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Camden N, Blumenfeld P, Roy S, Chowdhary M, King K, Shors S, Braun R, White G, Turian J, Wang D. Multiparametric Magnetic Resonance Imaging- Guided Dose-Escalated Radiation Therapy for Localized Prostate Cancer: A Prospective Phase 2 Trial. Pract Radiat Oncol 2024; 14:e132-e140. [PMID: 37923137 DOI: 10.1016/j.prro.2023.10.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Revised: 10/16/2023] [Accepted: 10/16/2023] [Indexed: 11/07/2023]
Abstract
PURPOSE This trial's purpose was to determine the late toxicity associated with dose escalation to Prostate Imaging Reporting and Data System (PI-RADS) III-V lesions on multiparametric magnetic resonance imaging (MRI) with an image guided combined IMRT-stereotactic body radiation therapy (SBRT) approach in men with localized prostate cancer. METHODS AND MATERIALS In this phase 2 trial patients with localized prostate cancer with clinical tumor stage T1-T3bN0 and at least one PIRADS III-V lesion were recruited to receive 45 Gy in 25 fractions to the prostate and seminal vesicles followed by a boost of 18 Gy in 3 fractions to the prostate with a simultaneous integrated boost 21 Gy in 3 fractions to the PI-RADS lesion(s). The primary endpoint was the cumulative incidence of late grade ≥3 genitourinary and gastrointestinal toxicity by 18 months (National Cancer Institute Common Terminology Criteria for Adverse Events, version 4.0). RESULTS Overall, 50 patients were enrolled in this study, and 43 patients completed at least 18 months of follow-up. The cumulative incidence of grade 1, 2, and 3 late genitourinary toxicity at 18 months was 18%, 53%, and 2%. One patient was noted to have grade 3 hematuria and needed cystoscopy-guided cauterization. No acute grade 3 gastrointestinal or genitourinary toxicities were observed. The cumulative incidence of grade 1, 2, and 3 late gastrointestinal toxicity at 18 months was 31%, 4%, and 0%, respectively. At a median follow-up of 43.5 months, 3 patients developed biochemical recurrence, each with distant bone metastases without local or nodal recurrence. At 3 years, freedom from biochemical failure rate was 95.3% (95% CI, 89.2%-100%). CONCLUSIONS Multiparametric MRI-guided dose escalation to PI-RADS III-V lesions using a combined image guided IMRT-SBRT approach is associated with an acceptable risk of late gastrointestinal and genitourinary toxicity. The results should be interpreted with caution considering their single institutional nature, small sample size, and short follow-up and should be validated in a larger study.
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Affiliation(s)
- Nathaniel Camden
- Department of Radiation Oncology, Rush University Medical Center, Chicago, Illinois
| | - Philip Blumenfeld
- Sharett Institute of Oncology, Hebrew University Medical Center, Jerusalem, Israel
| | - Soumyajit Roy
- Department of Radiation Oncology, Rush University Medical Center, Chicago, Illinois
| | - Mudit Chowdhary
- Department of Radiation Oncology, Lifespan Cancer Institute at Rhode Island Hospital, Brown University, Providence, Rhode Island
| | - Kevin King
- Department of Radiation Oncology, Rush University Medical Center, Chicago, Illinois
| | - Stephanie Shors
- Department of Diagnostic Radiology and Nuclear Medicine, Rush University Medical Center, Chicago, Illinois
| | - Ryan Braun
- Department of Radiation Oncology, Lifespan Cancer Institute at Rhode Island Hospital, Brown University, Providence, Rhode Island
| | - Greg White
- Department of Radiation Oncology, Lifespan Cancer Institute at Rhode Island Hospital, Brown University, Providence, Rhode Island
| | - Julius Turian
- Department of Radiation Oncology, Rush University Medical Center, Chicago, Illinois
| | - Dian Wang
- Department of Radiation Oncology, Rush University Medical Center, Chicago, Illinois.
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Shumway JW, Royce T, Bates J, Chhabra AM, Patel KR, Jones G, Vapiwala N, Marwaha G, Chowdhary M. Prospective 5-Year Analysis of the United States Radiation Oncology Job Market Using the ASTRO Career Center Website. Int J Radiat Oncol Biol Phys 2023; 115:828-835. [PMID: 36273522 DOI: 10.1016/j.ijrobp.2022.10.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Revised: 10/05/2022] [Accepted: 10/10/2022] [Indexed: 11/05/2022]
Abstract
PURPOSE We provide 5-year results of prospectively collected radiation oncology (RO) job opportunities and a longitudinal assessment of RO graduate numbers within the United States. METHODS AND MATERIALS Full-time domestic RO job opportunities were collected and categorized using the American Society for Radiation Oncology (ASTRO) Career Center from July 1, 2016 to June 30, 2021. A chi-square test was used to compare regional job availability by city size and position type. The corresponding number of graduating United States (US) RO residents (2017-2021) was collected. US census and Medicare database resources were used as comparators for population and workforce estimates. Pearson's correlation coefficients were used to examine changes in data over time and a 2-tailed t test was used to assess for statistical significance. RESULTS Over the 5-year study period, 819 unique job offers were posted, compared with 935 RO graduates (0.88 total jobs-to-graduates ratio). Most jobs were nonacademic (57.6%), located in populated areas >1 million (57.1%; median: 1.57M), with the largest proportion of jobs seen in the South region (32.4%). One-third of academic jobs were located at satellites. Regional differences were seen between academic versus nonacademic job availability (P < .01), with the highest proportion of academic jobs seen in the Northeast (60.3%) and the lowest in the Midwest (34.5%). Differences between regions were also observed for jobs in areas >1 million versus ≤1 million (P < .01), with the most jobs in areas >1 million seen in the West (64.6%) and the least in the South (51.3%). Regional job availability over time did not differ by position type (academic vs nonacademic) or population area size (P = .11 and P = .27, respectively). Annual graduate numbers increased with time (P = .02), with the highest percentage of graduates trained in the South (30.8%). Regional distribution of jobs versus graduates significantly differed (P < .01) with the lowest jobs-to-graduates ratio observed in the Northeast (0.67) and highest ratio in the West (1.07). Regional RO workforce estimates based on the 4336 radiation oncologists who were Medicare providers in 2020 were compared with total jobs and graduates by region with no difference observed between the distributions of the workforce and jobs (P = .39), but comparisons between the workforce and graduates were proportionally different (P < .01). The number of total jobs (vs graduates) per 10 million population in the Northeast, South, Midwest, and West were 30.2 (45.1), 21.0 (22.7), 30.6 (33.4), and 22.6 (21.2), respectively. CONCLUSIONS This multiyear quantitative assessment of the RO job market and graduates identified fewer job opportunities than graduates overall in most regions, most notably in the Northeast. Regional differences were seen between available job type (academic vs nonacademic) and population size (>1 million vs ≤1 million). The findings are worrisome for trainee oversupply and geographic maldistribution. The number and distribution of RO trainees and residency programs across the US should be evaluated to minimize job market imbalance for future graduates, promote workforce stability, and continue to meet the future societal needs of patients with cancer.
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Affiliation(s)
- John W Shumway
- Department of Radiation Oncology, University of North Carolina School of Medicine, Chapel Hill, North Carolina
| | - Trevor Royce
- Flatiron Health, New York, New York; Department of Radiation Oncology, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - James Bates
- Department of Radiation Oncology, Emory University School of Medicine, Atlanta, Georgia
| | | | | | - Gavin Jones
- Department of Radiation Oncology, The Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - Neha Vapiwala
- Department of Radiation Oncology, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania
| | - Gaurav Marwaha
- Department of Radiation Oncology, Rush University Medical Center, Chicago, Illinois
| | - Mudit Chowdhary
- Department of Radiation Oncology, The Warren Alpert Medical School of Brown University, Providence, Rhode Island; Northside Radiation Oncology Consultants, Northside Hospital Cancer Institute, Atlanta, Georgia.
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Dove AP, Ryckman J, Chhabra A, Beckta J, Chowdhary M. American Society of Clinical Oncology 2022 Annual Meeting Highlights for Radiation Oncologists. Adv Radiat Oncol 2022; 8:101107. [PMID: 36711066 PMCID: PMC9873492 DOI: 10.1016/j.adro.2022.101107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Accepted: 07/25/2022] [Indexed: 12/14/2022] Open
Abstract
The American Society of Clinical Oncology annual meeting is the largest multidisciplinary oncology-focused conference in the world. With almost 5000 total abstracts in 2022, it is difficult for individuals to evaluate all the results. Here we present a review of 28 selected abstracts, across all disease sites, focusing on those of greatest relevance to radiation oncologists.
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Affiliation(s)
- Austin P.H. Dove
- Department of Radiation Oncology, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Jeffrey Ryckman
- Department of Radiation Oncology, West Virginia University Medicine Camden Clark Medical Center, Parkersburg, West Virginia
| | | | - Jason Beckta
- Department of Radiation Oncology, University of Vermont Medical Center, Burlington, Vermont
| | - Mudit Chowdhary
- Northside Radiation Oncology Consultants, Northside Hospital Cancer Institute, Atlanta, Georgia
- Corresponding author: Mudit Chowdhary, MD
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Dove AP, Cmelak A, Darrow K, McComas KN, Chowdhary M, Beckta J, Kirschner AN. The Use of Low-Dose Radiotherapy in Osteoarthritis: A Review. Int J Radiat Oncol Biol Phys 2022; 114:203-220. [DOI: 10.1016/j.ijrobp.2022.04.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Revised: 04/08/2022] [Accepted: 04/21/2022] [Indexed: 11/26/2022]
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Siddiqui OM, Savla B, Chowdhary M, McAvoy S, Mishra M. From Beaming Cancer to Beaming Parent: Paternity Leave Experiences in Radiation Oncology. Int J Radiat Oncol Biol Phys 2022; 113:928-933. [DOI: 10.1016/j.ijrobp.2022.04.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Revised: 03/29/2022] [Accepted: 04/24/2022] [Indexed: 11/26/2022]
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Mattes MD, Deville C, Vega RBM, Fung CY, Suneja G, Shumway JW, Chowdhary M, Shah C, Bates JE, Mohindra P, Siker ML, Winkfield KM, Vapiwala N, Royce TJ. Demographics of ASTRO Student Members and Potential Implications for Future U.S. Radiation Oncology Workforce Diversity. Adv Radiat Oncol 2022; 7:100834. [PMID: 34977427 PMCID: PMC8688878 DOI: 10.1016/j.adro.2021.100834] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Revised: 09/06/2021] [Accepted: 09/28/2021] [Indexed: 11/20/2022] Open
Abstract
Purpose The radiation oncology workforce in the United States is comparatively less diverse than the U.S. population and U.S. medical school graduates. Workforce diversity correlates with higher quality care and outcomes. The purpose of this study was to determine whether student members of the American Society for Radiation Oncology (ASTRO) are any more diverse than resident members-in-training using the recently established medical student membership category. Methods and Materials Self-reported sex, race and Hispanic ethnicity, medical school, and degree(s) earned for all medical students (n = 268) and members-in-training (n = 713) were collected from the ASTRO membership database. International members were excluded. The χ2 test was used to assess for differences between subgroups. Results Compared with members-in-training, student members were more likely to be female (40.0% vs 31.5%, P = .032), black or African American (10.7% vs 4.8%, P = .009), candidates for or holders of a DO rather than MD degree (5.2% vs 1.5%, P = .002), and from a U.S. medical school that is not affiliated with a radiation oncology residency program (30.5% vs 20.9%, P = .001). There was no significant difference in self-reported Hispanic ethnicity (7.3% vs 5.4%, P = .356). There were no indigenous members in either category assessed. Conclusions Medical student members of ASTRO are more diverse in terms of black race, female sex, and osteopathic training, though not in terms of Hispanic ethnicity or nonmultiracial indigenous background, than the members-in-training. Longitudinal engagement with these students and assessment of the factors leading to specialty retention versus attrition may increase diversity, equity, and inclusion in radiation oncology.
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Affiliation(s)
- Malcolm D Mattes
- Department of Radiation Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick, New Jersey
| | - Curtiland Deville
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University, Baltimore, Maryland
| | - Raymond B Mailhot Vega
- Department of Radiation Oncology, University of Florida College of Medicine, Jacksonville, Florida
| | - Claire Y Fung
- Department of Radiation Oncology, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Gita Suneja
- Department of Radiation Oncology and Population Health Sciences, University of Utah, Salt Lake City, Utah
| | - John W Shumway
- Department of Radiation Oncology, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, North Carolina
| | - Mudit Chowdhary
- Department of Radiation Oncology, The Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - Chirag Shah
- Department of Radiation Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, Ohio
| | - James E Bates
- Department of Radiation Oncology, Winship Cancer Institute, Emory University, Atlanta, Georgia
| | - Pranshu Mohindra
- Department of Radiation Oncology, University of Maryland School of Medicine, Baltimore, Maryland
| | - Malika L Siker
- Department of Radiation Oncology, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Karen M Winkfield
- Meharry-Vanderbilt Alliance, Department of Radiation Oncology, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Neha Vapiwala
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Trevor J Royce
- Department of Radiation Oncology, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, North Carolina.,Flatiron Health, New York, New York
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Shukla U, Sueyoshi M, Diamond B, Chowdhury I, Stambaugh C, Wazer DE, Chowdhary M, Huber K. Disparities in Radiotherapy: Practice Patterns Analysis of DIBH use in Non-English Speakers. Int J Radiat Oncol Biol Phys 2022; 113:21-25. [PMID: 34986382 DOI: 10.1016/j.ijrobp.2021.12.171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Revised: 12/22/2021] [Accepted: 12/27/2021] [Indexed: 10/19/2022]
Abstract
PURPOSE/OBJECTIVES To examine current practice patterns in non-English speaking patients with breast cancer undergoing Deep Inspiratory Breath Hold (DIBH). MATERIALS/METHODS An anonymous, voluntary REDCap survey was distributed to 60 residency program coordinators of U.S. radiation oncology departments to survey their faculty and recent graduates. Eligibility was limited to board-certified radiation oncologists who have treated breast cancer within the prior 6 months. RESULTS There were 69 respondents, 53 of whom were eligible. 42% (n=22) of eligible respondents were from the main site at an academic center, with 28% (n=15) representing a satellite site, and 30% (n=16) from private practice. 53% reported at least 10% of their patients were non-English speaking. 90% offered DIBH at their institution and of those, 74% used DIBH for at least 1/4th of their patients with breast cancer. 98% of those who use DIBH performed coaching at simulation, with 32% answering they would be "less likely" to utilize DIBH for non-English speakers. When utilized, 94% take into consideration potential language barriers for proper execution of DIBH. However, 51% had an interpreter present 76-100% of the time at CT simulation, which decreased to 31% at first fraction, and 11% at subsequent treatments. For non-English speaking patients undergoing DIBH coaching without a certified interpreter, 55% of respondents indicated that they provided verbal coaching in English, 32% indicated "not applicable" because they always use a certified interpreter, 11% used visual aids, and 32% indicated "other." Of those who answered other, the most commonly cited response was utilizing therapists or staff who spoke the patient's native language. CONCLUSIONS Disparities in the application of DIBH exist despite its established utility in reducing cardiac dose. This study provides evidence that language barriers may impact physician treatment practices from initial consideration of DIBH to subsequent delivery. This data suggests that breast cancer treatment considerations and subsequent execution are negatively affected in non-English speaking patients.
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Affiliation(s)
- U Shukla
- Department of Radiation Oncology, Tufts University School of Medicine, Boston, MA; Department of Radiation Oncology, Warren Alpert Medical School of Brown University, Providence, RI.
| | - M Sueyoshi
- Department of Radiation Oncology, Tufts University School of Medicine, Boston, MA; Department of Radiation Oncology, Warren Alpert Medical School of Brown University, Providence, RI
| | - B Diamond
- Department of Radiation Oncology, Tufts University School of Medicine, Boston, MA; Department of Radiation Oncology, Warren Alpert Medical School of Brown University, Providence, RI
| | - I Chowdhury
- Department of Radiation Oncology, Tufts University School of Medicine, Boston, MA; Department of Radiation Oncology, Warren Alpert Medical School of Brown University, Providence, RI.
| | - C Stambaugh
- Department of Radiation Oncology, Tufts University School of Medicine, Boston, MA
| | - D E Wazer
- Department of Radiation Oncology, Tufts University School of Medicine, Boston, MA; Department of Radiation Oncology, Warren Alpert Medical School of Brown University, Providence, RI
| | - M Chowdhary
- Department of Radiation Oncology, Warren Alpert Medical School of Brown University, Providence, RI
| | - K Huber
- Department of Radiation Oncology, Tufts University School of Medicine, Boston, MA
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Shukla U, Chhabra A, Wazer D, Chowdhary M. American Society of Clinical Oncology 2021 Annual Meeting Highlights for Radiation Oncologists. Adv Radiat Oncol 2022; 7:100779. [PMID: 35071828 PMCID: PMC8767256 DOI: 10.1016/j.adro.2021.100779] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Accepted: 08/13/2021] [Indexed: 11/16/2022] Open
Abstract
The annual meeting of the American Society of Clinical Oncology is the largest multidisciplinary oncology-focused conference in the world. With more than 4900 total abstracts in 2021 alone, it is difficult for individuals to evaluate all the results. This article presents a review of 32 selected abstracts across all disease sites, focusing on those of greatest relevance to radiation oncologists.
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Affiliation(s)
- Utkarsh Shukla
- Department of Radiation Oncology, Tufts University School of Medicine, Boston, Massachusetts
- Department of Radiation Oncology, Lifespan Cancer Institute, The Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | | | - David Wazer
- Department of Radiation Oncology, Tufts University School of Medicine, Boston, Massachusetts
- Department of Radiation Oncology, Lifespan Cancer Institute, The Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - Mudit Chowdhary
- Department of Radiation Oncology, Tufts University School of Medicine, Boston, Massachusetts
- Department of Radiation Oncology, Lifespan Cancer Institute, The Warren Alpert Medical School of Brown University, Providence, Rhode Island
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Chowdhary M, O'Bryant S, Vapiwala N, Mohamad O, Royce TJ. In Reply to Chowdhry. Int J Radiat Oncol Biol Phys 2021; 111:1093. [PMID: 34655557 DOI: 10.1016/j.ijrobp.2021.07.1719] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Accepted: 07/30/2021] [Indexed: 11/26/2022]
Affiliation(s)
- Mudit Chowdhary
- Department of Radiation Oncology, The Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | | | - Neha Vapiwala
- Department of Radiation Oncology, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania
| | - Osama Mohamad
- Department of Radiation Oncology, University of California San Francisco, San Francisco, California
| | - Trevor J Royce
- Department of Radiation Oncology, University of North Carolina School of Medicine, Chapel Hill, North Carolina; Flatiron Health, New York, New York
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Chowdhury I, Shukla U, Witt J, McFarlane M, Royce T, Miller C, Huber K, Katz M, Chowdhary M. Unsealing the Source: Scope of Practice for Radiopharmaceuticals/Unsealed Sources Among U.S. Radiation Oncologists. Int J Radiat Oncol Biol Phys 2021. [DOI: 10.1016/j.ijrobp.2021.07.1067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Shukla U, Chowdhury IH, Beckta JM, Witt JS, McFarlane M, Miller CJ, Huber KE, Katz MS, Royce TJ, Chowdhary M. Unsealed Source: Scope of Practice for Radiopharmaceuticals Among United States Radiation Oncologists. Adv Radiat Oncol 2021; 7:100827. [PMID: 36148380 PMCID: PMC9486426 DOI: 10.1016/j.adro.2021.100827] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Accepted: 09/28/2021] [Indexed: 12/22/2022] Open
Abstract
Purpose Our purpose was to determine the utilization of and barriers to implementation of radiopharmaceutical therapy (RPT) among U.S. radiation oncologists. Methods and Materials An anonymous, voluntary 21-item survey directed toward attending radiation oncologists was distributed via social media platforms (Twitter, LinkedIn, Facebook, Student Doctor Network). Questions assessed practice characteristics, specific RPT prescribing patterns, RPT prescribing interest, and perceived barriers to RPT implementation. Nonparametric χ2 test was used for correlation statistics. Results Of the 142 respondents, 131 (92.3%) practiced in the United States and were included for this analysis. Respondents were well balanced in terms of practicing region, population size served, practice setting, and years in practice. Forty-eight percent (n = 63) reported prescribing at least 1 RPT. An additional 7% (n = 8) participate in RPT administration without billing themselves. Among those that actively prescribed RPT, the mean cumulative cases per month was 4.2 (range, 1-5). The most commonly prescribed radionuclides were radium-223 (40%; mean 2.8 cases/mo), iodine-131 (18%; mean 2.3 cases/mo), yttrium-90 (13%; mean 3.4 cases/mo), “other” (8%), samarium-153 (6%; mean 1.0 cases/mo), and strontrium-89 and phosphorous-32 (2% each; mean 1.8 and 0.4 cases/mo, respectively). Of those who answered “other,” lutetium-177 dotatate was most commonly prescribed (8%). No significant (P < .05) association was noted between practice type, practice location, years of practice, or practice volume with utilization of any RPTs. Most radiation oncologists (56%, n = 74) responded they would like to actively prescribe more RPT, although 27% (n = 35) were indifferent, and 17% (n = 22) said they would not like to prescribe more RPT. Perceived barriers to implementation were varied but broadly categorized into treatment infrastructure (44%, n = 57), interspecialty relations (41%, n = 53), lack of training (23%, n = 30), and financial considerations (16%, n = 21). Conclusions Among surveyed U.S. radiation oncologists, a significant number reported prescribing at least 1 RPT. The majority expressed interest in prescribing additional RPT. Wide-ranging barriers to implementation exist, most commonly interspecialty relations, treatment infrastructure, lack of training, and financial considerations.
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Affiliation(s)
- Utkarsh Shukla
- Department of Radiation Oncology, The Warren Alpert Medical School of Brown University, Providence, Rhode Island
- Department of Radiation Oncology, Tufts University School of Medicine, Boston, Massachusetts
| | - Imran H. Chowdhury
- Department of Radiation Oncology, The Warren Alpert Medical School of Brown University, Providence, Rhode Island
- Department of Radiation Oncology, Tufts University School of Medicine, Boston, Massachusetts
| | - Jason M. Beckta
- Northeastern Radiation Oncology, PLLC, Mollie Wilmot Radiation Oncology Center, Saratoga Springs, New York
| | - Jacob S. Witt
- Cancer Care Specialists of Illinois, O'Fallon, Illinois
| | | | - Chelsea J. Miller
- Department of Radiation Oncology, The Warren Alpert Medical School of Brown University, Providence, Rhode Island
- Department of Radiation Oncology, Tufts University School of Medicine, Boston, Massachusetts
| | - Kathryn E. Huber
- Department of Radiation Oncology, Tufts University School of Medicine, Boston, Massachusetts
| | - Matthew S. Katz
- Department of Radiation Medicine, Lowell General Hospital, Lowell, Massachusetts
| | - Trevor J. Royce
- Department of Radiation Oncology, University of North Carolina School of Medicine, Chapel Hill, North Carolina
- Flatiron Health, New York, New York
| | - Mudit Chowdhary
- Department of Radiation Oncology, The Warren Alpert Medical School of Brown University, Providence, Rhode Island
- Department of Radiation Oncology, Tufts University School of Medicine, Boston, Massachusetts
- Corresponding author: Mudit Chowdhary, MD
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Chowdhary M, Chhabra AM, Jhawar SR. Omission of Radiotherapy in Older Adults With Early-Stage Breast Cancer-Reply. JAMA Oncol 2021; 7:1398-1399. [PMID: 34292318 DOI: 10.1001/jamaoncol.2021.2407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Mudit Chowdhary
- Department of Radiation Oncology, The Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - Arpit M Chhabra
- Department of Radiation Oncology, New York Proton Center, New York, New York
| | - Sachin R Jhawar
- Department of Radiation Oncology, Ohio State University Comprehensive Cancer Center, Columbus
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Chowdhary M, Chhabra AM, Jhawar SR. Is It Time to Reevaluate Radiotherapy Omission in Older Patients With Favorable Early-Stage Breast Cancer? JAMA Oncol 2021; 7:965-966. [PMID: 33704370 DOI: 10.1001/jamaoncol.2021.0064] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Mudit Chowdhary
- Department of Radiation Oncology, Rush University Medical Center, Chicago, Illinois
| | - Arpit M Chhabra
- Department of Radiation Oncology, New York Proton Center, New York
| | - Sachin R Jhawar
- Department of Radiation Oncology, Ohio State University Comprehensive Cancer Center, Columbus
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Warren GW, Lim VS, Chowdhary M, Marwaha G, Abd Elbadee OM, Kirakli EK, Billiet C, Marin AG, Ramos M, Suppli MH, McGinnis GJ, Adjei AA. New Pulmonary Infiltrates Observed on Computed Tomography-Based Image Guidance for Radiotherapy Warrant Diagnostic Workup for Coronavirus Disease 2019. J Thorac Oncol 2021; 16:1946-1951. [PMID: 34166850 PMCID: PMC8216849 DOI: 10.1016/j.jtho.2021.06.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Revised: 05/21/2021] [Accepted: 06/08/2021] [Indexed: 11/09/2022]
Abstract
Introduction Screening for coronavirus disease 2019 (COVID-19) exposure, coupled with engaged decision making to prioritize cancer treatment in parallel with reducing risk of exposure and infection, is crucial in the management of COVID-19 during cancer treatment. After two reported case studies of imaging findings during daily computed tomography (CT)-based image-guided radiotherapy (RT) scans, a call for submission of anonymized case reports was published with the objective of rapidly determining if there was a correlation between the onset of new pulmonary infiltrates found during RT and COVID-19. We hereby report the results of the aggregate analysis. Methods Data of deidentified case reports for patients who developed biochemically confirmed COVID-19 during RT were submitted through an online portal. Information requested included a patient’s sex, age, cancer diagnosis and treatment, and COVID-19 diagnosis and outcome. Coplanar CT-based imaging was requested to reveal the presence or absence of ground-glass opacities or infiltrates. Results A total of seven reports were submitted from Turkey, Spain, Belgium, Egypt, and the United States. Results and imaging from the patients reported by Suppli et al. and McGinnis et al. were included for a total of nine patients for analysis. All patients were confirmed COVID-19 positive using polymerase chain reaction-based methods or nasopharyngeal swabs. Of the nine patients analyzed, abnormalities consistent with ground-glass opacities or infiltrates were observed in eight patients. Conclusions This is the largest case series revealing the potential use of CT-based image guidance during RT as a tool for identifying patients who need further workup for COVID-19. Considerations for reviewing image guidance for new pulmonary infiltrates and immediate COVID-19 testing in patients who develop new infiltrates even without COVID-19 symptoms are strongly encouraged.
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Affiliation(s)
- Graham W Warren
- Department of Radiation Oncology, Medical University of South Carolina, Charleston, South Carolina.
| | - Vun-Sin Lim
- International Association for the Study of Lung Cancer, Denver, Colorado
| | - Mudit Chowdhary
- Department of Radiation Oncology, Rush University Medical Center, Chicago, Illinois
| | - Gaurav Marwaha
- Department of Radiation Oncology, Rush University Medical Center, Chicago, Illinois
| | | | - Esra Korkmaz Kirakli
- Department of Radiation Oncology, Dr. Suat Seren Chest Diseases and Surgery Research and Training Hospital, Ismir, Turkey
| | - Charlotte Billiet
- Department of Radiation Oncology, Iridium Netwerk, Antwerp, Belgium; Center for Oncological Research (CORE), Integrated Personalized and Precision Oncology Network (IPPON), University of Antwerp, Antwerp, Belgium
| | | | - Monica Ramos
- Department of Radiation Oncology, Vall d'Hebron University Hospital, Barcelona, Spain
| | - Morten Hiul Suppli
- Department of Oncology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Gwendolyn J McGinnis
- Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Alex A Adjei
- Department of Oncology and Pharmacology, Mayo Clinic, Rochester, Minnesota
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Chowdhary M, O'Bryant S, Peters GW, Vapiwala N, Mohamad O, Royce TJ. United States Radiation Oncology Fellowship Growth From 2010 to 2020. Int J Radiat Oncol Biol Phys 2021; 111:622-626. [PMID: 34147580 DOI: 10.1016/j.ijrobp.2021.06.022] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2021] [Revised: 06/02/2021] [Accepted: 06/12/2021] [Indexed: 11/17/2022]
Abstract
PURPOSE To provide a comprehensive analysis of radiation oncology (RO) fellowship growth from 2010 to 2020. METHODS AND MATERIALS A collated database of RO fellowship programs and matriculants was created using (1) RO residency program (n = 92) and graduate (n = 2082) web searches, (2) prospective American Society for Radiation Oncology (ASTRO) Career Center postings database, (3) Association of Residents in Radiation Oncology Fellowship Directory, (4) RO fellowship survey data, (5) ASTRO Membership Directory, and (6) direct e-mail contact with fellowship program directors. Linear regression was used to assess the statistical significance of RO fellowship program, position, and matriculant growth over time. RESULTS From 2010 to 2020, the number of RO fellowship programs and annual positions significantly increased from 20 to 37 (1.60 increase per year; 95% confidence interval, 1.32-1.89; P < .001) and 20 to 39 (1.81 increase per year; 95% confidence interval, 1.52-2.10; P < .001), respectively. The most commonly offered fellowship disciplines were proton therapy (n = 10), brachytherapy (n = 7), stereotactic radiosurgery/stereotactic body radiation therapy (n = 6), general RO (n = 5), and customizable to trainees' interests (n = 3). Only 10 (27%) fellowships had a formal curriculum. All fellowships were unaccredited. Four (10.8%) programs were offered at institutions without an Accreditation Council for Graduate Medical Education-accredited RO residency training program, all established within the past 2 years. In addition, 54.8% (171 of 312) of available fellowship positions were filled between 2010 to 2020. Of these, 94 (55.0%) were graduates of US RO residency programs. The mean number of total fellows and US-residency trained fellows per year was 15 (range, 5-23) and 8 (range, 2-20), respectively. There was no significant increase in the number of annual matriculated fellows over time (P = .077). Among US-residency trained fellows, 27 (28.7%), 37 (39.4%), and 29 (30.9%) were from small (≤6), medium (7-12), and large (>12) residency programs, respectively. Twenty-eight (29.8%), 13 (13.8%), 25 (26.6%), and 27 (28.7%) trained in the Northeast, Midwest, South, and West, respectively. CONCLUSIONS There has been significant growth in unaccredited RO fellowship programs and annual positions during the past decade, although the number of matriculants has remained stable. We report for the first time the recent establishment of fellowships at institutions without an Accreditation Council for Graduate Medical Education-accredited RO residency program. The impact of fellowship programs on the training of RO residents should be studied.
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Affiliation(s)
- Mudit Chowdhary
- Department of Radiation Oncology, The Warren Alpert Medical School of Brown University, Providence, Rhode Island.
| | | | - Gabrielle W Peters
- Department of Therapeutic Radiology, Yale School of Medicine, New Haven, Connecticut
| | - Neha Vapiwala
- Department of Radiation Oncology, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania
| | - Osama Mohamad
- Department of Radiation Oncology, University of California San Francisco, San Francisco, California
| | - Trevor J Royce
- Department of Radiation Oncology, University of North Carolina School of Medicine, Chapel Hill, North Carolina; Flatiron Health, New York, New York
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Royce TJ, Jones GP, Muralidhar V, Chowdhary M, Holmes GM. US Primary Care vs Specialty Care Trainee Positions and Physician Incomes: Trends From 2001 to 2019. J Grad Med Educ 2021; 13:385-389. [PMID: 34178264 PMCID: PMC8207908 DOI: 10.4300/jgme-d-20-00941.1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Revised: 10/23/2020] [Accepted: 02/24/2021] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Much of the Affordable Care Act (ACA) and subsequent US health care policies were designed to address deficiencies in health care access and enhance primary care services. How residency positions and physician incomes have changed in the post-ACA era is not well characterized. OBJECTIVE We evaluated the growth of US trainee positions and physician income, in the pre- vs post-ACA environment by specialty and among primary care vs specialty care. METHODS Total resident complement by specialty and year was extracted from the National Graduate Medical Education (GME) Census and stratified into primary care vs specialty care. Median incomes were extracted from Medical Group Management Association surveys. Piecewise linear regression with interaction terms (pre-ACA, 2001-2010, vs post-ACA, 2011-2019) assessed growth rate by specialty and growth rate differences between primary care and specialty care. Sensitivity analyses were performed by focusing on family medicine and excluding additional GME positions contributed by the introduction of the 2015 single GME accreditation system. RESULTS Resident complements increased for primary care (+0.16%/year pre-ACA to +2.06%/year post-ACA, P < .001) and specialty care (+1.49%/year to +2.07%/year, P = .005). Specialty care growth outpaced primary care pre-ACA (P < .001) but not post-ACA (P = .10). Family medicine had the largest increase in the pre- vs post-ACA era (-0.77%/year vs +2.09%/year, P < .001). Excluding positions contributed by the single GME accreditation system transition did not result in any statistically significant changes to the findings. Income growth increased for primary care (+0.84%/year to +1.37%/year, P = .044), but decreased for specialty care (+1.44%/year to +0.49%/year, P = .011). Specialty care income growth outpaced primary care pre-ACA (P < .001), but not post-ACA (P = .22). CONCLUSIONS We found significant growth differences in resident complement and income among primary care versus specialty care in the pre-/post-ACA eras.
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Affiliation(s)
- Trevor J. Royce
- Trevor J. Royce, MD, MS, MPH, is Assistant Professor, Department of Radiation Oncology, University of North Carolina at Chapel Hill
| | - Gavin P. Jones
- Gavin P. Jones, MD, is a Resident Physician, Department of Radiation Oncology, University of Kentucky
| | - Vinayak Muralidhar
- Vinayak Muralidhar, MD, MSc, is Chief Resident, Department of Radiation Oncology, Dana Farber Cancer Institute
| | - Mudit Chowdhary
- Mudit Chowdhary, MD, is a Resident Physician, Department of Radiation Oncology, Rush University
| | - George M. Holmes
- George M. Holmes, PhD, is Professor, Department of Health Policy and Management, University of North Carolina at Chapel Hill
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Jones G, Dhawan N, Chowdhary A, Royce TJ, Patel KR, Chhabra A, Knoll M, Deville C, Winkfield KM, Vapiwala N, Duma N, Chowdhary M. Gender and racial/ethnic disparities in academic oncology leadership. J Clin Oncol 2021. [DOI: 10.1200/jco.2021.39.15_suppl.11009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
11009 Background: Gender & racial/ethnic leadership disparities have been independently identified in academic hematology/oncology (HO) and radiation oncology (RO). Here, we evaluate gender and racial/ethnic intersectionality from the trainee to the leadership level. Methods: All ACGME accredited HO and RO training program websites were queried to identify constituent trainees, academic faculty, program directors (PD) and department chairs (DC), with a leadership position defined as PD or DC. Individual gender & race/ethnicity was determined using externally validated software tools (Gender-API, NamSor, & Onolytics), publicly available descriptors, and image review. We grouped individuals into 6 categories: White Male (WM), White Female (WF), Asian Male (AM), Asian Female (AF), Underrepresented Groups in Medicine (as defined by AAMC) Male (URMM) and Female (URMF). The chi-squared goodness-of-fit test was applied to examine if deviations exist between the observed vs. expected proportions of gender/race dyads in trainees, PD, and DC compared to academic faculty. Results: We identified 7,722 individuals from 2019-2020: 1,759 trainees (HO=1525; RO=234), 5,726 faculty (HO=4834; RO=892), 242 PD (HO=149; RO=93) and 237 DC (HO=144; RO=93). Leadership positions were most often comprised by WM (52.6%), and least often comprised by URMF (2.9%). Combined HO/RO analysis revealed significant differences in the observed representation of trainees & DC vs expected levels based on total faculty, respectively: WM (33.7% & 60.3% vs. 42.3%), WF (19.2% & 13.9% vs. 22.3%), AM (20.75% & 16.9% vs. 16.4%), AF (17.9% & 2.5% vs. 12.7%), URMM (4.09% & 5.5% vs. 3.5%) and URMF (4.3% & 0.8% vs. 2.8%), p<0.01. No differences were seen between PD vs total faculty. On subset analysis, there were significant differences observed in HO programs at the trainee, PD and DC levels compared to total faculty, whereas significant differences in RO programs were seen only at the DC level [Table]. Conclusions: Gender & racial/ethnic disparity is present in academic oncology. Specifically, women of all races/ethnicities are proportionally underrepresented in DC positions in HO and RO programs. These data can serve as a benchmark to raise awareness and monitor progress towards a more balanced workforce in oncology.[Table: see text]
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Affiliation(s)
| | | | - Akansha Chowdhary
- Robert H. Lurie Comprehensive Cancer Center of Northwestern University, Chicago, IL
| | | | - Kirtesh R. Patel
- Emory University School of Medicine, Winship Cancer Institute of Emory University, Atlanta, GA
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Affiliation(s)
- Gavin P Jones
- Department of Radiation Medicine, University of Kentucky School of Medicine, Lexington, Kentucky
| | - Trevor J Royce
- Department of Radiation Oncology, University of North Carolina School of Medicine, Chapel Hill, North Carolina
| | - Mudit Chowdhary
- Department of Radiation Oncology, Rush University Medical Center, Chicago, Illinois
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Paul J, Grelewicz Z, Chowdhary M, Liao Y, Bernard D, Patel K, Turian J. Quantitative Medical Physics National Job Data Distribution Analysis. Pract Radiat Oncol 2021; 11:e438-e445. [PMID: 33689922 DOI: 10.1016/j.prro.2021.02.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Revised: 01/11/2021] [Accepted: 02/26/2021] [Indexed: 11/26/2022]
Abstract
PURPOSE The purpose of this study was to investigate the contemporary distribution of medical physics (MP) employment opportunities across the United States. METHODS AND MATERIALS An annual record (2018-2019) of advertised full-time MP jobs was created using publicly available information from the American Association of Physicists in Medicine and Indeed websites. Listed jobs were categorized based on position name, work experience, job function, and geographic region. To account for regional population differences, a preponderance of employment opportunities per 10 million people was computed. Using Commission on Accreditation of Medical Physics Education Programs residency accreditation data, the nationwide locations of the MP training centers and the number of residency positions per annum were identified. A chi-square goodness-of-fit test was used for statistical analysis. RESULTS A total of 441 unique MP jobs were identified nationwide per annum (2018-2019). The highest percentage of MP jobs was reported from the South region (33.6%), and the lowest (17.2%) was from the West. Analysis revealed that 148 jobs (33.6%) were academic and 293 (66.4%) were nonacademic. The South had the most academic jobs overall (31.8%), whereas the West had the fewest (13.5%). Regionally, the highest percentage of academic jobs (46.9%) was reported from the Northeast, whereas the West had the lowest percentage (26.3%). The analysis of academic versus nonacademic job comparison by regions showed statistically significant differences (P = .0133). The Midwest and the West regions, respectively, showed the highest (18.2) and lowest (10.24) number of jobs per unit population, measured in 10 million. CONCLUSIONS To our knowledge, this is one of the first national quantitative job data analyses of MP job distributions. This study revealed the level of demand for qualified candidates in 2018 to 2019, showing an imbalance between academic and nonacademic positions across the regions of the United States. Moreover, the geographic distribution of job listings deviated significantly from expectation given the relative population of each region.
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Affiliation(s)
- Jijo Paul
- Department of Radiation Oncology, Rush University Medical Center, Chicago, Illinois; Department of Radiation Oncology, Karmanos Cancer Institute (Wayne State University) at McLaren Healthcare-Macomb/Clarkston/Oakland, Michigan.
| | - Zachary Grelewicz
- Department of Radiation Oncology, Rush University Medical Center, Chicago, Illinois
| | - Mudit Chowdhary
- Department of Radiation Oncology, Rush University Medical Center, Chicago, Illinois
| | - Yixiang Liao
- Department of Radiation Oncology, Rush University Medical Center, Chicago, Illinois
| | - Damian Bernard
- Department of Radiation Oncology, Rush University Medical Center, Chicago, Illinois
| | - Kirtesh Patel
- Department of Radiation Oncology, Kaiser Permanente, Atlanta, Georgia
| | - Julius Turian
- Department of Radiation Oncology, Rush University Medical Center, Chicago, Illinois
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Vengaloor Thomas T, Perekattu Kuruvilla T, Kahn J, Bhanat E, Parr AQ, Albert A, Chowdhary M, Beriwal S, Vijayakumar S. Variations in Resources Among Radiation Oncology Residency Programs in the United States. Adv Radiat Oncol 2021; 6:100544. [PMID: 33521395 PMCID: PMC7820023 DOI: 10.1016/j.adro.2020.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Revised: 06/21/2020] [Accepted: 08/03/2020] [Indexed: 11/25/2022] Open
Abstract
The purpose of this research was to assess the existing variations in the residency training resources among radiation oncology (RO) residency programs in the United States. We queried each residency program website and Fellowship Residency Electronic Interactive Data Access System website (www.freida.ama-assn.org) to obtain information on faculty and available treatment modalities. The data were continuously updated, most recently as of April 30, 2019. A total of 94 RO residency programs were identified during the academic year 2018-2019, and data were collected. The median number of attending physicians was 13 (range, 4 -71). The median number of physicists and biologists were 9 and 3, respectively. The conventional techniques, including 3 dimensional conformal radation therapy, intensity modulated radiation therapy, electron therapy, and stereotactic body radiation therap/stereotactic radiosurgery, were available in all residency programs. In terms of specialized external beam radiation therapy machines, gamma knife, CyberKnife, and magnetic resonance imaging (MRI) linear accelerator were available in 49 (52%), 21(22%), and 7 (8%) programs, respectively. Only 19 programs (20%) had in-house proton therapy availability; however, 37 programs (39%) offered proton therapy training via resident rotation at an affiliated institution. Prostate, gynecologic, and breast brachytherapy were available in 81 (86%), 82 (87%), and 58 (62%) programs, respectively. Eighty-one (86%) programs reported to have high dose rate, and only 20 (21%) programs had low dose rate brachytherapy. Our study found that marked variations exist among RO residency programs in the United States during academic year 2018-2019 and will serve as a baseline for future intervention.
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Affiliation(s)
| | | | - Jenna Kahn
- Oregon Health & Science University (OHSU), Portland, Oregon
| | - Eldrin Bhanat
- University of Mississippi Medical Center, Jackson, Mississippi
| | - Amy Q Parr
- University of Mississippi Medical Center, Jackson, Mississippi
| | - Ashley Albert
- University of Mississippi Medical Center, Jackson, Mississippi
| | | | - Sushil Beriwal
- University of Pittsburgh Medical Center (UPMC), Pittsburgh, Pennsylvania
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Chowdhary M, Parikh SD, Lee A, Tendulkar RD, Royce TJ. Radiation Oncology Resident Quality by National Resident Matching Program Metrics From 2007 to 2018. Int J Radiat Oncol Biol Phys 2021; 109:324-328. [PMID: 32891796 DOI: 10.1016/j.ijrobp.2020.08.062] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Revised: 08/21/2020] [Accepted: 08/31/2020] [Indexed: 11/17/2022]
Abstract
PURPOSE To quantify how the quality of US medical students accepted to radiation oncology (RO) training programs, as defined by National Resident Matching Program (NRMP) metrics, has changed over time. METHODS AND MATERIALS We examined NRMP data of senior US medical students matched into RO training programs from 2007 to 2018. Metrics include United States Medical Licensing Exam (USMLE) Step 1 and 2-Clinical Knowledge scores, research output, percentage with PhD, and percentage in Alpha Omega Alpha (AOA), among others. Linear regression analysis assessed the statistical significance of changes in available metrics of matched RO residents over time. The Student t test and χ2 test compared quality metrics between matched students in RO versus all other specialties. RESULTS From 2007 to 2018, the mean USMLE Step 1 and 2-Clinical Knowledge for RO residents significantly increased from 235 to 247 (1.0 point/year; 95% confidence interval [CI], 0.70-1.52; P = .002) and from 237 to 253 (1.3 points/year; 95% CI, 1.27-1.62; P <.001), respectively. The mean number of research experiences and abstracts/presentations/publications increased from 3.7 to 6.1 (0.2/year; 95% CI, 0.12-0.29; P = .003) and from 6.3 to 15.6 (0.78/year; 95% CI, 0.60-1.04; P <.001), respectively. The percentage of RO residents inducted into AOA increased from 24.2% to 35.2%, whereas those with a PhD remained stable (∼21%). Matched RO residents had statistically superior metrics versus all other specialties for USMLE Step 1 scores (mean +13.5 points; 95% CI, 7.26-19.67; P <.001), research experience (mean +2.04; 95% CI, 1.11-2.97; P <.001), abstracts/presentations/publications (mean +6.80; 95% CI, 3.38-10.22; P = .001), percentage with a PhD (22.2% vs 4.1%; P <.001), and percentage in AOA (29.5% vs 15.8%; P <.001). CONCLUSIONS RO resident quality, defined by routinely reported NRMP metrics, increased from 2007 to 2018. Furthermore, RO resident quality is significantly higher than in all other specialties combined for most metrics. Whether the recent decline in medical student interest in RO will correlate with reduced NRMP quality metrics is unknown.
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Affiliation(s)
- Mudit Chowdhary
- Department of Radiation Oncology, Rush University Medical Center, Chicago, Illinois.
| | - Simul D Parikh
- Department of Radiation Oncology, Banner MD Anderson Cancer Center, Glendale, Arizona
| | - Anna Lee
- Department of Radiation Oncology, MD Anderson Cancer Center, Houston, Texas
| | | | - Trevor J Royce
- Department of Radiation Oncology, University of North Carolina School of Medicine, Chapel Hill, North Carolina
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Chhabra AM, Chowdhary M, Choi JI, Hasan S, Press RH, Simone CB. A National Survey of Radiation Oncology Experiences Completing Tele-Consultations During the Coronavirus Disease (COVID-19) Pandemic. Adv Radiat Oncol 2021; 6:100611. [PMID: 33458451 PMCID: PMC7803621 DOI: 10.1016/j.adro.2020.10.024] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Revised: 10/22/2020] [Accepted: 10/29/2020] [Indexed: 12/12/2022] Open
Abstract
Purpose The emergence of the coronavirus disease (COVID-19) global pandemic has led to a significant shift in the delivery of health care, including an explosive growth of telemedicine services. This reverberated in the field of radiation oncology, with a recent American Society for Radiation Oncology (ASTRO) nationwide survey reporting 89% of surveyed clinics began to offer telemedicine programs to patients because of the pandemic. However, this survey did not study the perceptions and experiences of those clinicians delivering telemedicine services. Methods and Materials We investigated through a national physician survey the merits and limitations of radiation oncology tele-consultations. An anonymous web-based survey was distributed using SurveyMonkey (www.surveymonkey.com) via email. Results Seventy six respondents (16.1% overall response rate) completed the survey, with broad representation from both academic and community-based practices. Many respondents agreed that transitioning to tele-consultations was a needed step given the emergence of the pandemic, despite most having never previously offered this service. Despite many radiation oncologists having little prior experience with tele-consultations, a majority were satisfied in being able to explain the details of a medical diagnosis, provide results of imaging and bloodwork, and discuss recommendations around radiation treatments through this format. Nearly half of the respondents agreed that tele-consultations felt impersonal, with the inability to complete physical examinations noted as a contributor to the impersonality. Nevertheless, respondents still agreed that telemedicine will play an important role going forward, and almost 90% agreed that they would offer tele-consultations even after the pandemic has resolved.
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Affiliation(s)
- Arpit M. Chhabra
- New York Proton Center, New York City, New York
- Corresponding author: Arpit Chhabra, MD
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Chowdhary M, Taparra K, Bates JE, Royce TJ. Radiation Oncology Application and Match Patterns, Pre- and Post-SOAP (Supplemental Offer and Acceptance Program) from 2012 to 2020. Pract Radiat Oncol 2020; 11:152-153. [PMID: 33158778 DOI: 10.1016/j.prro.2020.05.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2020] [Accepted: 05/19/2020] [Indexed: 10/23/2022]
Affiliation(s)
- Mudit Chowdhary
- Department of Radiation Oncology, Rush University Medical Center, Chicago, Illinois.
| | - Kekoa Taparra
- Mayo Clinic Alix School of Medicine, Rochester, Minnesota
| | - James E Bates
- Department of Radiation Oncology, University of Florida College of Medicine, Gainesville, Florida
| | - Trevor J Royce
- Department of Radiation Oncology, University of North Carolina School of Medicine, Chapel Hill, North Carolina
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Chowdhary M, Royce T, Bates J, Chhabra A, Patel K, Vapiwala N, Cox B, Marwaha G. A 4-Year Analysis of the Domestic Radiation Oncology Job Market. Int J Radiat Oncol Biol Phys 2020. [DOI: 10.1016/j.ijrobp.2020.07.2524] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Chowdhary M, Chowdhary A, Sen N, Zaorsky N, Patel K, Wang D. OC-0088: Neoadjuvant Radiotherapy vs Chemoradiotherapy for High-Risk Extremity and Trunk Soft Tissue Sarcoma. Radiother Oncol 2020. [DOI: 10.1016/s0167-8140(21)00114-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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King K, Chowdhary M, Blumenfeld P, White G, Turian J, Wang D. Multiparametric MRI Results After Dose Escalated Radiotherapy Of Localized Prostate Cancer: 2 Year Follow-Up Of A Prospective Phase II Trial. Int J Radiat Oncol Biol Phys 2020. [DOI: 10.1016/j.ijrobp.2020.07.529] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Chowdhary M, Peters G, Vapiwala N, Mohamad O, Royce T. Radiation Oncology Fellowship Growth from 2010-2020. Int J Radiat Oncol Biol Phys 2020. [DOI: 10.1016/j.ijrobp.2020.07.2559] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Bates JE, Parekh AD, Chowdhary M, Amdur RJ. Geographic Distribution of Radiation Oncologists in the United States. Pract Radiat Oncol 2020; 10:e436-e443. [DOI: 10.1016/j.prro.2020.04.008] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Revised: 03/31/2020] [Accepted: 04/22/2020] [Indexed: 11/16/2022]
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Knoll MA, Chowdhary M, Dicker A, Eichler T. Virtual Connectivity During Quarantine: The Role of Social Media for Radiation Oncology During COVID-19. Int J Radiat Oncol Biol Phys 2020; 108:506-508. [PMID: 32890544 PMCID: PMC7462933 DOI: 10.1016/j.ijrobp.2020.06.044] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Accepted: 06/21/2020] [Indexed: 11/26/2022]
Affiliation(s)
| | | | - Adam Dicker
- Thomas Jefferson University, Philadelphia, Pennsylvania
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Sim AJ, Laucis AM, Chowdhary M, Chino F, Golden DW, Tendulkar RD. Taking a Step in the Right Direction for Radiation Oncology. Int J Radiat Oncol Biol Phys 2020; 107:1014-1015. [PMID: 32698971 DOI: 10.1016/j.ijrobp.2020.04.033] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Accepted: 04/17/2020] [Indexed: 10/23/2022]
Affiliation(s)
- Austin J Sim
- Department of Radiation Oncology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, Florida
| | - Anna M Laucis
- Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan
| | - Mudit Chowdhary
- Department of Radiation Oncology, Rush University Medical Center, Chicago, Illinois
| | - Fumiko Chino
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Daniel W Golden
- Department of Radiation and Cellular Oncology, University of Chicago, Chicago, Illinois
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Chowdhary M, Greco L, McFarlane M, Spraker MB. In regard to Kabarriti et al. Adv Radiat Oncol 2020; 5:711-712. [PMID: 32775779 PMCID: PMC7255989 DOI: 10.1016/j.adro.2020.05.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Affiliation(s)
- Mudit Chowdhary
- Department of Radiation Oncology, Rush University Medical Center, Chicago, Illinois
| | | | - Matt McFarlane
- Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan
| | - Matthew B. Spraker
- Department of Radiation Oncology, Washington University in St Louis School of Medicine, St. Louis, Missouri
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Press RH, Zhang C, Chowdhary M, Prabhu RS, Ferris MJ, Xu KM, Olson JJ, Eaton BR, Shu HKG, Curran WJ, Crocker IR, Patel KR. Hemorrhagic and Cystic Brain Metastases Are Associated With an Increased Risk of Leptomeningeal Dissemination After Surgical Resection and Adjuvant Stereotactic Radiosurgery. Neurosurgery 2020; 85:632-641. [PMID: 30335175 DOI: 10.1093/neuros/nyy436] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2018] [Accepted: 08/19/2018] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Brain metastases (BM) treated with surgical resection and focal postoperative radiotherapy have been associated with an increased risk of subsequent leptomeningeal dissemination (LMD). BMs with hemorrhagic and/or cystic features contain less solid components and may therefore be at higher risk for tumor spillage during resection. OBJECTIVE To investigate the association between hemorrhagic and cystic BMs treated with surgical resection and stereotactic radiosurgery and the risk of LMD. METHODS One hundred thirty-four consecutive patients with a single resected BM treated with adjuvant stereotactic radiosurgery from 2008 to 2016 were identified. Intracranial outcomes including LMD were calculated using the cumulative incidence model with death as a competing risk. Univariable analysis and multivariable analysis were assessed using the Fine & Gray model. Overall survival was analyzed using the Kaplan-Meier method. RESULTS Median imaging follow-up was 14.2 mo (range 2.5-132 mo). Hemorrhagic and cystic features were present in 46 (34%) and 32 (24%) patients, respectively. The overall 12- and 24-mo cumulative incidence of LMD with death as a competing risk was 11.0 and 22.4%, respectively. On multivariable analysis, hemorrhagic features (hazard ratio [HR] 2.34, P = .015), cystic features (HR 2.34, P = .013), breast histology (HR 3.23, P = .016), and number of brain metastases >1 (HR 2.09, P = .032) were independently associated with increased risk of LMD. CONCLUSION Hemorrhagic and cystic features were independently associated with increased risk for postoperative LMD. Patients with BMs containing these intralesion features may benefit from alternative treatment strategies to mitigate this risk.
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Affiliation(s)
- Robert H Press
- Department of Radiation Oncology, Winship Cancer Institute of Emory University, Atlanta, Georgia
| | - Chao Zhang
- Biostatistics and Bioinformatics Shared Resource, Winship Cancer Institute of Emory University, Atlanta, Georgia
| | - Mudit Chowdhary
- Department of Radiation Oncology, Rush University, Chicago, Illinois
| | - Roshan S Prabhu
- Southeast Radiation Oncology Group, Levine Cancer Institute, Charlotte, North Carolina
| | - Matthew J Ferris
- Department of Radiation Oncology, Winship Cancer Institute of Emory University, Atlanta, Georgia
| | - Karen M Xu
- Department of Radiation Oncology, Winship Cancer Institute of Emory University, Atlanta, Georgia
| | - Jeffrey J Olson
- Department of Neurological Surgery, Emory University, Atlanta, Georgia
| | - Bree R Eaton
- Department of Radiation Oncology, Winship Cancer Institute of Emory University, Atlanta, Georgia
| | - Hui-Kuo G Shu
- Department of Radiation Oncology, Winship Cancer Institute of Emory University, Atlanta, Georgia
| | - Walter J Curran
- Department of Radiation Oncology, Winship Cancer Institute of Emory University, Atlanta, Georgia
| | - Ian R Crocker
- Department of Radiation Oncology, Winship Cancer Institute of Emory University, Atlanta, Georgia
| | - Kirtesh R Patel
- Department of Therapeutic Radiology, Smilow Cancer Center, Yale University, New Haven, Connecticut
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Chowdhary M, Chowdhary A, Royce TJ, Patel KR, Chhabra AM, Jain S, Knoll MA, Vapiwala N, Pro B, Marwaha G. Women's Representation in Leadership Positions in Academic Medical Oncology, Radiation Oncology, and Surgical Oncology Programs. JAMA Netw Open 2020; 3:e200708. [PMID: 32159809 PMCID: PMC7066474 DOI: 10.1001/jamanetworkopen.2020.0708] [Citation(s) in RCA: 70] [Impact Index Per Article: 17.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
IMPORTANCE Women are underrepresented in medical leadership positions; however, representation of women among academic oncology leadership is unknown. OBJECTIVES To evaluate representation of women overall and in leadership positions in academic medical oncology (MO), radiation oncology (RO), and surgical oncology (SO) programs and to examine the association of women leadership with overall faculty representation of women per program. DESIGN, SETTING, AND PARTICIPANTS In this cross-sectional study, MO, RO, and SO training program websites were queried from October 2018 through June 2019. All faculty from 265 of 273 accredited MO, RO, and SO training programs (97.1%) were included. EXPOSURE Gender. MAIN OUTCOMES AND MEASURES Observed proportions of women in leadership positions compared with the expected proportion of overall women faculty in MO, RO, and SO were assessed. Rates of representation of women across each MO, RO, and SO program's faculty based on the presence or absence of a woman in a leadership position were compared. RESULTS Of 6030 total faculty, only 2164 (35.9%) were women. Total representation of women among MO, RO, and SO faculty was 37.1% (1563 of 4215), 30.7% (389 of 1269), and 38.8% (212 of 546), respectively. Women composed only 21.7% (30 of 138), 11.7% (11 of 94), and 3.8% (1 of 26) of MO, RO, and SO chair positions, respectively. The observed proportion of women in chair positions was significantly lower than the expected proportion for MO, RO, and SO. In all, 47.9%, 33%, and 18.5% of MO, RO, and SO programs, respectively, had at least 1 woman in a leadership position (program director or chair). Programs with 1 or more women in a leadership position were associated with a higher mean (SD) percentage of women faculty than those without at least 1 woman leader in MO (40.7% [12.5%] vs 33.1% [11.0%]; P < .001) and RO (36.2% [13.3%] vs 23.4% [12.3%]; P < .001) but not SO (40.2% [15.4%] vs 31.4% [16.9%]; P = .29). CONCLUSIONS AND RELEVANCE Gender disparity exists in academic MO, RO, and SO faculty, which is magnified at the chair level. Programs in MO and RO with a woman physician in a leadership position were associated with a higher percentage of women faculty, but this was not true for SO. These data will serve as a benchmark to monitor progress toward a more balanced workforce.
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Affiliation(s)
- Mudit Chowdhary
- Department of Radiation Oncology, Rush University Medical Center, Chicago, Illinois
| | - Akansha Chowdhary
- Robert H. Lurie Comprehensive Cancer Center, Division of Hematology and Medical Oncology, Northwestern University, Chicago, Illinois
| | - Trevor J. Royce
- Department of Radiation Oncology, University of North Carolina School of Medicine, Chapel Hill
| | - Kirtesh R. Patel
- Department of Radiation Oncology, Kaiser Permanente, Atlanta, Georgia
| | - Arpit M. Chhabra
- Department of Radiation Oncology, New York Proton Center, New York
| | - Shikha Jain
- Division of Hematology, Oncology and Stem Cell Transplant, Rush University Medical Center, Chicago, Illinois
| | - Miriam A. Knoll
- John Theurer Cancer Center, Department of Radiation Oncology, Hackensack University Medical Center, Hackensack, New Jersey
| | - Neha Vapiwala
- Department of Radiation Oncology, University of Pennsylvania School of Medicine, Philadelphia
| | - Barbara Pro
- Robert H. Lurie Comprehensive Cancer Center, Division of Hematology and Medical Oncology, Northwestern University, Chicago, Illinois
| | - Gaurav Marwaha
- Department of Radiation Oncology, Rush University Medical Center, Chicago, Illinois
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Agarwal A, Royce TJ, Goodman CR, Chowdhary M. Unfilled Positions in the 2019 National Resident Matching Program Radiation Oncology Match and Supplemental Offer and Acceptance Program. Pract Radiat Oncol 2019; 9:501-502. [PMID: 31685167 DOI: 10.1016/j.prro.2019.07.002] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2019] [Accepted: 07/07/2019] [Indexed: 11/18/2022]
Affiliation(s)
- Ankit Agarwal
- Department of Radiation Oncology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Trevor J Royce
- Department of Radiation Oncology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.
| | - Chelain R Goodman
- Department of Radiation Oncology, Northwestern University, Chicago, Illinois
| | - Mudit Chowdhary
- Department of Radiation Oncology, Rush University Medical Center, Chicago, Ilinois
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Miccio JA, Jairam V, Gao S, Augustyn A, Oladeru OT, Onderdonk BE, Chowdhary M, Han D, Khan S, Friedlaender G, Lindskog DM, Desphande HA, Osborn H, Roberts KB, Patel KR. Predictors of Lymph Node Involvement by Soft Tissue Sarcoma of the Trunk and Extremity: An Analysis of the National Cancer Database. Cureus 2019; 11:e6038. [PMID: 31824805 PMCID: PMC6886621 DOI: 10.7759/cureus.6038] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Background and Objectives Lymph node metastases (LNM) in soft tissue sarcoma (STS) of the trunk and extremity are rare but are associated with worse survival. Established risk factors for LNM in this group are based on small institutional retrospective reviews. This study identifies the risk factors associated with LNM in otherwise non-metastatic trunk/extremity STS patients using the National Cancer Database (NCDB) and sought out to delineate a high-risk group that may be considered for pathologic nodal evaluation. Methods The files of 10,731 patients with STS of the trunk/extremity without distant metastasis from 2004 - 2015 were evaluated. Exclusion criteria included neoadjuvant therapy and a lack of pathologic nodal evaluation. Univariate and multivariable logistic regression models were performed to evaluate variables associated with LNM. Results Of the total of 10,731 patients, 223 (2.1%) had LNM. On multivariable analysis, LNM was associated with Grade 3 tumors (odds ratio (OR) 15.6, 95% confidence interval (CI) 6.36 - 38.04, p < 0.001) and clear cell/angiosarcoma/rhabdomyosarcoma/epithelioid (CARE) histology (OR 4.72, 95% CI 3.35 - 6.66, p < 0.001), lymphovascular invasion (LVI) (OR 5.86, 95% CI 3.33 - 10.31, p < 0.001, and bone invasion (BI) (OR 2.73, 95% CI 1.32 - 5.61, p = 0.006). Patients with Grade 3 CARE tumors (n = 402) had an 11.9% risk of LNM vs. 1.7% of adults without all these characteristics (p < 0.001). Patients with Grade 3 CARE tumors and either LVI or BI (n = 36) had a 33.3% risk of LNM. Conclusions High-grade and CARE histology are associated with LNM in STS. Adult patients with both features have an overall 11.9% risk of LNM and may be considered for pathologic LN assessment, particularly with the presence of LVI or BI.
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Affiliation(s)
- Joseph A Miccio
- Department of Therapeutic Radiology, Yale School of Medicine, New Haven, USA
| | - Vikram Jairam
- Department of Therapeutic Radiology, Yale School of Medicine, New Haven, USA
| | - Sarah Gao
- Department of Therapeutic Radiology, Yale School of Medicine, New Haven, USA
| | - Alexander Augustyn
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, USA
| | - Oluwadamilola T Oladeru
- Department of Radiation Oncology, Massachusetts General Hospital/Harvard Medical School, Boston, USA
| | - Benjamin E Onderdonk
- Department of Radiation and Cellular Oncology, University of Chicago Medical Center, Chicago, USA
| | - Mudit Chowdhary
- Department of Radiation Oncology, Rush University Medical Center, Chicago, USA
| | - Dale Han
- Department of Surgical Oncology, Oregon Health and Science University, Portland, USA
| | - Sajid Khan
- Department of Surgery, Yale School of Medicine, New Haven, USA
| | - Gary Friedlaender
- Department of Orthopaedics and Rehabilitation, Yale School of Medicine, New Haven, USA
| | - Dieter M Lindskog
- Department of Orthopaedics and Rehabilitation, Yale School of Medicine, New Haven, USA
| | - Hari A Desphande
- Department of Medical Oncology, Yale School of Medicine, New Haven, USA
| | - Heather Osborn
- Department of Otolaryngology, Yale School of Medicine, New Haven, USA
| | - Kenneth B Roberts
- Department of Radiation Oncology, Yale School of Medicine, New Haven, USA
| | - Kirtesh R Patel
- Department of Therapeutic Radiology, Yale School of Medicine, New Haven, USA
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Jhaveri J, Chowdhary M, Zhang X, Press RH, Switchenko JM, Ferris MJ, Morgan TM, Roper J, Dhabaan A, Elder E, Eaton BR, Olson JJ, Curran WJ, Shu HKG, Crocker IR, Patel KR. Does size matter? Investigating the optimal planning target volume margin for postoperative stereotactic radiosurgery to resected brain metastases. J Neurosurg 2019; 130:797-803. [PMID: 29676690 DOI: 10.3171/2017.9.jns171735] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2017] [Accepted: 09/08/2017] [Indexed: 12/12/2022]
Abstract
OBJECTIVE The optimal margin size in postoperative stereotactic radiosurgery (SRS) for brain metastases is unknown. Herein, the authors investigated the effect of SRS planning target volume (PTV) margin on local recurrence and symptomatic radiation necrosis postoperatively. METHODS Records of patients who received postoperative LINAC-based SRS for brain metastases between 2006 and 2016 were reviewed and stratified based on PTV margin size (1.0 or > 1.0 mm). Patients were treated using frameless and framed SRS techniques, and both single-fraction and hypofractionated dosing were used based on lesion size. Kaplan-Meier and cumulative incidence models were used to estimate survival and intracranial outcomes, respectively. Multivariate analyses were also performed. RESULTS A total of 133 patients with 139 cavities were identified; 36 patients (27.1%) and 35 lesions (25.2%) were in the 1.0-mm group, and 97 patients (72.9%) and 104 lesions (74.8%) were in the > 1.0-mm group. Patient characteristics were balanced, except the 1.0-mm cohort had a better Eastern Cooperative Group Performance Status (grade 0: 36.1% vs 19.6%), higher mean number of brain metastases (1.75 vs 1.31), lower prescription isodose line (80% vs 95%), and lower median single fraction-equivalent dose (15.0 vs 17.5 Gy) (all p < 0.05). The median survival and follow-up for all patients were 15.6 months and 17.7 months, respectively. No significant difference in local recurrence was noted between the cohorts. An increased 1-year rate of symptomatic radionecrosis was seen in the larger margin group (20.9% vs 6.0%, p = 0.028). On multivariate analyses, margin size > 1.0 mm was associated with an increased risk for symptomatic radionecrosis (HR 3.07, 95% CI 1.13-8.34; p = 0.028), while multifraction SRS emerged as a protective factor for symptomatic radionecrosis (HR 0.13, 95% CI 0.02-0.76; p = 0.023). CONCLUSIONS Expanding the PTV margin beyond 1.0 mm is not associated with improved local recurrence but appears to increase the risk of symptomatic radionecrosis after postoperative SRS.
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Affiliation(s)
- Jaymin Jhaveri
- Departments of1Radiation Oncology and.,2Winship Cancer Institute, Emory University, Atlanta, Georgia
| | - Mudit Chowdhary
- Departments of1Radiation Oncology and.,3Department of Radiation Oncology, Rush University Medical Center, Chicago, Illinois; and
| | - Xinyan Zhang
- 4Biostatistics and Bioinformatics Shared Resource
| | - Robert H Press
- Departments of1Radiation Oncology and.,2Winship Cancer Institute, Emory University, Atlanta, Georgia
| | | | - Matthew J Ferris
- Departments of1Radiation Oncology and.,2Winship Cancer Institute, Emory University, Atlanta, Georgia
| | - Tiffany M Morgan
- Departments of1Radiation Oncology and.,2Winship Cancer Institute, Emory University, Atlanta, Georgia
| | - Justin Roper
- Departments of1Radiation Oncology and.,2Winship Cancer Institute, Emory University, Atlanta, Georgia
| | - Anees Dhabaan
- Departments of1Radiation Oncology and.,2Winship Cancer Institute, Emory University, Atlanta, Georgia
| | - Eric Elder
- Departments of1Radiation Oncology and.,2Winship Cancer Institute, Emory University, Atlanta, Georgia
| | - Bree R Eaton
- Departments of1Radiation Oncology and.,2Winship Cancer Institute, Emory University, Atlanta, Georgia
| | - Jeffrey J Olson
- 2Winship Cancer Institute, Emory University, Atlanta, Georgia.,5Neurosurgery, and
| | - Walter J Curran
- Departments of1Radiation Oncology and.,2Winship Cancer Institute, Emory University, Atlanta, Georgia
| | - Hui-Kuo G Shu
- Departments of1Radiation Oncology and.,2Winship Cancer Institute, Emory University, Atlanta, Georgia
| | - Ian R Crocker
- Departments of1Radiation Oncology and.,2Winship Cancer Institute, Emory University, Atlanta, Georgia
| | - Kirtesh R Patel
- Departments of1Radiation Oncology and.,2Winship Cancer Institute, Emory University, Atlanta, Georgia.,6Department of Therapeutic Radiology, Yale School of Medicine, New Haven, Connecticut
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Chowdhary M, Chowdhary A, Sen N, Zaorsky NG, Patel KR, Wang D. Does the addition of chemotherapy to neoadjuvant radiotherapy impact survival in high-risk extremity/trunk soft-tissue sarcoma? Cancer 2019; 125:3801-3809. [PMID: 31490546 DOI: 10.1002/cncr.32386] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2019] [Revised: 06/14/2019] [Accepted: 06/15/2019] [Indexed: 01/02/2023]
Abstract
BACKGROUND The role of chemotherapy in extremity/trunk soft-tissue sarcoma (ET-STS) is controversial, even for patients at high risk for distant recurrence and death (those with high-grade tumors ≥5 cm in size). This study examines the impact of integrating chemotherapy with neoadjuvant radiotherapy (RT) on overall survival (OS) for patients with high-risk ET-STS. METHODS The National Cancer Data Base was queried for adult patients with high-risk ET-STS who received neoadjuvant RT and limb salvage surgery between 2006 and 2014. Patients were stratified into RT and chemoradiotherapy (CRT) cohorts. OS for the RT and CRT cohorts was analyzed with the Kaplan-Meier method, log-rank tests, and Cox proportional hazards models. Propensity score matching (PSM) analysis was used to account for a potential treatment selection bias between the cohorts. RESULTS A total of 884 patients were identified: 639 (72.3%) in the RT cohort and 245 (27.7%) in the CRT cohort. The unadjusted 5-year Kaplan-Meier OS rate was significantly higher in the CRT cohort: 72.0% versus 56.1% (P < .001). Neoadjuvant chemotherapy was associated with improved OS in univariate and multivariable analyses (hazard ratio [HR], 0.57; 95% confidence interval [CI], 0.41-0.78; P < .001). PSM identified 2 evenly matched cohorts of 212 patients each. The 5-year matched Kaplan-Meier OS rates were 69.8% and 55.4% for the CRT and RT cohorts, respectively (P = .002). The addition of neoadjuvant chemotherapy remained prognostic for OS on PSM (HR, 0.56; 95% CI, 0.39-0.83; P = .003). CONCLUSIONS The addition of chemotherapy to neoadjuvant RT was associated with improved OS for patients with high-risk ET-STS. In the absence of randomized data evaluating CRT versus RT, these findings warrant further investigation.
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Affiliation(s)
- Mudit Chowdhary
- Department of Radiation Oncology, Rush University Medical Center, Chicago, Illinois
| | - Akansha Chowdhary
- Division of Hematology and Medical Oncology, Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago, Illinois
| | - Neilayan Sen
- Department of Radiation Oncology, Rush University Medical Center, Chicago, Illinois
| | - Nicholas G Zaorsky
- Department of Radiation Oncology, Penn State Cancer Institute, Hersey, Pennsylvania
| | - Kirtesh R Patel
- Department of Therapeutic Radiology, Yale School of Medicine, New Haven, Connecticut
| | - Dian Wang
- Department of Radiation Oncology, Rush University Medical Center, Chicago, Illinois
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Chowdhary M, Sen N, Marwaha G, Ahmed A, Vapiwala N, Patel K, Royce T. A Growing Specialty: A 15-year Profile of US Radiation Oncology Residency Growth and Implications for Workforce Imbalances. Int J Radiat Oncol Biol Phys 2019. [DOI: 10.1016/j.ijrobp.2019.06.509] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Chowdhary M, Chowdhary A, Sen N, Zaorsky N, Patel K, Wang D. Neoadjuvant Radiotherapy Versus Chemoradiotherapy for Large, High-Grade Extremity and Trunk Soft Tissue Sarcoma. Int J Radiat Oncol Biol Phys 2019. [DOI: 10.1016/j.ijrobp.2019.06.2502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Mowery YM, Patel K, Chowdhary M, Rushing CN, Roy Choudhury K, Lowe JR, Olson AC, Wisdom AJ, Salama JK, Hanks BA, Khan MK, Salama AKS. Retrospective analysis of safety and efficacy of anti-PD-1 therapy and radiation therapy in advanced melanoma: A bi-institutional study. Radiother Oncol 2019; 138:114-120. [PMID: 31252292 PMCID: PMC7566286 DOI: 10.1016/j.radonc.2019.06.013] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2019] [Revised: 06/05/2019] [Accepted: 06/11/2019] [Indexed: 11/24/2022]
Abstract
BACKGROUND AND PURPOSE Antibodies against programmed cell death protein 1 (PD-1) are standard treatments for advanced melanoma. Palliative radiation therapy (RT) is commonly administered for this disease. Safety and optimal timing for this combination for melanoma has not been established. MATERIALS AND METHODS In this retrospective cohort study, records for melanoma patients who received anti-PD-1 therapy at Duke University or Emory University (1/1/2013-12/30/2015) were reviewed. Patients were categorized by receipt of RT and RT timing relative to anti-PD-1. RESULTS 151 patients received anti-PD-1 therapy. Median follow-up was 12.9 months. Patients receiving RT (n = 85) had worse baseline prognostic factors than patients without RT (n = 66). One-year overall survival (OS) was lower for RT patients than patients without RT (66%, 95% CI: 55-77% vs 83%, 95% CI: 73-92%). One-year OS was 61% for patients receiving RT before anti-PD-1 (95% CI: 46-76%), 78% for RT during anti-PD-1 (95% CI: 60-95%), and 58% for RT after anti-PD-1 (95% CI: 26-89%). On Cox regression, OS for patients without RT did not differ significantly from patients receiving RT during anti-PD-1 (HR 1.07, 95% CI: 0.41-2.84) or RT before anti-PD-1 (HR 0.56, 95% CI: 0.21-1.45). RT and anti-PD-1 therapy administered within 6 weeks of each other was well tolerated. CONCLUSION RT can be safely administered with anti-PD-1 therapy. Despite worse baseline prognostic characteristics for patients receiving RT, OS was similar for patients receiving concurrent RT with anti-PD-1 therapy compared to patients receiving anti-PD-1 therapy alone.
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Affiliation(s)
- Yvonne M Mowery
- Department of Radiation Oncology, Duke University Medical Center, Durham, United States.
| | - Kirtesh Patel
- Department of Radiation Oncology, Emory University School of Medicine, Atlanta, United States.
| | - Mudit Chowdhary
- Department of Radiation Oncology, Emory University School of Medicine, Atlanta, United States.
| | - Christel N Rushing
- Department of Biostatistics and Bioinformatics, Duke University Medical Center, Durham, United States.
| | - Kingshuk Roy Choudhury
- Department of Biostatistics and Bioinformatics, Duke University Medical Center, Durham, United States; Department of Radiology, Duke University Medical Center, Durham, United States.
| | - Jared R Lowe
- Department of Medicine, Duke University Medical Center, Durham, United States.
| | - Adam C Olson
- Department of Radiation Oncology, Duke University Medical Center, Durham, United States.
| | - Amy J Wisdom
- Duke University School of Medicine, Durham, United States.
| | - Joseph K Salama
- Department of Radiation Oncology, Duke University Medical Center, Durham, United States.
| | - Brent A Hanks
- Department of Medicine, Duke University Medical Center, Durham, United States.
| | - Mohammad K Khan
- Department of Radiation Oncology, Emory University School of Medicine, Atlanta, United States.
| | - April K S Salama
- Department of Medicine, Duke University Medical Center, Durham, United States.
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Chowdhary M, Chowdhary A, Sen N, Zaorsky NG, Patel KR, Wang D. Does the addition of chemotherapy to neoadjuvant radiotherapy impact survival in high-risk extremity and trunk soft tissue sarcoma? J Clin Oncol 2019. [DOI: 10.1200/jco.2019.37.15_suppl.11054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
11054 Background: Large, high-grade extremity/trunk (ET) non-rhabdomyosarcoma soft-tissue sarcoma (STS) is at high risk for distant recurrence and death. The integration of chemotherapy (C) to standard of care neoadjuvant radiotherapy (RT) remains controversial, even for these patients. This study examines the impact of adding C to neoadjuvant RT on overall survival (OS) in high risk ET-STS. Methods: The National Cancer Data Base (NCDB) was queried for patients ≥18 years with high risk (≥5 cm + high grade) non-rhabdomyosarcoma ET-STS (WHO histology) who received neoadjuvant RT and limb sparing surgery from 2006-2014. Patients were next stratified based upon receipt of C (RT and CRT cohorts). Overall survival (OS) for RT vs CRT cohorts was analyzed using the Kaplan-Meier (KM) method, log-rank test, and Cox proportional hazards models. Propensity score-matched analysis (PSM) was employed to account for potential treatment selection bias between cohorts. Results: A total of 848 (71.1%) and 344 (28.9%) patients received RT and CRT, respectively. Patient cohorts were well-balanced except for the CRT cohort having higher rates of treatment in the West (22.1% vs 10.6%) & Midwest (28.3% vs 22.7%), Charlson-Deyo [CD] score 0 vs ≥1 (85.5% vs 79.4%), younger age (≤50) (45.9% vs 21.7%), synovial sarcoma histology (18.9% vs 3.2%), earlier year of diagnosis (2006-2010) (39.5% vs 32.3%), and positive lymphovascular invasion (2.0 vs 1.51%), (p < 0.05 each). The KM 5-year OS was significantly higher in the CRT vs RT cohort: 69.2% vs 58.1% on univariate (p < 0.0001) and multivariate analysis (Hazard Ratio [HR]: 0.66; 95% Confidence Interval [CI]: 0.52-0.85; p = 0.001) even after adjusting for age, race, income, CD score, histology, tumor size, tumor grade, and primary site (lower extremity; upper extremity; trunk). PSM identified evenly matched cohorts of 300 patients each with respect to age, income, CD score, histology, grade, tumor size, and primary site. The addition of neoadjuvant C remained prognostic for OS on PSM (HR: 0.74 [0.56-0.99], p = 0.042). Conclusions: The addition of C to neoadjuvant RT was associated with improved OS in patients with high risk non-rhabdomyosarcoma ET-STS in the NCDB. These hypothesis generating results support prospective evaluation.
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Affiliation(s)
| | - Akansha Chowdhary
- Robert H. Lurie Comprehensive Cancer Center of Northwestern University, Chicago, IL
| | | | | | | | - Dian Wang
- Rush University Medical Center, Chicago, IL
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Chowdhary M, Chowdhary A, Patel KR, Royce TJ, Sen N, Barry PN, Jain S, Rao RD, Levy MA, Knoll M, Vapiwala N, Wang D, Pro B, Marwaha G. It starts at the top: An analysis of female representation in academic medical oncology (MO), radiation oncology (RO), and surgical oncology (SO) program leadership positions. J Clin Oncol 2019. [DOI: 10.1200/jco.2019.37.15_suppl.10520] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
10520 Background: Female underrepresentation in academic medicine leadership is well-documented; however, oncology specific data are scarce. This study evaluates female leadership representation in academic medical oncology (MO), radiation oncology (RO) and surgical oncology (SO) programs. Furthermore, we examine the impact of female leadership on overall female faculty representation. Methods: A total of 264 (96%) Accreditation Council for Graduate Medical Education actively accredited MO [144 of 153], RO [93 of 94] and SO [27 of 27] training programs were included. The gender of overall faculty and those in leadership positions (program director and departmental chair/division chief) of each program was determined using hospital websites from 10/01/18 to 01/27/19. The chi-squared goodness-of-fit test was used to examine whether the observed proportion of females in leadership positions deviates significantly from the expected proportion based on the actual proportion of overall female faculty in MO, RO and SO. Two-sample t-tests were used to compare rates of female faculty representation across each program based on the presence/absence of female in a leadership position for MO, RO and SO. Results: Female faculty representation in MO, RO and SO was 37.1% (1,554/4,191), 30.7% (389/1,269) and 38.8% (212/546), respectively. Female representation in leadership positions was 31.5% (82/260), 17.4% (31/178) and 11.1% (5/45), respectively. The observed proportion of females in leadership positions was significantly lower than the expected proportion of females in leadership positions for RO (17.4% vs. 30.7%, p = .0001) and SO (11.1% vs. 38.8%, p = .0001), and demonstrated a trend towards significance for MO (31.5% vs. 37.1%, p = .063). 47.9%, 33% and 18.5% of MO, RO and SO programs had ≥1 female in a leadership position, respectively. Programs that had a female in a leadership position had a higher mean percentage of overall female faculty than those that did not: 41.0% vs 35.0% (p = .0006), 36.0% vs 26.0% (p = .0002) and 39.0% vs 32.0% (p = .348) for MO, RO and SO, respectively. Conclusions: Gender disparity exists in academic MO, RO and SO faculty and is magnified at the leadership level. Programs with a female physician in a leadership position are associated with a higher percentage of female faculty.
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Affiliation(s)
| | - Akansha Chowdhary
- Robert H. Lurie Comprehensive Cancer Center of Northwestern University, Chicago, IL
| | | | - Trevor J. Royce
- University of North Carolina School of Medicine, Chapel Hill, NC
| | | | | | | | | | | | - Miriam Knoll
- Hackensack University Medical Center, Hackensack, NJ
| | | | - Dian Wang
- Rush University Medical Center, Chicago, IL
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Chowdhary M, Sen N, Chowdhary A, Usha L, Cobleigh MA, Wang D, Patel KR, Barry PN, Rao RD. Safety and Efficacy of Palbociclib and Radiation Therapy in Patients With Metastatic Breast Cancer: Initial Results of a Novel Combination. Adv Radiat Oncol 2019; 4:453-457. [PMID: 31360799 PMCID: PMC6639750 DOI: 10.1016/j.adro.2019.03.011] [Citation(s) in RCA: 47] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2019] [Accepted: 03/22/2019] [Indexed: 12/04/2022] Open
Abstract
Purpose Palbociclib is a selective cyclin-dependent kinase 4/6 inhibitor approved for metastatic ER+/HER2- breast cancer. Preclinical evidence suggests a possible synergistic effect of palbociclib when combined with radiation therapy (RT); however, the toxicity of this pairing is unknown. We report preliminary results on the use of this combination. Methods and Materials Records of patients treated with palbociclib at our institution from 2015 to 2018 were retrospectively reviewed. Patients who received RT for symptomatic metastases concurrently or within 14 days of palbociclib were included. Local treatment effect was assessed by clinical examination and subsequent computed tomography/magnetic resonance imaging. Toxicity was graded based on Common Terminology Criteria for Adverse Events version 5.0. Results A total of 16 women received palliative RT in close temporal proximity to palbociclib administration. Four patients received palbociclib before RT (25.0%), 5 concurrently (31.3%), and 7 after RT (43.8%). The median interval from closest palbociclib use to RT was 5 days (range, 0-14). The following sites were irradiated in decreasing order of frequency: bone (11 axial skeleton [9 vertebra and 2 other]; 4 pelvis; 3 extremity), brain (4: 3 whole brain RT and 1 stereotactic radiosurgery), and mediastinum (1). The median and mean follow-up time is 14.7 and 17.6 months (range, 1.7-38.2). Pain relief was achieved in all patients. No radiographic local failure was noted in the 13 patients with evaluable follow-up imaging. Leukopenia, neutropenia, and thrombocytopenia were seen in 4 (25.0%), 5 (31.3%), and 1 (6.3%) patient before RT. After RT, 5 (31.3%), 1 (6.3%), and 3 (18.8%) patients were leukopenic, neutropenic, and thrombocytopenic, respectively. All but 2 (grade 2) hematologic toxicities were grade 1. No acute or late grade 2+ cutaneous, neurologic, or gastrointestinal toxicities were noted. Toxicity results did not differ based on disease site, palbociclib-RT temporal association, or irradiated site. Conclusions The use of RT in patients receiving palbociclib resulted in minimal grade 2 and no grade 3+ toxicities. This preliminary work suggests that symptomatic patients receiving palbociclib may be safely irradiated.
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Affiliation(s)
- Mudit Chowdhary
- Department of Radiation Oncology, Rush University Medical Center, Chicago, Illinois
| | - Neilayan Sen
- Department of Radiation Oncology, Rush University Medical Center, Chicago, Illinois
| | - Akansha Chowdhary
- Department of Medicine, Division of Hematology and Oncology, Northwestern University School of Medicine, Chicago, Illinois
| | - Lydia Usha
- Department of Medicine, Division of Hematology, Oncology, and Stem Cell Transplant, Rush University Medical Center, Chicago, Illinois
| | - Melody A Cobleigh
- Department of Medicine, Division of Hematology, Oncology, and Stem Cell Transplant, Rush University Medical Center, Chicago, Illinois
| | - Dian Wang
- Department of Radiation Oncology, Rush University Medical Center, Chicago, Illinois
| | - Kirtesh R Patel
- Department of Therapeutic Radiology, Yale School of Medicine, New Haven, Connecticut
| | - Parul N Barry
- Department of Radiation Oncology, Rush University Medical Center, Chicago, Illinois
| | - Ruta D Rao
- Department of Medicine, Division of Hematology, Oncology, and Stem Cell Transplant, Rush University Medical Center, Chicago, Illinois
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Chowdhary M, Lee A, Gao S, Barry P, Diaz R, Bagadiya N, Park H, Yu J, Wilson L, Moran M, Higgins S, Knowlton C, Patel K. PV-0045 Is proton therapy a "pro" for breast cancer? A comparison of proton vs. non-proton RT using the NCDB. Radiother Oncol 2019. [DOI: 10.1016/s0167-8140(19)30465-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Chowdhary M, Dhawan R, Switchenko J, Tian S, King K, Batus M, Fidler M, Bonomi P, Sen N, Patel K, Khan M, Gaurav M. PO-0776 Neutrophil-to-lymphocyte ratio dynamics predict for survival in lung cancer treated with SBRT. Radiother Oncol 2019. [DOI: 10.1016/s0167-8140(19)31196-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Chowdhary M, Chhabra AM, Jhaveri J, Sen N, Abrams RA, Patel KR, Marwaha G. In reply to Royce. Int J Radiat Oncol Biol Phys 2019; 100:530-531. [PMID: 29353663 DOI: 10.1016/j.ijrobp.2017.10.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2017] [Accepted: 10/04/2017] [Indexed: 11/28/2022]
Affiliation(s)
- Mudit Chowdhary
- Department of Radiation Oncology, Rush University Medical Center, Chicago, Illinois
| | - Arpit M Chhabra
- Department of Radiation Oncology, University of Maryland School of Medicine, Baltimore, Maryland
| | - Jaymin Jhaveri
- Department of Radiation Oncology, Winship Cancer Institute of Emory University, Atlanta, Georgia
| | - Neilayan Sen
- Department of Radiation Oncology, Rush University Medical Center, Chicago, Illinois
| | - Ross A Abrams
- Department of Radiation Oncology, Rush University Medical Center, Chicago, Illinois
| | - Kirtesh R Patel
- Department of Therapeutic Radiology and Smilow Cancer Center, Yale School of Medicine, New Haven, Connecticut
| | - Gaurav Marwaha
- Department of Radiation Oncology, Rush University Medical Center, Chicago, Illinois
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Chowdhary M, Sen N, Chowdhary A, Usha L, Cobleigh M, Patel KR, Wang D, Barry PN, Rao RD. Abstract PD8-12: Safety and efficacy of palbociclib and radiotherapy in metastatic breast cancer patients: Initial results of a novel combination. Cancer Res 2019. [DOI: 10.1158/1538-7445.sabcs18-pd8-12] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Purpose: Palbociclib is a selective CDK4/6 inhibitor approved for the treatment of metastatic ER+/HER2- breast cancer. Inhibition of CDK4/6 prevents cell cycle progression from G1 to the more radioresistant S phase, raising the possibility of an enhanced therapeutic effect if combined with radiotherapy (RT). Despite this potential benefit, clinicians seldom use this combination due to fear that RT may exacerbate palbociclib toxicity, particularly leukopenia. Our aim is to report the preliminary results of patients with metastatic breast cancer who received RT while receiving palbociclib.
Methods: We retrospectively reviewed records of all patients who were treated with palbociclib at our institution from 2015-2018. Patients who received RT for symptomatic metastases concurrently or within 14 days of last drug administration were included in our analysis. Local treatment effect was assessed by clinical exam and subsequent CT or MRI imaging, if applicable. Toxicity was graded based on CTCAE v5.0.
Results: A total of 16 females received palliative RT in association with palbociclib. The median age of the treated patients was 59.6 (range 33.3-91.0) years. The median time of closest palbociclib use to RT administration was 5 (range 0-14) days.
The following sites were treated in order of frequency: bone (10-axial skeleton [8-vertebra]; 1-ilium), brain (4: 3-WBRT & 1-SRS), and mediastinum (1). RT dose/fractionation for bone was 30 Gy/10 fxn (7), 35 Gy/14 fxn (2), 37.5 Gy/15 fxn (1), and 18 Gy/1 fxn (1). WBRT dose/fractionation was 30 Gy/10 fxn for all patients. SRS brain dose was 25 Gy/5 fxn. The patient treated to the mediastinum received 36 Gy/18 fxn.
At most recent follow-up, 12 patients are still living. The median time from RT to last known follow-up or death is 10.3 (range 1.7-29.6) months. Pain relief was achieved in 15 of 16 (93.8%) patients. No radiographic local failure was noted in the 13 patients with evaluable follow-up imaging.
The combination of RT and palbociclib was well-tolerated. Grade 1 fatigue, dermatitis, and nausea was noted in 5, 3, and 1 patient, respectively. One patient with WBRT developed Grade 1 headache. Six of 16 patients were leukopenic prior to RT initiation. Following RT, 7 patients were observed to have a drop in WBC count, of which 2 dropped into the leukopenic range. Only a total of 5 patients were leukopenic following RT, of which 3 were leukopenic before receiving RT. No acute or late Grade 2 or higher cutaneous, neurological, gastrointestinal, or hematologic toxicities were noted.
Conclusions: The use of RT in patients receiving palbociclib resulted in minimal Grade 1 and no Grade 2+ toxicities, including leukopenia. This treatment can be used safely in symptomatic patients without discontinuation of systemic therapy. Further larger prospective studies with longer follow-up are needed to confirm these results.
Citation Format: Chowdhary M, Sen N, Chowdhary A, Usha L, Cobleigh M, Patel KR, Wang D, Barry PN, Rao RD. Safety and efficacy of palbociclib and radiotherapy in metastatic breast cancer patients: Initial results of a novel combination [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr PD8-12.
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Affiliation(s)
- M Chowdhary
- Rush University Medical Center, Chicago, IL; Northwestern University School of Medicine, Chicago, IL; Yale School of Medicine, New Haven, CT
| | - N Sen
- Rush University Medical Center, Chicago, IL; Northwestern University School of Medicine, Chicago, IL; Yale School of Medicine, New Haven, CT
| | - A Chowdhary
- Rush University Medical Center, Chicago, IL; Northwestern University School of Medicine, Chicago, IL; Yale School of Medicine, New Haven, CT
| | - L Usha
- Rush University Medical Center, Chicago, IL; Northwestern University School of Medicine, Chicago, IL; Yale School of Medicine, New Haven, CT
| | - M Cobleigh
- Rush University Medical Center, Chicago, IL; Northwestern University School of Medicine, Chicago, IL; Yale School of Medicine, New Haven, CT
| | - KR Patel
- Rush University Medical Center, Chicago, IL; Northwestern University School of Medicine, Chicago, IL; Yale School of Medicine, New Haven, CT
| | - D Wang
- Rush University Medical Center, Chicago, IL; Northwestern University School of Medicine, Chicago, IL; Yale School of Medicine, New Haven, CT
| | - PN Barry
- Rush University Medical Center, Chicago, IL; Northwestern University School of Medicine, Chicago, IL; Yale School of Medicine, New Haven, CT
| | - RD Rao
- Rush University Medical Center, Chicago, IL; Northwestern University School of Medicine, Chicago, IL; Yale School of Medicine, New Haven, CT
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Chowdhary M, Lee A, Gao S, Barry PN, Diaz R, Decker RH, Wilson LD, Evans SB, Moran MS, Knowlton CA, Patel KR. Abstract P3-12-19: Withdrawn. Cancer Res 2019. [DOI: 10.1158/1538-7445.sabcs18-p3-12-19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
This abstract was withdrawn by the authors.
Citation Format: Chowdhary M, Lee A, Gao S, Barry PN, Diaz R, Decker RH, Wilson LD, Evans SB, Moran MS, Knowlton CA, Patel KR. Withdrawn [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P3-12-19.
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Affiliation(s)
- M Chowdhary
- Rush University Medical Center, Chicago, IL; SUNY Downstate Medical Center, Brooklyn, NY; Yale School of Medicine, New Haven, CT; Moffitt Cancer Center, Tampa, FL
| | - A Lee
- Rush University Medical Center, Chicago, IL; SUNY Downstate Medical Center, Brooklyn, NY; Yale School of Medicine, New Haven, CT; Moffitt Cancer Center, Tampa, FL
| | - S Gao
- Rush University Medical Center, Chicago, IL; SUNY Downstate Medical Center, Brooklyn, NY; Yale School of Medicine, New Haven, CT; Moffitt Cancer Center, Tampa, FL
| | - PN Barry
- Rush University Medical Center, Chicago, IL; SUNY Downstate Medical Center, Brooklyn, NY; Yale School of Medicine, New Haven, CT; Moffitt Cancer Center, Tampa, FL
| | - R Diaz
- Rush University Medical Center, Chicago, IL; SUNY Downstate Medical Center, Brooklyn, NY; Yale School of Medicine, New Haven, CT; Moffitt Cancer Center, Tampa, FL
| | - RH Decker
- Rush University Medical Center, Chicago, IL; SUNY Downstate Medical Center, Brooklyn, NY; Yale School of Medicine, New Haven, CT; Moffitt Cancer Center, Tampa, FL
| | - LD Wilson
- Rush University Medical Center, Chicago, IL; SUNY Downstate Medical Center, Brooklyn, NY; Yale School of Medicine, New Haven, CT; Moffitt Cancer Center, Tampa, FL
| | - SB Evans
- Rush University Medical Center, Chicago, IL; SUNY Downstate Medical Center, Brooklyn, NY; Yale School of Medicine, New Haven, CT; Moffitt Cancer Center, Tampa, FL
| | - MS Moran
- Rush University Medical Center, Chicago, IL; SUNY Downstate Medical Center, Brooklyn, NY; Yale School of Medicine, New Haven, CT; Moffitt Cancer Center, Tampa, FL
| | - CA Knowlton
- Rush University Medical Center, Chicago, IL; SUNY Downstate Medical Center, Brooklyn, NY; Yale School of Medicine, New Haven, CT; Moffitt Cancer Center, Tampa, FL
| | - KR Patel
- Rush University Medical Center, Chicago, IL; SUNY Downstate Medical Center, Brooklyn, NY; Yale School of Medicine, New Haven, CT; Moffitt Cancer Center, Tampa, FL
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Chowdhary M, Lee A, Gao S, Wang D, Barry PN, Diaz R, Bagadiya NR, Park HS, Yu JB, Wilson LD, Moran MS, Higgins SA, Knowlton CA, Patel KR. Is Proton Therapy a "Pro" for Breast Cancer? A Comparison of Proton vs. Non-proton Radiotherapy Using the National Cancer Database. Front Oncol 2019; 8:678. [PMID: 30693271 PMCID: PMC6339938 DOI: 10.3389/fonc.2018.00678] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2018] [Accepted: 12/21/2018] [Indexed: 12/25/2022] Open
Abstract
Background: Limited data exists demonstrating the clinical benefit of proton radiotherapy (PRT) in breast cancer. Using the National Cancer Database, we evaluated predictors associated with PRT use for patients with breast cancer. An exploratory analysis also investigates the impact of PRT on overall survival (OS). Methods: Patients with non-metastatic breast cancer treated with adjuvant radiotherapy from 2004 to 2014 were identified. Patients were stratified based on receipt of PRT or non-PRT (i.e., photons ± electrons). A logistic regression model was used to determine predictors for PRT utilization. For OS, Multivariable analysis (MVA) was performed using Cox proportional hazard model. Results: A total of 724,492 patients were identified: 871 received PRT and 723,621 received non-PRT. 58.3% of the PRT patients were group stage 0–1. Median follow-up time was 62.2 months. On multivariate logistic analysis, the following factors were found to be significant for receipt of PRT (all p < 0.05): academic facility (odds ratio [OR] = 2.50), South (OR = 2.01) and West location (OR = 12.43), left-sided (OR = 1.21), ER-positive (OR = 1.59), and mastectomy (OR = 1.47); pT2-T4 disease predicted for decrease use (OR = 0.79). PRT was not associated with OS on MVA for all patients: Hazard Ratio: 0.85, p = 0.168. PRT remained not significant on MVA after stratifying for subsets likely associated with higher heart radiation doses, including: left-sided (p = 0.140), inner-quadrant (p = 0.173), mastectomy (p = 0.095), node positivity (p = 0.680), N2-N3 disease (p = 0.880), and lymph node irradiation (LNI) (p = 0.767). Conclusions: Receipt of PRT was associated with left-sided, ER+ tumors, mastectomy, South and West location, and academic facilities, but not higher group stages or LNI. PRT was not associated with OS, including in subsets likely at risk for higher heart doses. Further studies are required to determine non-OS benefits of PRT. In the interim, given the high cost of protons, only well-selected patients should receive PRT unless enrolled on a clinical trial.
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Affiliation(s)
- Mudit Chowdhary
- Department of Radiation Oncology, Rush University Medical Center, Chicago, IL, United States
| | - Anna Lee
- Department of Radiation Oncology, SUNY Downstate Medical Center, Brooklyn, NY, United States
| | - Sarah Gao
- Department of Therapeutic Radiology, Smilow Cancer Center, Yale University School of Medicine, New Haven, CT, United States
| | - Dian Wang
- Department of Radiation Oncology, Rush University Medical Center, Chicago, IL, United States
| | - Parul N Barry
- Department of Radiation Oncology, Rush University Medical Center, Chicago, IL, United States
| | - Roberto Diaz
- Department of Radiation Oncology, Moffitt Cancer Center, Tampa, FL, United States
| | - Neeti R Bagadiya
- Department of Radiology, Emory University School of Medicine, Atlanta, GA, United States
| | - Henry S Park
- Department of Therapeutic Radiology, Smilow Cancer Center, Yale University School of Medicine, New Haven, CT, United States
| | - James B Yu
- Department of Therapeutic Radiology, Smilow Cancer Center, Yale University School of Medicine, New Haven, CT, United States
| | - Lynn D Wilson
- Department of Therapeutic Radiology, Smilow Cancer Center, Yale University School of Medicine, New Haven, CT, United States
| | - Meena S Moran
- Department of Therapeutic Radiology, Smilow Cancer Center, Yale University School of Medicine, New Haven, CT, United States
| | - Susan A Higgins
- Department of Therapeutic Radiology, Smilow Cancer Center, Yale University School of Medicine, New Haven, CT, United States
| | - Christin A Knowlton
- Department of Therapeutic Radiology, Smilow Cancer Center, Yale University School of Medicine, New Haven, CT, United States
| | - Kirtesh R Patel
- Department of Therapeutic Radiology, Smilow Cancer Center, Yale University School of Medicine, New Haven, CT, United States
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Chowdhary M, Switchenko JM, Sen N, Chhabra AM, Katz LM, Jegadeesh NK, Barry PN, Wang D, Royce TJ, Curran WJ, Vapiwala N, Wilson LD, Abrams RA, Marwaha G, Patel KR. The Impact of Graduates' Job Preferences on the Current Radiation Oncology Job Market. Int J Radiat Oncol Biol Phys 2018; 104:27-32. [PMID: 30583039 DOI: 10.1016/j.ijrobp.2018.12.026] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2018] [Revised: 11/26/2018] [Accepted: 12/16/2018] [Indexed: 10/27/2022]
Abstract
PURPOSE To examine the role of radiation oncology (RO) graduates' application patterns and personal preferences in current labor concerns. METHODS AND MATERIALS An anonymous, voluntary survey was distributed to 665 domestic RO graduates from 2013 to 2017. Questions assessed graduates' regional (Northeast [NE]; Midwest [MW]; South [SO]; West [WT]) job type and population size preferences. Top regional choice was compared across other categorical and numerical variables using the χ2 test and analysis of variance, respectively. RESULTS Complete responses were obtained from 299 (45.0% response rate) participants: 82 (27.4%), 74 (24.7%), 85 (28.4%), and 58 (19.4%) graduated from NE, MW, SO, and WT programs. The most to least commonly applied regions were SO (69.2%), MW (55.9%), and then NE/WT (55.2% each). The first and last regional choices were the WT (29.4%) and MW (15.7%), respectively. The most and least common application and top choice preferences were consistent in terms of city size: >500,000 (86.0% and 64.5%, respectively) and <100,001 (26.1% and 7.0%, respectively). The majority of applicants applied to both academic and nonacademic positions (60.9%), with top job type choice being equally split. The majority of respondents independently received a job offer in their preferred region (75.3%), city population size (72.6%) or job type (81.9%). Additionally, 52.5% received a job offer that included all three preferences. Those who underwent residency training (44.3% vs 62.0%-83.6%, P < .001) or medical schooling (50.7% vs 56.3%-75.6%, P < .001) or grew up in the MW (60.8% vs 70.0%-74.7%, P < .001) were least likely to choose this region as their top regional choice compared with other regions. CONCLUSIONS The MW and jobs in smaller cities are less appealing to RO graduates, even if they receive training in the MW, which may contribute to current job market concerns. Nonetheless, the majority of respondents received a job offer in the region, population size, and job type of their top choice. Assessing prospective candidates' city size and geographic preferences and prioritizing applicants who are compatible with positions may help address potential job market discrepancies.
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Affiliation(s)
- Mudit Chowdhary
- Department of Radiation Oncology, Rush University Medical Center, Chicago, Illinois.
| | - Jeffrey M Switchenko
- Biostatistics and Bioinformatics Shared Resource, Winship Cancer Institute of Emory University, Atlanta, Georgia; Department of Radiation Oncology, Winship Cancer Institute of Emory University, Atlanta, Georgia
| | - Neilayan Sen
- Department of Radiation Oncology, Rush University Medical Center, Chicago, Illinois
| | - Arpit M Chhabra
- Department of Radiation Oncology, University of Maryland Medical Center, Baltimore, Maryland
| | - Leah M Katz
- New York-Presbyterian Hudson Valley Hospital, Peekskill, New York
| | - Naresh K Jegadeesh
- Department of Radiation Oncology, Rush University Medical Center, Chicago, Illinois
| | - Parul N Barry
- Department of Radiation Oncology, Rush University Medical Center, Chicago, Illinois
| | - Dian Wang
- Department of Radiation Oncology, Rush University Medical Center, Chicago, Illinois
| | - Trevor J Royce
- Department of Radiation Oncology, University of North Carolina School of Medicine, Chapel Hill, North Carolina
| | - Walter J Curran
- Department of Radiation Oncology, Winship Cancer Institute of Emory University, Atlanta, Georgia
| | - Neha Vapiwala
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Lynn D Wilson
- Department of Therapeutic Radiology, Yale University School of Medicine, New Haven, Connecticut
| | - Ross A Abrams
- Department of Radiation Oncology, Rush University Medical Center, Chicago, Illinois
| | - Gaurav Marwaha
- Department of Radiation Oncology, Rush University Medical Center, Chicago, Illinois
| | - Kirtesh R Patel
- Department of Therapeutic Radiology, Yale University School of Medicine, New Haven, Connecticut
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