSION

Overall satisfaction scores for current CME practices were mediocre amongst Canadian radiation oncologists - a group that is mostly in university-affiliated/academic practices with 98% involved in clinical teaching. There are notable barriers and unmet needs in research, teaching and administration - highlighting potential areas for future CPD initiatives in radiation oncology.

RAPid SimPLE (RAPPLE) Targeted Radiation Treatment vs. Whole Brain Radiotherapy: A Retrospective Study of Matched Patients with Brain Metastases and Poor Prognosis

PURPOSE/OBJECTIVE(S)

Patients with brain metastases and poor prognosis are often treated with whole brain radiotherapy (WBRT) which can cause a variety of side effects. Our institution devised a new brain-sparing radiotherapy technique to treat multiple brain metastasis for patients whose poor prognosis does not warrant SRS. This study compares the oncologic outcomes of matched patients treated with RAPPLE and WBRT.

MATERIALS/METHODS

RAPPLE uses single-isocenter, coplanar volumetric modulated arc therapy and a non-stereotactic head-shell with IntegraBite™. Brain metastasis were contoured in a single gross tumor volume and expanded by 3 mm to create a planning target volume, of which 99.5% was covered with 95-110% of 20 Gy in 5 fractions. Patients treated with a first course of RAPPLE from January 2017 to December 2021 were identified in an institutional database. Using age, cancer diagnosis, and treatment date, we identified a matched cohort of patients receiving a first course of WBRT with 20 Gy in 5 fractions. Overall survival (OS) was calculated using the Kaplan-Meier method, and intracranial progression was calculated using cumulative incidence with a competing risk of death. Log-rank, Cox regression and Fine-Gray analyses were used for comparisons. Paired t-tests were used to compare patient-reported fatigue measured using 5-level Likert scales before and 2-6 weeks after radiotherapy.

RESULTS

The RAPPLE and WBRT cohorts each had 137 patients. The matched median age was 69 years. Primary diagnoses were lung cancer (72%) and other cancers (28%). The minimum, median, and maximum numbers of metastases treated with RAPPLE were 1, 3, and 18, respectively. The median Karnofsky Performance Score (KPS) was 70 in both cohorts. The median survival was 4.1 months for RAPPLE and 4.2 months for WBRT, and the 18-month OS was 11% for RAPPLE and 12% for WBRT (log-rank p = 0.8). On multivariable analysis, KPS, diagnosis, extracranial disease, and use of systemic therapy before and after RT were predictive of OS, but use of RAPPLE vs. WBRT was not (HR = 0.97, 95% CI: 0.75-1.25, p = 0.8). The 18-month cumulative incidence of intracranial progression was 0.49 for RAPPLE and 0.37 for WBRT (p = 0.04). After RAPPLE, 17% required more focal RT and 4% required salvage WBRT, while after WBRT, 3% required focal RT and 4% required repeat WBRT. After RAPPLE, mean patient-reported fatigue remained stable from baseline to first follow-up (2.18 vs. 2.27, p = 0.9), but, after WBRT, it worsened from baseline to first follow-up (1.95 vs. 2.63, p = 0.002).

CONCLUSION

As expected, after RAPPLE, more targeted radiotherapy was required for intracranial progression, but there was no difference in OS between the RAPPLE and WBRT cohorts. Patients reported significantly worse fatigue after WBRT. Almost all patients (96%) treated with RAPPLE avoided WBRT.