“We have a consult for radiation oncology regarding a 60-year-old gentleman with a history of lung cancer and is currently admitted. His oncologist is Dr. Heme Onc.”
As a new radiation oncology resident, I was surprised to hear the consulting physician refer to the patient’s medical oncologist as “his oncologist.” What about the patient’s radiation oncologist? Indeed, I remembered the patient well: he was diagnosed with Stage IIIB non-small cell lung cancer and received six weeks of definitive radiotherapy with concurrent chemotherapy. Since completing his treatment over a year ago, he had maintained regular interval follow-up with both radiation oncology and medical oncology.
As I have progressed through my training, I have learned that many physicians don’t appreciate the central role that radiation oncologists play in cancer care. Often, I am paged and told “oncology asked me to contact you” or asked questioningly: “Do radiation oncologists leave the basement?” Furthermore, surveys of internal medicine and family medicine residents show that many are uncertain regarding the benefits of radiotherapy and lack an understanding on when to consult radiation oncology.
The role of radiotherapy
Radiotherapy was initially utilized in the late 1890s and preceded the use of chemotherapy for cancer treatment by 50 years. Today, more than 50 percent of all cancer patients will be recommended to receive radiotherapy as part of their treatment. Radiotherapy is a vital component of interdisciplinary cancer care, whether in the definitive, neoadjuvant, adjuvant, salvage or palliative settings. It can be administered either alone or in combination with other modalities, such as chemotherapy or surgery. Some of the potential benefits of radiotherapy include improving survival, preventing tumor recurrence, palliating symptoms and improving patient quality of life.
A variety of malignancies, from head to toe, benefit from radiotherapy. In fact, it is considered a primary treatment option in CNS (i.e., brain metastases, gliomas, spinal cord tumors), eye (uveal melanoma), H&N, breast, lung (NSCLC, SCLC, mesothelioma), GI (esophagus, rectum, anal, pancreas), GYN (cervix, endometrium, ovarian), GU (prostate, bladder, testicular), lymphomas, and sarcoma. The majority of radiotherapy is delivered utilizing ionizing photon radiation, predominantly high-energy X-rays. The process is non-invasive, and many patients undergoing irradiation can still go to work and carry on day-to-day life activities. Significant advancements in radiotherapy delivery over the past 20-30 years have led to faster treatments with fewer side effects, allowing for patients to return to their regular routines sooner.
Why is basic education regarding the role of radiotherapy important for all clinicians? Overall, radiotherapy is being underutilized worldwide, and this is in part due to a lack of understanding of radiation oncology. This decreased use is associated with deleterious effects on patient survival and may even exacerbate disparities across geographic and/or socioeconomic segments
Call to action
Exposure to the field of radiation oncology should begin at the medical school preclinical level. A great way to spread awareness is to host a radiation oncology interest group. Radiation oncologists should aim to regularly give lectures during the oncology portion of the medical curriculum. When medical students choose elective rotations in radiation oncology, explaining our field and role in cancer care, rather than assign busy work should be prioritized.
Radiation oncologists need to educate our physician colleagues in other medical disciplines regarding the indications and benefits of radiotherapy. This is particularly important for our primary care colleagues who are often the gateway to cancer care and remain their patient’s primary physician during their illness. It is important for radiation oncologists to participate in general medicine grand rounds, join physician networking groups and partner with other specialists at disease-specific community events.
For patients, radiation oncologists can consider giving talks in the community regarding the safety and therapeutic goals of radiotherapy. Physicians can work directly with patient advocacy or support groups as well. Increasingly, social media is becoming a powerful tool for medical specialties. Curating an online presence can allow radiation oncologists to rapidly and accurately disseminate cancer and radiotherapy information.
The above ideas can help reinforce the central role radiation oncology should play in cancer care. One thing is certain: It is time radiation oncologists “left the basement” to both raise positive awareness and reduce misconceptions of radiotherapy for the benefit of our patients.
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