HealthCare Business News recently reached out to ASTRO chair, Dr. David Beyer to discuss his views on radiation oncology and its future.

HCB News: How is multidisciplinary cancer care changing?
Dr. David Beyer: Professionals are experimenting with new models for multidisciplinary care every day. We have a long history of tumor boards to discuss challenging cases with members of other specialties. Today, we are seeing more integrated clinics where care is shared among several different specialists. We are seeing new therapies, such as radiation treatments being combined with drugs to trigger the immune system. And we are seeing, more and more, the integration of other disciplines to improve patients’ quality of life. As an example, in the small community hospital where I practice, social workers, counselors, physical therapists and palliative care physicians and nurses are now routinely attending our multidisciplinary conferences. This helps us prepare a comprehensive survivorship plan from the first day of treatment.

HCB News: With the patient experience growing in importance, how is it being addressed by the radiation oncology field?
DB: Quality of life has long been embedded in the fabric of radiation oncology. Along with like-minded surgeons and other oncologists, we helped pioneer organ-preserving therapy in cancers of the breast, larynx and extremity sarcoma, to name a few. Now, research in the field is advancing to the next level, both for extending life and for preserving quality of life, such as the work on stereotactic radiation (SBRT) as a possible curative therapy for inoperable lung cancers.

At the same time, radiation oncology departments, which have been designed over the years to efficiently and safely deliver radiation, are now listening to patients and rethinking how we can improve their satisfaction during treatments that may span several weeks of care.

HCB News: What is the role of radiation oncology in modern cancer care?
DB: Radiation remains a core piece of the triumvirate of surgery, radiation and chemotherapy that has been central to cancer treatment for many years. Some patients are best served by a single modality, while others require combinations or sequences of these therapies. The radiation oncologist is and needs to be involved in this decision-making and remain a resource, even for those patients where radiation treatment is not primarily recommended.



HCB News: How would you describe the shift in the perception of radiation oncology? What is ASTRO’s role in this evolution?
DB: Radiation oncology may have once been considered a niche field, buried deep in the basement. Today, we are a vibrant specialty and an equal partner in cancer care — and we work to live that every day. ASTRO is pushing for radiation oncologists around the country to act as leaders in clinical care so that both patients and referring physicians know we are caring for the whole patient. We can only do that with our hands on the patient and not on the computer mouse. As we work to elevate the profile of our field, we want those outside of our specialty to recognize our value to the house of medicine — as an innovative specialty that is generating impactful science, providing advice and input to physician peers on oncology issues and reflecting the diversity of the patients we serve.

HCB News: How does a medical society like ASTRO support collaborative, multidisciplinary research? Are there tangible ways to break down silos in cancer research?
DB: Just this year, ASTRO’s Science Council created and publicized a research agenda of the big questions that we see. Many of these issues are in areas that cross disciplines, such as drug development and delivery, genomics, immunotherapy and physics, to name a few. By identifying these key areas, we hope to stimulate the next generation to begin their research careers without ever seeing a silo or walls limiting their creativity. Last spring, ASTRO convened a meeting of drug researchers, radiation oncology researchers, governmental researchers and regulators to identify new ways we can work together. We have been working on this effort, but there is much more to do.

HCB News: What is the role of health policy in this discussion? In what ways does the turbulence in the American health care landscape affect cancer care? Is ASTRO doing anything to stay in front of these changes?
DB: One of our goals is to remain vigilant in our efforts to help craft health policy that supports radiation oncologists’ ability to succeed—which will result in better outcomes for our patients. We remain vocal advocates for access to affordable care, particularly in rural and medically underserved areas. For example, we are working with policy stakeholders such as the Centers for Medicare and Medicaid Services (CMS) to create and implement new Alternative Payment Models (APMs). We continue to advocate for quality and safety through our APEX accreditation program and RO-ILS.

As the country is going through the uncertainty of health care reform, we are also committed to helping craft the rules under which we all work. We have already been frequent visitors on Capitol Hill and with CMS and the Center for Medicare & Medicaid Innovation (CMMI) to confer on relevant policy questions. We are working to increase our participation on advisory panels such as the MedCAC (Medicare Evidence Development & Coverage Advisory Committee), where several radiation oncologists have served, and on new panels such as PTAC (Physician-Focused Payment Model Technical Advisory Committee) as they begin their work.

The landscape is turbulent, but as long as we are advocating for high quality and safe care for our patients, then we believe the specialty will remain vibrant.