From Puppies to Advocacy, ASTRO 2024 Focuses on Provider Wellness
With another American Society for Radiation Oncology (ASTRO) meeting fresh in the books, Applied Radiation Oncology asked ASTRO Past President and Chair of the Board of Directors Howard Sandler, MD, MS, FASTRO, FASCO, for his reflections on the 66th annual conference. From self-care to clinical updates to future plans, below are his highlights of the meeting, held September 29 to October 2 in Washington, DC.
Wellness Matters
The theme of ASTRO 2024, “Targeting provider wellness for exceptional patient care,” is a topic of discussion across many health care societies and organizations, including Cedars-Sinai Cancer, where Dr Sandler is chair of the Department of Radiation Oncology. A recent US health care study found that unfavorable work conditions such as staffing shortages, lack of clinician control over workload, and generally poor work environments can lead to higher rates of clinician burnout, turnover and negative patient safety ratings.1 Even in organizations known as good places to work, physicians and nurses are under substantial pressure. When considering the added stress of treating patients with potentially life-threatening diseases such as cancer, stress can take a toll on job satisfaction, work environments, and provider well-being.
ASTRO contributes to provider wellness by organizing social gatherings and networking opportunities during its annual meetings. This year, Dr Sandler hoped to inspire conversations about wellness among attendees, including their relationships with colleagues and how balance between work, family, and personal wellness can impact patient outcomes.
“The meeting theme is mostly a backdrop and a conversation starter to get people to think about wellness in their own organization,” Dr Sandler says. “There was a fair amount of discussions and networking on this topic, but one of the hits of this year’s meeting was puppies.”
ASTRO coordinated with a local pet adoption organization in Washington, DC, to bring in puppies available for adoption. Attendees could pet, hold and take pictures with the puppies. This special event, coordinated specifically for the provider wellness theme, was well received and often had many waiting in line for a restorative dose of puppy love.
“The theme of provider wellness seemed to resonate with the attendees. And I could hear conversations taking place as one individual would be talking to another individual about wellness-related things. Maybe they would've done that anyway. But I think highlighting wellness as a theme was good for the annual meeting and it ended up being one of my favorite meetings — and I've been to a lot of ASTRO meetings.”
Advances in Genitourinary Cancer Treatment
In his role as president, Dr Sandler organized the Presidential Symposium, “New Innovations in Genitourinary Cancers,” with sessions focused on renal, bladder and prostate cancer.
“What I wanted to do was have the speakers discuss novel treatments using radiation for GU cancers that were ready for the attendees to, if they weren't already, bring back into their clinic and start implementing right away. So, it was meant to be novel but also practical in that sense.”
The renal cancer session highlighted randomized data demonstrating that SBRT is ready for implementation in the clinic to treat kidney cancers. “The time is ripe for selected renal cell cancer patients to get SBRT for their primary tumors,” he says.
Although a niche treatment, bladder preservation without cystectomy is seeing increased interest due to reported results of several clinical trials, including a large trial by the Southwest Oncology Group (SWOG) and NRG Oncology SWOG/NRG 1806.2 This session discussed a trimodality therapy approach using cystoscopic tumor resection, radiation and chemotherapy.
The third session focused on prostate cancer and evidence supporting the use of the FLAME technique — a focal boost of radiation to the MR-defined lesion in patients with localized cancer.
“So, using the FLAME technique or microboost technique, I think, is ready for prime time. And I was hoping that individuals in the audience who may not have implemented microboost techniques are going to go back to their clinic and start doing that because there's no more toxicity and there’s better disease control with the microboost technique.”
Dr Sandler’s goal was modest. “I pointed to the audience and said if one of you goes home and does kidney SBRT, or bladder preservation or starts doing microboost, then I would consider the session successful.”
With prostate cancer treatments a significant portion of Dr Sandler’s clinical and research work, he found the Prostate Advanced Radiation Technologies Investigating Quality of Life (PARTIQoL) phase 3 randomized trial to be an important study. The trial showed no measurable differences in men with intermediate- or low-risk prostate cancer treated with intensity-modulated radiation therapy (IMRT) vs proton beam therapy (PBT). Nearly 450 patients were initially treated (PBT = 221, IMRT = 216) and in the 424 participants alive at the study’s conclusion, there were no differences between PBT or IMRT in mean change of bowel score, in bowel function at earlier and later timepoints, or in other domains (urinary, sexual, hormonal). The study also reported no difference in progression-free survival or quality of life.3
“Radiation for prostate cancer is highly effective in that men with prostate cancer who are looking for radiation options could choose either proton therapy or nonproton therapy and be confident that they will be well-treated.”
Dr Sandler adds that the quality of prostate radiation therapy has improved over time and the 93% progression-free survival at 5 years demonstrates this.
Two other important trial results discussed at the ASTRO meeting were from the NRG Oncology HN005 trial of patients with HPV-positive oropharynx cancer, and the RT CHARM (Alliance A221505) trial involving patients with breast cancer, notes Dr Sandler. In NRG HN005, researchers investigated deintensification attempts in the treatment and whether it delivered similar results to conventional treatment but with reduced side effects. Results of the phase 2/3 trial indicated that the 2 deintensification approaches did not match the standard of care’s 98% rate of 2-year progression-free survival and were halted. Dr Sandler is hopeful other studies will explore ways to continue the same intensity of treatment with fewer side effects.
In RT CHARM, the researchers explored whether a hypofractionated regimen of 16 radiation treatment sessions for breast cancer patients planning to undergo breast reconstruction after mastectomy was safe compared with standard radiation therapy consisting of 25 sessions. RT CHARM found that in this patient cohort, a 16-fraction course of hypofractionated therapy is safe and effective.5
“It is safe as far as reconstruction complications go to use the shorter treatment approach, and that will make treatment easier and less complicated for patients undergoing a long course of treatment for breast cancer,” Dr Sandler says. “I think it's a practice-changing study in the sense that it will open the door and will validate the shorter treatment approach for these patients.”
Advocating for the Future
Looking ahead, Dr Sandler plans to continue his advocacy for radiation oncology, whether it involves engaging with CMS or members of Congress or working with other ASTRO board members to encourage early career members to become more engaged with ASTRO. The society has added an ad hoc early career member to the board and Dr Sandler is hopeful that continued outreach to this membership segment will encourage others to become more involved.
References
- Aiken LH, Lasater KB, Sloane DM, et al. Physician and nurse well-being and preferred interventions to address burnout in hospital practice: factors associated with turnover, outcomes, and patient safety. JAMA Health Forum. 2023;4(7):e231809. doi:10.1001/jamahealthforum.2023.1809
- Baumann BC, Efstathiou JA. Adjuvant radiation therapy for locally advanced bladder cancer: a safe and promising emerging treatment option. Int J Radiat Oncol Biol Phys. Published September 24, 2024. Online ahead of print. doi:10.1016/j.ijrobp.2024.09.042
- Efstathiou JA, Yeap BY, Michalski JM, et al. Prostate Advanced Radiation Technologies Investigating Quality of Life (PARTIQoL): phase III randomized clinical trial of proton therapy vs. IMRT for localized prostate cancer. Int J Radiat Oncol Biol Phys. 2024;120(2);S1.
- ASTRO press release. Existing standard chemoradiation superior to deintensification approaches for HPV-related oropharyngeal cancer. September 30, 2024. Accessed October 28, 2024. https://www.astro.org/news-and-publications/news-and-media-center/news-releases/2024/astro24yom
- Poppe MM, Le-Rademacher J, Haffty BG Jr, et al. A randomized trial of hypofractionated post-mastectomy radiation therapy (PMRT) in women with breast reconstruction (RT CHARM, Alliance A221505). Int J Radiat Oncol Biol Phys. 2024;120(2);S11.
