Why target the globe?: 4-year report (2009-2013) of the Association of Residents in Radiation Oncology Global Health Initiative

Optimizing Clinical Implementation of Hypofractionation: Comprehensive Evidence Synthesis and Practical Guidelines for Low- and Middle-Income Settings

The global cancer burden, especially in low- and middle-income countries (LMICs), worsens existing disparities, amplified by the rising costs of advanced treatments. The shortage of radiation therapy (RT) services is a significant issue in LMICs. Extended conventional treatment regimens pose significant challenges, especially in resource-limited settings. Hypofractionated radiotherapy (HRT) and ultra-hypofractionated/stereotactic body radiation therapy (SBRT) offer promising alternatives by shortening treatment durations. This approach optimizes the utilization of radiotherapy machines, making them more effective in meeting the growing demand for cancer care. Adopting HRT/SBRT holds significant potential, especially in LMICs. This review provides the latest clinical evidence and guideline recommendations for the application of HRT/SBRT in the treatment of breast, prostate, and lung cancers. It emphasizes the critical importance of rigorous training, technology, stringent quality assurance, and safety protocols to ensure precise and secure treatments. Additionally, it addresses practical considerations for implementing these treatments in LMICs, highlighting the need for comprehensive support and collaboration to enhance patient access to advanced cancer care.

COMPUTED RADIOGRAPHY UTILIZATION FOR TELECOBALT60 TO ACHIEVE THE RADIATION CERTAINTY

OBJECTIVE

The aim: This research aimed to show the achievement of Telecobalt60 radiation certainty using computed radiography, in comparation with non-verified computed radiography.

PATIENTS AND METHODS

Materials and methods: This research is a quantitative study, randomized double-blind, and consecutive sampling design. The study was conducted by observing and com¬paring the data of verified computed radiography (VerC) computed radiograph for Telecobalt60 compared to the non-verified computed radiography (nVerC) Telecobalt60 data.

RESULTS

Results: The results showed that there are significant statistical differences in several measurement characteristics between the verified computed radiography arm and the non-verified computed radiography arm. All of the value divergences of the verified computed radiography arm are less than 7 mm while the non-verified computed radiography arm are 7 mm or more (P<0.050). Furthermore, all of the edge aspect of measurement in the verified computed radiography arms are less than the non-verified computed radiography, all without manual block utilization (P<0.050).

CONCLUSION

Conclusions: We conclude that Telecobalt60 radiation certainty is significantly better achieved by using computed radiography, when compared to non-verified computed radiography Telecobalt60 use. This research contributes to provide evidence based for better Telecobalt60 radiation accuracy and quality of radiotherapy outcome by using computed radiography.

Frameworks for Radiation Oncology Global Health Initiatives in US Residency Programs

PURPOSE

To understand trends, pathways, and experiences and to establish a framework for radiation oncology (RO) programs interested in developing global health (GH) initiatives.

METHODS

An in-depth interview was conducted of all US RO programs with established GH initiatives. Programs were identified by reviewing results of the 2018 Association of Residents in Radiation Oncology Global Health Resident Survey and individualized outreach to screen for additional programs meeting the following criteria: (1) active resident involvement in RO-specific GH opportunities, (2) active faculty involvement in these initiatives, and (3) department chair or program director awareness and support for ongoing opportunities. Among 88 residency programs, 11 were identified. Standardized questions explored the type of initiative, planning, staff and resident involvement, challenges, components to success, and history of programs through December 2018.

RESULTS

Between 2010 and 2018, 11 programs started initiatives. Total resident participants ranged from one to 13 (median = 3) in each program's history. Initiatives spanned education (n = 9 [82%]), clinical mentorship (73%), innovative technology (55%), bilateral hosting programs (45%), clinical development and equipment (45%), promotion of local research (36%), clinical care (36%), industry partnerships (27%), and remote tumor board (18%). Faculty involvement included radiation oncologists (91%), medical physicists (55%), and non-RO department faculty (27%). Six programs (55%) had faculty with prior GH experience. Four (36%) programs reported medical student involvement in projects. Barriers included international communication (36%), time for faculty (18%), funding (9%), and legal (9%) concerns. Commonest components of success included fostering relationships with international sites and identifying needs before solutions.

CONCLUSION

RO GH initiatives were reported as positive, educational, and feasible across 11 US residency programs. Growth is expected, representing opportunities for innovation and service among US programs.

Recommendations from the ASCO Academic Global Oncology Task Force

In recognition of the rising incidence and mortality of cancer in low- and middle-resource settings, as well as the increasingly international profile of its membership, ASCO has prioritized efforts to enhance its engagement at a global level. Among the recommendations included in the 2016 Global Oncology Leadership Task Force report to the ASCO Board of Directors was that ASCO should promote the recognition of global oncology as an academic field. The report suggested that ASCO could serve a role in transitioning global oncology from an informal field of largely voluntary activities to a more formal discipline with strong research and well-defined training components. As a result of this recommendation, in 2017, ASCO formed the Academic Global Oncology Task Force (AGOTF) to guide ASCO’s contributions toward formalizing the field of global oncology. The AGOTF was asked to collect and analyze key issues and barriers toward the recognition of global oncology as an academic discipline, with an emphasis on training, research, and career pathways, and produce a set of recommendations for ASCO action. The outcome of the AGOTF was the development of recommendations designed to advance the status of global oncology as an academic discipline.

Global Health Perspectives Among Radiation Oncology Residency Program Directors: A Knowledge, Attitudes, and Practices Survey

PURPOSE

Interest in global health has risen among medical students applying to and residents training in radiation oncology, often outpacing available educational offerings. The Association of Residents in Radiation Oncology Global Health Subcommittee sought to determine the perceptions of program directors (PDs) in radiation oncology and their current or planned global health curricular opportunities.

METHODS AND MATERIALS

A standardized, Knowledge-Attitudes-Practices survey composed of 32 binary items was sent to PDs for all Accreditation Council for Graduate Medical Education-accredited radiation oncology programs.

RESULTS

The program response rate was 60% (55 of 91). Responding programs were distributed evenly geographically and included a range of training program sizes. Most PDs (77%) knew that most nations did not meet standard minimum benchmarks for radiation therapy access. Although 89% would support residents in pursuing global health rotations, only 22% would support departmental funding of such rotations. Furthermore, 94% believed that global health was a field worthy of an academic career, but only 39% believed that it had appropriate rigor. Only 8% of programs had dedicated global health rotations.

CONCLUSIONS

Radiation oncology PDs largely expressed favorable views of global health as a pursuit and affirmed a high degree of resident and medical student interest. However, faculty commitment and program offerings currently lag behind the interest level. In particular, a substantial number of PDs do not perceive global health to be a rigorous academic endeavor. Future progress in academic global health in radiation oncology will require strategies to systematically support pathways for the development of experience and scholarship both within and beyond residency.

Global palliative radiotherapy: a framework to improve access in resource-constrained settings

Radiotherapy is an essential component of cancer therapy. Lack of access to radiotherapy in less-developed countries prevents its use for both cure and symptom relief, resulting in a significant disparity in patient suffering. Several recent initiatives have highlighted the need for expanded access to both palliative medicine and radiotherapy globally. Yet, these efforts have remained largely independent, without attention to overlap and integration. This review provides an update on the progress toward global palliative radiotherapy access and proposes a strategic framework to address further scale-up. Synergies between radiotherapy, palliative medicine, and other global health initiatives will be essential in bringing palliative radiotherapy to patients around the globe.

Global health from a cancer care perspective

Cancer is now recognized as one of the four leading causes of morbidity and mortality worldwide, and incidence is expected to rise significantly in the next two decades. Unfortunately, low- and middle-income countries (LMIC) suffer disproportionately from the world's cancer cases. The growing burden of cancer and maldistribution of cancer care resources in LMIC warrant a massive re-evaluation of the structural inequalities that produce global oncological disparities and a worldwide commitment to improve both prevention and treatment strategies. Efforts to improve cancer care capacity should focus on horizontal strengthening of healthcare systems that provide safe, affordable, effective and sustainable care. In response to current deficiencies, many international organizations have started to partner with LMIC to create solutions. Telemedicine and international collaboration are also promising ways to effect change and improve global oncological care.

The international cancer expert corps: a unique approach for sustainable cancer care in low and lower-middle income countries

The growing burden of non-communicable diseases including cancer in low- and lower-middle income countries (LMICs) and in geographic-access limited settings within resource-rich countries requires effective and sustainable solutions. The International Cancer Expert Corps (ICEC) is pioneering a novel global mentorship-partnership model to address workforce capability and capacity within cancer disparities regions built on the requirement for local investment in personnel and infrastructure. Radiation oncology will be a key component given its efficacy for cure even for the advanced stages of disease often encountered and for palliation. The goal for an ICEC Center within these health disparities settings is to develop and retain a high-quality sustainable workforce who can provide the best possible cancer care, conduct research, and become a regional center of excellence. The ICEC Center can also serve as a focal point for economic, social, and healthcare system improvement. ICEC is establishing teams of Experts with expertise to mentor in the broad range of subjects required to establish and sustain cancer care programs. The Hubs are cancer centers or other groups and professional societies in resource-rich settings that will comprise the global infrastructure coordinated by ICEC Central. A transformational tenet of ICEC is that altruistic, human-service activity should be an integral part of a healthcare career. To achieve a critical mass of mentors ICEC is working with three groups: academia, private practice, and senior mentors/retirees. While in-kind support will be important, ICEC seeks support for the career time dedicated to this activity through grants, government support, industry, and philanthropy. Providing care for people with cancer in LMICs has been a recalcitrant problem. The alarming increase in the global burden of cancer in LMICs underscores the urgency and makes this an opportune time fornovel and sustainable solutions to transform cancer care globally.