The American Society for Radiation Oncology Workforce Taskforce Review of the United States Radiation Oncology Workforce Analysis

Over the past decade, concerns have arisen in radiation oncology regarding potential workforce supply and demand imbalance. The American Society for Radiation Oncology commissioned an independent analysis in 2022, looking at supply and demand in the United States radiation oncology workforce and projecting future trends for 2025 and 2030. The final report entitled, "Projected Supply and Demand for Radiation Oncologists in the U.S. in 2025 and 2030" is now available. The analysis included evaluating radiation oncologist supply (new graduates, exits from the specialty), potential changes in demand (growth of Medicare beneficiaries, hypofractionation, loss of indications, new indications) as well as radiation oncologist productivity (growth of work RVUs produced) and demand per beneficiary. The results demonstrated a relative balance between radiation oncology supply and demand for radiation services; the growth in radiation oncologists was balanced by the rapid growth of Medicare beneficiaries over the same time period. The primary factors driving the model were found to be growth of Medicare beneficiaries, and change in work RVU productivity with hypofractionation and loss of indication having only a moderate impact; while the most likely scenario was a balance of workforce supply and demand, scenarios did demonstrate the possibility of over and under supply. Oversupply may become a concern if radiation oncologist wRVU productivity reaches the highest region; beyond 2030, this is also possible if growth in radiation oncologist supply does not parallel Medicare beneficiary growth. Limitations of the analysis included the lack of inclusion of most technical reimbursement and its impact as well as failing to account for SBRT. A modeling tool is available to allow individuals to evaluate different scenarios. Moving forward, continued study will be needed to evaluate trends (particularly work RVU productivity and Medicare beneficiary growth) to allow for continued assessment of workforce supply and demand in radiation oncology.

Impact of the COVID-19 Pandemic on Canadian Radiation Oncology Practices

Purpose

To survey Canadian radiation oncology (RO) practice leaders to determine the effect of the COVID-19 pandemic on radiation services and patient and staff issues in the early phase of the pandemic and 1 year later.

Methods and Materials

The RO leader (department or division head) from every Canadian cancer center with radiation services was identified. Two surveys were circulated to the identified leader via email from the Canadian Association of Radiation Oncology central office, using the SurveyMonkey survey tool: the first closed in June 2020 and the second (expanded) survey in June 2021, representing 2 points in time of the COVID-19 pandemic. Questions included patient volume, service interruptions and delays, and changes in scheduling and telemedicine use. Additional questions were included in the follow-up survey to determine further effects on disease presentation, volume, vaccination and access, and personnel issues.

Results

Telemedicine was widely adopted early in the pandemic and continued to be a common technique to communicate and connect with patients. Although many centers were deferring or delaying certain disease sites early in the pandemic, this was not as prevalent 1 year later. Reduced cancer screening and patients presenting with more advanced disease were concerns documented in the 2021 survey. A high level of concern regarding stress among health care professionals was identified.

Conclusions

Canadian RO centers have faced numerous challenges during the COVID-19 pandemic but continued to provide timely and essential cancer care for patients with cancer. Future evaluation of RO center practices will be important to continue to document and address the effect of the COVID-19 pandemic on issues relevant to RO leaders, patients, and staff.

Variable Impact of the COVID-19 Pandemic on U.S. Radiation Oncology Practices

Early in the pandemic, the American Society for Radiation Oncology (ASTRO) surveyed physician leaders at U.S. radiation oncology practices to understand how the field was responding to the outbreak of COVID-19. Surveys were repeated at multiple points during the pandemic, with a response rate of 43% in April 2020 and 23% in January 2021. To our knowledge, this is the only longitudinal COVID-19 practice survey in oncology in the U.S. The surveys indicate that patient access to essential radiation oncology services in the United States has been preserved throughout the COVID-19 pandemic. Safety protocols were universally adopted, telehealth was widely adopted and remains in use, and most clinics no longer deferred or postponed radiation treatments as of early 2021. Late-stage disease presentation, treatment interruptions, PPE shortages, and vaccination barriers were reported significantly more at community-based practices than academic practices, and rural practices appear to have faced increased obstacles. These findings provide unique insights into the initial longitudinal impact of the COVID-19 pandemic on the delivery of radiation therapy in the United States. Downstream lessons in service adaptation and improvement can potentially be guided by formal concepts of resilience, which have been broadly embraced across the U.S. economy.

Initial Impact and Operational Responses to the COVID-19 Pandemic by American Radiation Oncology Practices

PURPOSE

In February 2020, the COVID-19 pandemic reached the United States. The impact of the pandemic on the US radiation oncology field remains unknown. The American Society for Radiation Oncology surveyed US radiation oncology practice leaders to gauge initial impact and immediate operational responses to the pandemic.

METHODS AND MATERIALS

From April 16 to April 30, 2020, the American Society for Radiation Oncology surveyed US radiation oncology practice leaders by email to gauge initial impact and immediate operational responses to the COVID-19 pandemic.

RESULTS

Two hundred twenty-two (43%) of 517 leaders responded from community and academic practices (62% and 34%, respectively), hospital-based and free-standing centers (69% and 29%), and metro and rural locations (88% and 12%). Practices reported treating an average of 1086 patients per year in 2019 (range, 0-7900) with an average daily treatment volume of 70 patients (range, 5-400). All practices reported uninterrupted operation. On average, practices were treating 68% of their typical volume (range, 10%-95%), with 92% implementing planned treatment postponement for lower risk patients. An estimated revenue decrease of 20% or more was experienced by 71% of practices. Confirmed COVID-19 patient cases were treated by 39% of practices. Seventy percent experienced staff shortages. Almost all (98%) practices implemented formal operational procedures to protect patients and staff, although personal protective equipment/infection control supply shortages were reported by 78% of practices. Seventy-four percent used telemedicine for virtual follow-up surveillance, and 15% leveraged telemedicine for on-treatment assessment.

CONCLUSIONS

The clinical and financial impacts of the COVID-19 pandemic on US radiation oncology were deep and broad. Despite reported shortages in personal protective equipment, declines in revenue, and reduced patient volumes, practices adapted quickly by refining standard processes of care, implementing recommended safety measures, and employing telemedicine to facilitate treatment continuity. Patients with higher risk disease experienced uninterrupted access to care. We plan to continue regular surveying across the lifespan of the pandemic to document the geographic and temporal impact of COVID-19 on the field and its patients.

Effect of COVID-19 pandemic on practice in European radiation oncology centers

ESTRO surveyed European radiation oncology department heads to evaluate the impact of COVID-19. Telemedicine was used in 78% of the departments, and 60% reported a decline in patient volume. Use of protective measures was implemented on a large scale, but shortages of personal protective equipment were present in more than half of the departments.

Supporting family dementia caregivers: testing the efficacy of dementia care management on multifaceted caregivers' burden

OBJECTIVES

Current research suggests that dementia care management (DCM) can decrease burden and associated health impairments of caregivers. The objective of this secondary analysis is to investigate the impact of DCM on multifaceted caregivers' burden dimensions by differentiating between objective and subjective burden.

METHODS

A sample of n = 317 dyads of caregivers and community-dwelling people with dementia (PwD) participated in a general practitioner-based, cluster-randomized intervention trial (Identifier:NCT01401582) with two arms and comprehensive data assessment at baseline and 12-month follow-up. Data provided by the caregiver included an inventory with 88 items in 20 different dimensions.

RESULTS

Caregivers in the intervention 'DCM' group showed decreased caregiver burden, especially in caregivers' objective burden due to caring (i.e. emotional support), caregivers' subjective burden due to behavior change (i.e. cognition, aggression and resistance, depression, late symptoms) and caregivers' subjective burden due to perceived conflicts between needs and responsibilities to care (i.e. financial losses) compared to caregivers in the control 'care as usual' group, which showed significant increased caregiver burden after 12 months.

CONCLUSION

Our findings support evidence for the effectiveness of DCM to lower family dementia caregivers' burden in multifaceted dimensions.

[Unmet needs of family dementia caregivers of persons with dementia : Primary medical care]

BACKGROUND

Results of current research studies revealed that providing informal care for people with dementia (PwD) is associated with caregivers' burden and a variety of health impairments. In order to provide optimal support for family caregivers of PwD, general practitioners and specialists should be able to identify caregivers' unmet needs in primary care.

OBJECTIVES

The present article provides an overview of unmet needs of family caregivers that are relevant for general practitioners as well as specialists in neurology, psychiatry, psychotherapy and psychosomatics.

MATERIAL AND METHODS

The present overview is based on current reviews on unmet needs of caregivers of PwD and on results of the general practitioner-based, cluster-randomized controlled intervention trial DelpHi-MV (Life- and person-centred help in Mecklenburg-Western Pomerania, Germany; Identifier: NCT01401582).

RESULTS

The article provides an overview of unmet needs of family caregivers for PwD, especially in the domains of social integration, psychological and physical health, legal and financial issues, as well as available and valid measurements.

DISCUSSION

The article illustrates the importance and the possibilities for general practitioners and specialists to identify caregivers' unmet needs. The question to what extent unmet needs' assessments for family caregivers of PwD could be implemented and financed in routine care is still under debate.

Optical detection of nonradiating alkali atoms in solid helium

We have detected by optical means nonfluorescing 85Rb and 87Rb atoms implanted in a body centered cubic 4He crystal. In contrast to cesium the resonance fluorescence of rubidium is strongly quenched by the helium matrix, and the weak resonance absorption of the two Rb isotopes was detected using a double resonance technique. From a comparative study of the (optically detected) magnetic resonance spectra of 85Rb, 87Rb, and 133Cs we infer their effective g(F) factors and conclude that they are not perturbed by the He matrix at a level of 2 x 10(-4). We show further that optical pumping of Rb proceeds via depopulation, whereas for Cs it proceeds via repopulation.

Territorial spacing and interspecific competition in three species of reed warblers

Ecological and temporal aspects of the occurrence and dispersion patterns in three reed warbler species were examined. This provided insight into their intra-and interspecific territoriality. Seasonal changes in the occurrence of territorial males in a reed bed along a gradient from the shore landward were studied. The results demonstrate that intra- and interspecific spacing depends on interspecific dominance and/or ecological constraints. In this case it was shown that there is competition for common habitats between reed warblers and great reed warblers, whereas the moustached warbler is ecologically segregated. The reasons for these dispersal patterns are discussed. They do not appear to enhance the availability of food resources. It seems more likely that territorial spacing might function to reduce nest predation.