Radiation Oncology Committee
Radiation Oncology Committee Report – April 2021
The Declining Residency Applicant Pool: A Multi-Institutional Medical Student Survey to Identify Precipitating Factors
From 2014 to 2018, the RO applicant pool was steady, with around 190 applicants per year, until an abrupt drop in the 2019 Main Residency Match.
This plunge resulted in a 14.5% unmatched rate, the highest by double in 10 years. In the most recent 2019/ 2020 application cycle, applicants decreased to 128 from 163 the preceding year, giving rise to a total unmatched rate of 18.3%, before the Supplemental Offer and Acceptance Program.
The top negative factors were the field’s interplay with physics, competitive United States Medical Licensing Examination board scores for matched applicants, and the focus placed on research during medical school. In the subgroup of students who were interested in RO but ultimately applied to another specialty, the job market was the most salient concern.
COVID-19 Member Survey (3/30/21)
Doctors report that people with cancer are facing additional burden due to the COVID-19 pandemic.
- Two-thirds of the physicians said new patients are presenting with more advanced disease compared to before the pandemic.
- Nearly three-fourths noticed missed cancer screenings among their patient populations, echoing the existing data on lapsed
- Two-thirds said their existing patients experienced treatment interruptions due to the pandemic, most often caused by COVID-19 quarantine or illness of the patient or their caregiver.
- Because the pandemic and cancer cause disproportionately more harm for Black and other medically underserved populations, these rates may be even higher for some vulnerable communities.
The survey also found that clinics have largely stopped deferring or postponing radiation treatments. Only 15% reported postponing treatment in January/February 2021, compared to 92% in April 2020. Similarly, 12% reported deferring any new patient visits in 2021, compared to 75% in the early weeks of the pandemic.
Screening for Lung Cancer US Preventive Services Task Force Recommendation Statement
The USPSTF recommends annual screening for lung cancer with LDCT in adults aged 50 to 80 years who have a 20 pack-year smoking history and currently smoke or have quit within the past 15 years. Screening should be discontinued once a person has not smoked for 15 years or develops a health problem that substantially limits life expectancy or the ability or willingness to
have curative lung surgery. (B recommendation) This recommendation replaces the 2013 USPSTF statement that recommended annual screening for lung cancer with LDCT in adults aged 55 to 80 years who have a 30 pack-year smoking history and currently smoke or have quit within the past 15 years. The ACR urges CMS to quickly update its LCS National Coverage Decision to reflect the USPSTF changes.
ASTRO leaders discuss RO model with new CMMI director
On March 30, ASTRO leaders met with the newly appointed director of the Centers for Medicare and Medicaid Innovation (CMMI) Elizabeth Fowler to discuss ways to fix the Radiation Oncology Alternative Payment Model (RO Model). As CMMI considers additional rule-making on the model, ASTRO pointed out serious flaws in the payment methodology and compliance burden that make the model untenable for practices without significant reforms. ASTRO told Fowler that the cuts mandated under the model are excessive and could jeopardize quality and access. ASTRO committed to working with the Agency on reforms, including ways to leverage the model to address cancer disparities. ASTRO will continue advocating with federal agencies and lawmakers to ensure a better balanced RO model prior to its January 1, 2022, start date.
Christian A. Gasson, MD