Demand for Radiation Therapy to Outpace Supply in Next Decade

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Demand for radiation therapy will exceed the number of radiation oncologists practicing in the U.S. by ten-fold between 2010 and 2020, according to research from The University of Texas MD Anderson Cancer Care Center.

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Published in the October 18, 2010 issue of The Journal of Clinical Oncology, the study estimates that the number of cancer patients requiring radiation therapy will increase by 22% over the next decade, while the number of full-time equivalent radiation oncologists entering the workforce will increase by just 2%. Researchers based their calculations on projections that in 2010, 3,943 radiation oncologists will treat an estimated 470,000 patients in the U.S.

Benjamin Smith, MD, assistant professor in the Department of Radiation Oncology at MD Anderson and lead author of the study, said the anticipated radiation oncologist shortage could profoundly impede the ability to provide patients with sufficient access to appropriate and/or timely cancer treatment. “A shortage will strain the complex web of multidisciplinary relationships needed to orchestrate multi-modality care across medical specialties,” he told imagingBiz via email. “A robust literature has demonstrated that in order to be optimally effective, radiation therapy must begin within a relatively narrow time window in many clinical situations—for example, as post-operative therapy following surgery for breast or head and neck cancer. If the initiation of radiation is delayed beyond the optimal time window because there is insufficient access to radiation oncology, a patient may be at higher risk for recurrence and death.”

Moreover, Smith added, patients’ inability to access radiation therapy altogether may negatively impact the ability to cure specific cancers or lead them to pursue more invasive, non-radiation- based treatment strategies. “For instance,” he explained, “they may opt for a mastectomy instead of a lumpectomy, or a laryngectomy rather than chemoradiation.”

Part of a Greater Trend
The findings augment a growing body of literature compiled by the American Society for Clinical Oncology and other organizations on the projected shortage of cancer physicians over the next ten years. Such a trend is driven largely by demographic changes, including an increase in older adults and minorities, groups in which certain cancers are more prevalent. Data from the study indicates that over the next decade, the need for radiation therapy for adults ages 65 and older will increase by 38%; for minorities, by 45%.

Smith said additional research is necessary to determine how practices can be changed to accommodate more patients and better provide radiation therapy without compromising quality of and access to care. However, the paper includes several proposed strategies for offsetting the shortage:

• Adopting a patient management team model. Under this model, physician assistants and/or advanced practice registered nurses would assist physicians in caring for patients receiving radiation therapy, thereby increasing the number individuals who could receive care at the same time.
• Providing shorter radiation treatment courses, which Smith and his fellow researchers deemed “proven”, in some cases, to be “more efficient than, and just as effective as, long-course radiation”.
• Increasing the size of residency programs. A gradual increase in the number of trainees admitted to programs would help to grow the number of radiation oncologists available to treat patients over the next ten years, the study’s authors asserted.

To project the number of radiation oncologists in 2020, researchers examined the current number of board certified radiation oncologists and active residents who would become certified by 2014; consideration was given to age and gender in determining approximate retirement age and full-time status. This model was then used to simulate the class composition for the remainder of the decade. Demand for radiation therapy and the supply of radiation oncologists were measured using figures on current radiation therapy utilization and population projections from the Surveillance, Epidemiology and End Results (SEER)-17 database, the U.S. Census, and American Board of Radiology data on the current workforce and trainees.

“For the first time, we have a clearer sense of how a shortage in the oncology field may play out,” Smith noted upon publication of the study. “While our projections in the number of full- time practicing radiation oncologists