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J B Yu - One of the best experts on this subject based on the ideXlab platform.
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The impact of county-level Radiation Oncologist density on prostate cancer mortality in the United States
Prostate Cancer and Prostatic Diseases, 2012Co-Authors: Sanjay Aneja, J B YuAbstract:Background: The distribution of Radiation Oncologists across the United States varies significantly among geographic regions. Accompanying these variations exist geographic variations in prostate cancer mortality. Prostate cancer outcomes have been linked to variations in urologist density, however, the impact of geographic variation in the Radiation Oncologist workforce and prostate cancer mortality has yet to be investigated. The goal of this study was to determine the effect of increasing Radiation Oncologist density on regional prostate cancer mortality. Methods: Using county-level prostate cancer mortality data from the National Cancer Institute and Centers for Disease Control as well as physician workforce and health system data from the Area Resource File a regression model was built for prostate cancer mortality controlling for categorized Radiation Oncologist density, urologist density, county socioeconomic factors and pre-existing health system infrastructure. Results: There was statistically significant reduction in prostate cancer mortality (3.91–5.45% reduction in mortality) in counties with at least 1 Radiation Oncologist compared with counties lacking Radiation Oncologists. However, increasing the density of Radiation Oncologists beyond 1 per 100 000 residents did not yield statistically significant incremental reductions in prostate cancer mortality. Conclusion: The presence of at least one Radiation Oncologist is associated with significant reductions in prostate cancer mortality within that county. However, the incremental benefit of increasing Radiation Oncologist density exhibits a plateau effect providing marginal benefit. In order to optimize outcomes a geographically aware policy, which addresses the size and distribution of the workforce, must be in place in order prevent geographic disparities in prostate cancer mortality.
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the impact of county level Radiation Oncologist density on prostate cancer mortality in the united states
Prostate Cancer and Prostatic Diseases, 2012Co-Authors: Sanjay Aneja, J B YuAbstract:The impact of county-level Radiation Oncologist density on prostate cancer mortality in the United States
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Radiation Oncologist density and prostate cancer mortality
Journal of Clinical Oncology, 2011Co-Authors: Sanjay Aneja, J B YuAbstract:72 Background: There exists a geographic variation among the distribution of Radiation Oncologists (RO). The goal of this study was to determine the effect of RO density (ROD) on prostate cancer (PC) mortality (PCM). Methods: Using county- level data from the 2008 Area Resource File, National Program for Cancer Registries, and US Centers for Disease Control, a multivariate regression model was constructed for PCM, controlling for county-level categorized ROD, demographics, socioeconomic status, and existing hospital facilities. Urologist and allergy/immunology density (UD and AID) were explored to assess whether the association with PCM was due to differences in regions with high medical specialist density or whether it was due to access to PC specific specialists. Results: There was a statistically significant reduction in PCM (reduction ranging from 9% to 29% p<.001) associated with counties that possessed at least 1 RO. Moreover, increasing the county density to greater than 2 ROs per 100,000 people ha...
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Radiation Oncologist density and colorectal cancer mortality
Journal of Clinical Oncology, 2011Co-Authors: Sanjay Aneja, J B YuAbstract:605 Background: Although the use of Radiation therapy is increasing, there exists geographic variation among the distribution of Radiation Oncologists. The impact of this variation on colorectal cancer (CRC) outcomes remains unexplored. The goal of this study was to determine the effect of Radiation Oncologist density on CRC mortality. Methods: Using county-level data from the 2008 Area Resource File, National Program for Cancer Registries, and US Centers for Disease Control, a regression model was constructed for CRC mortality, controlling for county-level categorized Radiation Oncologists density, demographics, socioeconomic status and existing healthcare facilities. Results: There was a statistically significant reduction in CRC mortality (reduction in mortality ranging from 12% to 47%, p<0.001) associated with counties that possessed at least one Radiation Oncologist. However, increasing the county density to greater than two Radiation Oncologists per 100,000 people had no statistically significant re...
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Radiation Oncologist density and esophageal cancer mortality
Journal of Clinical Oncology, 2011Co-Authors: Sanjay Aneja, J B YuAbstract:116 Background: Although the use of Radiation therapy to treat esophageal cancer is increasing, there exists a geographic variation among the distribution of Radiation Oncologists. The impact of this variation on esophageal cancer (EC) outcomes remains unexplored. The goal of this study was to determine the effect of Radiation Oncologist density on EC mortality. Methods: Using county- level data from the 2008 Area Resource File, National Program for Cancer Registries, and U.S. Centers for Disease Control, a multivariate regression model was constructed for EC mortality, controlling for county-level categorized Radiation Oncologists density, demographics, socioeconomic status, and existing hospital facilities. Results: There was a statistically significant reduction in esophageal cancer mortality (reduction ranging from 22% to 79% p < 0.001) associated with counties that possessed at least one Radiation Oncologist. However, increasing the county density to greater than two Radiation Oncologists per 100,000...
Sanjay Aneja - One of the best experts on this subject based on the ideXlab platform.
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The impact of county-level Radiation Oncologist density on prostate cancer mortality in the United States
Prostate Cancer and Prostatic Diseases, 2012Co-Authors: Sanjay Aneja, J B YuAbstract:Background: The distribution of Radiation Oncologists across the United States varies significantly among geographic regions. Accompanying these variations exist geographic variations in prostate cancer mortality. Prostate cancer outcomes have been linked to variations in urologist density, however, the impact of geographic variation in the Radiation Oncologist workforce and prostate cancer mortality has yet to be investigated. The goal of this study was to determine the effect of increasing Radiation Oncologist density on regional prostate cancer mortality. Methods: Using county-level prostate cancer mortality data from the National Cancer Institute and Centers for Disease Control as well as physician workforce and health system data from the Area Resource File a regression model was built for prostate cancer mortality controlling for categorized Radiation Oncologist density, urologist density, county socioeconomic factors and pre-existing health system infrastructure. Results: There was statistically significant reduction in prostate cancer mortality (3.91–5.45% reduction in mortality) in counties with at least 1 Radiation Oncologist compared with counties lacking Radiation Oncologists. However, increasing the density of Radiation Oncologists beyond 1 per 100 000 residents did not yield statistically significant incremental reductions in prostate cancer mortality. Conclusion: The presence of at least one Radiation Oncologist is associated with significant reductions in prostate cancer mortality within that county. However, the incremental benefit of increasing Radiation Oncologist density exhibits a plateau effect providing marginal benefit. In order to optimize outcomes a geographically aware policy, which addresses the size and distribution of the workforce, must be in place in order prevent geographic disparities in prostate cancer mortality.
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the impact of county level Radiation Oncologist density on prostate cancer mortality in the united states
Prostate Cancer and Prostatic Diseases, 2012Co-Authors: Sanjay Aneja, J B YuAbstract:The impact of county-level Radiation Oncologist density on prostate cancer mortality in the United States
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the influence of regional Radiation Oncologist and urologist capacities on treatment choice for prostate cancer management
Journal of Clinical Oncology, 2012Co-Authors: James B Yu, Sanjay Aneja, Danil V Makarov, Kenneth B Roberts, Cary P GrossAbstract:108 Background: Our study investigates the influence of regional variations of Radiation oncology and urology services on the treatment modality chosen for prostate cancer (PCa) management. Methods: PCa treatment choice and patient data from 2004-2007 were obtained from the NCI Surveillance, Epidemiology, and End Results (SEER) database and combined with the health system data from the Area Resource File. The health system characteristics analyzed were Radiation Oncologist (RO) density, urologist (U) density, primary care provider (PCP) density, IMRT equipped hospital density, general Radiation therapy (RT) equipped hospital density, and median household income. Patient factors analyzed included race, marital status, and age. Separate logistic regression models were built to test the association between health system characteristics and whether patients received any form of RT (EBRT, brachytherapy, or a combination) or just surgical treatment. Results: Overall of the 108,612 patients in our sample, 43.7% ...
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Radiation Oncologist density and prostate cancer mortality
Journal of Clinical Oncology, 2011Co-Authors: Sanjay Aneja, J B YuAbstract:72 Background: There exists a geographic variation among the distribution of Radiation Oncologists (RO). The goal of this study was to determine the effect of RO density (ROD) on prostate cancer (PC) mortality (PCM). Methods: Using county- level data from the 2008 Area Resource File, National Program for Cancer Registries, and US Centers for Disease Control, a multivariate regression model was constructed for PCM, controlling for county-level categorized ROD, demographics, socioeconomic status, and existing hospital facilities. Urologist and allergy/immunology density (UD and AID) were explored to assess whether the association with PCM was due to differences in regions with high medical specialist density or whether it was due to access to PC specific specialists. Results: There was a statistically significant reduction in PCM (reduction ranging from 9% to 29% p<.001) associated with counties that possessed at least 1 RO. Moreover, increasing the county density to greater than 2 ROs per 100,000 people ha...
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Radiation Oncologist density and colorectal cancer mortality
Journal of Clinical Oncology, 2011Co-Authors: Sanjay Aneja, J B YuAbstract:605 Background: Although the use of Radiation therapy is increasing, there exists geographic variation among the distribution of Radiation Oncologists. The impact of this variation on colorectal cancer (CRC) outcomes remains unexplored. The goal of this study was to determine the effect of Radiation Oncologist density on CRC mortality. Methods: Using county-level data from the 2008 Area Resource File, National Program for Cancer Registries, and US Centers for Disease Control, a regression model was constructed for CRC mortality, controlling for county-level categorized Radiation Oncologists density, demographics, socioeconomic status and existing healthcare facilities. Results: There was a statistically significant reduction in CRC mortality (reduction in mortality ranging from 12% to 47%, p<0.001) associated with counties that possessed at least one Radiation Oncologist. However, increasing the county density to greater than two Radiation Oncologists per 100,000 people had no statistically significant re...
Michael Brundage - One of the best experts on this subject based on the ideXlab platform.
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taking stock the canadian association of Radiation oncology 2017 Radiation Oncologist workforce study
International Journal of Radiation Oncology Biology Physics, 2019Co-Authors: Shaun K Loewen, C M Doll, Ross Halperin, Guila Delouya, Jean Archambault, Teri Stuckless, Michael BrundageAbstract:Purpose To identify and report Radiation Oncologist (RO) workforce demographics, clinical workload trends, and equipment inventory in Canada. Methods and Materials The Canadian Association of Radiation Oncology (CARO) distributed an online survey to RO administrative leaders at 47 Canadian cancer centers providing Radiation therapy services from June to December 2017. The survey queried RO staff demographics, clinical workload, and equipment inventory from 2014 to 2016. Results The response rate was 98% and represented 46 of 47 centers for analysis. In 2016, 510 ROs were in practice, with 98 ROs (19.2%) having 200,000 (84.9%). Approximately half (52.3%) were ≥46 years old. The male-to female ratio was 1.5:1 or higher in all regions of Canada except for Quebec, where there was no gender gap. Part-time employment was more common among female ROs (P Conclusions The Canadian RO workforce demonstrated incremental growth, but rising annual caseloads suggest that Radiation therapy demand outpaced RO supply gains. Government funding is required to replace aging equipment in Canada.
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managing a national Radiation Oncologist workforce a workforce planning model
Radiotherapy and Oncology, 2012Co-Authors: Teri Stuckless, Michael Milosevic, Catherine De Metz, Matthew Parliament, Brent Tompkins, Michael BrundageAbstract:Abstract Purpose The specialty of Radiation oncology has experienced significant workforce planning challenges in many countries. Our purpose was to develop and validate a workforce-planning model that would forecast the balance between supply of, and demand for, Radiation Oncologists in Canada over a minimum 10-year time frame, to identify the model parameters that most influenced this balance, and to suggest how this model may be applicable to other countries. Methods A forward calculation model was created and populated with data obtained from national sources. Validation was confirmed using a historical prospective approach. Results Under baseline assumptions, the model predicts a short-term surplus of RO trainees followed by a projected deficit in 2020. Sensitivity analyses showed that access to radiotherapy (proportion of incident cases referred), individual RO workload, average age of retirement and resident training intake most influenced balance of supply and demand. Within plausible ranges of these parameters, substantial shortages or excess of graduates is possible, underscoring the need for ongoing monitoring. Conclusions Workforce planning in Radiation oncology is possible using a projection calculation model based on current system characteristics and modifiable parameters that influence projections. The workload projections should inform policy decision making regarding growth of the specialty and training program resident intake required to meet oncology health services needs. The methods used are applicable to workforce planning for Radiation oncology in other countries and for other comparable medical specialties.
Joseph Lipscomb - One of the best experts on this subject based on the ideXlab platform.
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Association Between Urologist Characteristics and Radiation Oncologist Consultation for Patients With Locoregional Prostate Cancer
Journal of The National Comprehensive Cancer Network, 2015Co-Authors: Ruben G.w. Quek, Katherine S. Virgo, Kenneth M Portier, Viraj A. Master, Kevin C Ward, Joseph LipscombAbstract:Physicians managing patients with prostate cancer play a critical role in subsequent specialist consultations and initial treatment choice, especially in cases for which no consensus exists regarding optimal treatment strategy. The NCCN Guidelines for Prostate Cancer recommend Radiation as a therapy option for patients with locoregional prostate cancer. The authors examined the association of urologist characteristics with the likelihood that patients would consult Radiation Oncologists. A retrospective cohort of 39,934 patients aged 66 years or older who were diagnosed with locoregional prostate cancer between 2004 and 2007, and the 2405 urologists who performed the patient diagnostic biopsies were constructed using the SEER-Medicare linked database and the American Medical Association Physician Masterfile. Logistic multilevel regression analysis was used to evaluate the influence of urologists' characteristics on Radiation Oncologist consultation within 9 months of locoregional prostate cancer diagnosis. Overall, 24,549 (61.5%) patients consulted a Radiation Oncologist. After adjusting for patient and urologist characteristics, patients diagnosed by urologists in noninstitutional settings (eg, physician office) were significantly more likely to consult a Radiation Oncologist (odds ratio [OR], 1.40; 95% CI, 1.17-1.67; P=.0002) compared with those diagnosed by urologists in institutional settings with a major medical school affiliation. In addition, patients diagnosed by urologists older than 57 years were significantly more likely to consult a Radiation Oncologist (OR, 1.21; 95% CI, 1.07-1.38, P=.003). Copyright © 2015 by the National Comprehensive Cancer Network.
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Association between urologist characteristics and Radiation Oncologist consultation for patients with locoregional prostate cancer
JNCCN Journal of the National Comprehensive Cancer Network, 2015Co-Authors: Ruben G.w. Quek, Katherine S. Virgo, Chun-chieh Lin, Kenneth M Portier, Viraj A. Master, Kevin C Ward, Joseph LipscombAbstract:BACKGROUND: Physicians managing patients with prostate cancer play a critical role in subsequent specialist consultations and initial treatment choice, especially in cases for which no consensus exists regarding optimal treatment strategy. The NCCN Guidelines for Prostate Cancer recommend Radiation as a therapy option for patients with locoregional prostate cancer. PURPOSE: The authors examined the association of urologist characteristics with the likelihood that patients would consult Radiation Oncologists. METHODS: A retrospective cohort of 39,934 patients aged 66 years or older who were diagnosed with locoregional prostate cancer between 2004 and 2007, and the 2405 urologists who performed the patient diagnostic biopsies were constructed using the SEER-Medicare linked database and the American Medical Association Physician Masterfile. Logistic multilevel regression analysis was used to evaluate the influence of urologists' characteristics on Radiation Oncologist consultation within 9 months of locoregional prostate cancer diagnosis. RESULTS: Overall, 24,549 (61.5%) patients consulted a Radiation Oncologist. After adjusting for patient and urologist characteristics, patients diagnosed by urologists in noninstitutional settings (eg, physician office) were significantly more likely to consult a Radiation Oncologist (odds ratio [OR], 1.40; 95% CI, 1.17-1.67; P=.0002) compared with those diagnosed by urologists in institutional settings with a major medical school affiliation. In addition, patients diagnosed by urologists older than 57 years were significantly more likely to consult a Radiation Oncologist (OR, 1.21; 95% CI, 1.07-1.38, P=.003).
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Role of the urologist in whether locoregional prostate cancer patients consult with a Radiation Oncologist.
Journal of Clinical Oncology, 2013Co-Authors: Ruben G.w. Quek, Katherine S. Virgo, Kenneth M Portier, Viraj A. Master, Kevin C Ward, Joseph LipscombAbstract:e16029 Background: Multiple treatment options exist for prostate cancer patients, and therapeutic recommendations may differ depending on characteristics of the specialist consulted. The clinical judgment of specialists can play a critical role in the initial treatment choice, especially in cases where there is no professional consensus regarding the optimal treatment strategy. We examined the association between prostate cancer patients’ urologists’ practice affiliation with medical schools on the likelihood the patient would consult a Radiation Oncologist. Methods: Using the Surveillance, Epidemiology and End Results – Medicare linked database and the American Medical Association Physician Masterfile, we conducted a retrospective cohort study of 39,915 patients aged 66 years or older who were diagnosed between 2004 - 2007 with locoregional prostate cancer, and the 2,404 urologists who performed the diagnostic biopsies. Multilevel regression analysis was used to evaluate the influence of patients’ urologists’ practice affiliations with medical schools on the patients’ consultation with a Radiation Oncologist within 9 months of diagnosis. Results: Overall, 25,110 (62.9%) patients consulted with a Radiation Oncologist. After adjusting for patient, tumor and urologist characteristics, patients who saw urologists practicing within non-institutional settings were significantly more likely to consult with a Radiation Oncologist (odds ratio [OR], 1.19; 95% confidence interval [95% CI], 1.05-1.34, p = 0.006) when compared to those who saw urologists practicing within settings with a major medical school affiliation. In addition, patients who saw urologists ≥ 58 years old were significantly more likely to consult with a Radiation Oncologist (OR, 1.71; 95% CI, 1.16-2.50, p = 0.006) when compared to those who saw urologists < 43 years old. Conclusions: Locoregional prostate cancer patients who received their diagnostic biopsy by urologists practicing in non-institutional settings and those who saw older urologists were significantly more likely to eventually consult with a Radiation Oncologist. This may have implications on which patient eventually receives Radiation as initial therapy.
Shlomo A Koyfman - One of the best experts on this subject based on the ideXlab platform.
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clinical research ethics considerations for the Radiation Oncologist
International Journal of Radiation Oncology Biology Physics, 2017Co-Authors: Shlomo A KoyfmanAbstract:Consideration of clinical research ethics in Radiation oncology is underexplored relative to other areas of oncology. A number of ethical challenges related to informed consent, randomization, conflicts of interest, and scientific validity and social value are shared with other areas of medicine, although their exact inflections are specific to Radiation oncology. In addition, there are unique concerns in Radiation oncology arising from the rapid evolution and uneven distribution of Radiation technologies; the greater unfamiliarity of the general public and research oversight committees in regard to Radiation oncology clinical practice; and the high complexity of managing most Radiation oncology research, much of which is carried out in high-acuity multidisciplinary oncologic settings. To produce the best research, adherence to the highest ethical standards should be pursued as an integral component of all Radiation oncology research.
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transoral robotic surgery the Radiation Oncologist s perspective
Oral Oncology, 2016Co-Authors: M C Ward, Shlomo A KoyfmanAbstract:Transoral Robotic Surgery (TORS) is a fascinating new technology allowing for excellent functional outcomes after resection of head and neck tumors that previously required morbid surgical approaches for access. With a new technology, however, come new questions as to optimal patient selection and its impact on adjuvant therapy considerations. Here we review the issues most pertinent to a Radiation Oncologist adapting to the use of TORS. Patient selection, indications for adjuvant radiotherapy, Radiation dose and target volumes are discussed. Finally, ongoing clinical trials and future directions are considered.
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Transoral robotic surgery: The Radiation Oncologist’s perspective
Oral Oncology, 2016Co-Authors: M C Ward, Shlomo A KoyfmanAbstract:Transoral Robotic Surgery (TORS) is a fascinating new technology allowing for excellent functional outcomes after resection of head and neck tumors that previously required morbid surgical approaches for access. With a new technology, however, come new questions as to optimal patient selection and its impact on adjuvant therapy considerations. Here we review the issues most pertinent to a Radiation Oncologist adapting to the use of TORS. Patient selection, indications for adjuvant radiotherapy, Radiation dose and target volumes are discussed. Finally, ongoing clinical trials and future directions are considered.