- Email: [email protected]
Integrating Radiation Oncology Into the Medical School Curriculum: Initial Results of the Oncology Education Initiative
Proceedings of the 49th Annual ASTRO Meeting
2651
S565
Recruitment Model for Decision Making in Innovative Therapies: Application to Carbon Ions and Protons Radiotherapy
P. Pommier1, J. Borras2, M. Barom3, E. Amsallem4, F. Feschet5 1 4
Centre Le´on Be´rard, Lyon, France, 2Pla director Oncologia, Barcelona, Spain, 3University Hospital, Besanc¸on, France, CNAMTS, Saint Etienne, France, 5University Institute of Technology, Clermont Ferrand, France
Purpose/Objective(s): An original model was developed to simulate the consequences on patients’ recruitment in innovative therapy facilities of several scenarios for the expected clinical benefit and the specificities of the demand and the offer. It was applied to carbon ions and protons radiotherapy and tested in the French context: carbon ion radiotherapy facility project and two existing protons facilities, Medicyc (Nice) with indications limited to eye melanoma and the ICPO (Paris) within renovation with an additional gantry. Materials/Methods: The demand consisted on selected indications, each of them associated with a proton and/or a carbon ions therapeutic protocol that are classified in ‘‘priority levels’’ according to the expected benefit and its level of proof compared to alternative standard therapies. Each protocol specified several requirements: gantry versus fixed beams and treatment room immobilization duration. The offer included 4 centers: ICPO, MediCyc and two potential locations for a carbon ion center, Lyon (ETOILE) and/or Caen (Asclepios). Each of the treatment rooms were characterized by their medical and technical equipment and by a treatment time capacity. The impact of the distance for patient recruitment led to the definition of sub-areas with specific geographic attraction towards each centre and in which the incidence of each indication was estimated. Two scenarios for the recruitment area were simulated: one limited to France and one extended to Europe (Table 1). The multi-step allocation process starts with a random draw of a patient in the highest priority levels’ protocol, identifies room(s) available, applies if required the geographic attraction factors as to propose a room allocation to the patient, who will finally accept or not to be recruited according the expected benefit and the distance factors. Results: Major quantitative and qualitative consequences were reported. For instance, the increase of high priority indications obtained by the extension to Europe and the equipment of all the rooms with a gantry was also associated to a significant reduction of the total recruitment due to protocols’ characteristics. The modification of the expected benefit or attraction values or led to an extension of the indications only in the ‘‘France scenario’’. The location of the carbon ion centers did not impact the recruitment with only one center, but the simulation of both centers resulted in significant qualitative differences for their respective recruitment. Conclusions: The recruitment model may be an important contribution to support decision making in a context on uncertainties and competition for innovative therapies. Table 1 France
Europe
ETOILE Priority Group % 1 2 4 5 7 N
Asclepios
ETOILE
Asclepios
Ref.
1 shift
Low attract.
Gantries
Ref.
Ref.
1 shift
Low attract.
Gantries
Ref.
18 27 55
39.8 48.8 11.3
26.6 73 0.4
16.6 26.3 57%
66.5 33 0.5
99 0.4 0.4
63 36.5 0.5
67 32.7 0.3
65 34.4 0.5
0.1 888
0.1 399
14.3 18.6 40 2 25 1038
0.1 603
904
651
425
644
641
648
Author Disclosure: P. Pommier, None; J. Borras, None; M. Baron, None; E. Amsallem, None; F. Feschet, None.
2652
Integrating Radiation Oncology Into the Medical School Curriculum: Initial Results of the Oncology Education Initiative
D. Singh, P. J. Slanetz, A. E. Hirsch Boston University School of Medicine, Boston, MA Purpose/Objective(s): Multidisciplinary cancer care requires integration of teaching across established educational boundaries. As exposure to oncology and radiation oncology is limited in the undergraduate medical education curriculum, we introduced an Oncology Education Initiative. We report on the addition of structured multidisciplinary oncology education to the required radiology core clerkship at our Institution. Materials/Methods: We conducted an institutional based cohort study of fourth-year medical students rotating through a required clerkship in radiology at our Institution beginning with the class of 2007. An educational questionnaire measuring perceived quality of oncology education prior to and following exposure to a structured didactic program. Results: Of the 149 fourth-year students, 82 (55%) have completed the clerkship to date. While 28 of 82 (34%) of students reported having limited exposure to cancer care in the clinical years, 76 of 82 (93%) were motivated to learn more about the subject and 69 of 82 (84%) reported a better understanding of the multidisciplinary nature of cancer care following this oncology education initiative. Seventy-four of 82 (90%) felt that the radiology clerkship was an opportune time to receive oncology and radiation oncology teaching. As a result of the initiative, nearly one third of the students not applying for a radiation oncology residency elected to rotate through the department for advanced on-site training in the field. Conclusions: Systematic exposure to multidisciplinary oncology education as part of a radiology core clerkship provides an excellent opportunity for integrated teaching of oncologic principles and patient management. This type of experience addresses an important yet underrepresented component of undergraduate medical education. Author Disclosure: D. Singh, None; P.J. Slanetz, None; A.E. Hirsch, None.
2651
S565
Recruitment Model for Decision Making in Innovative Therapies: Application to Carbon Ions and Protons Radiotherapy
P. Pommier1, J. Borras2, M. Barom3, E. Amsallem4, F. Feschet5 1 4
Centre Le´on Be´rard, Lyon, France, 2Pla director Oncologia, Barcelona, Spain, 3University Hospital, Besanc¸on, France, CNAMTS, Saint Etienne, France, 5University Institute of Technology, Clermont Ferrand, France
Purpose/Objective(s): An original model was developed to simulate the consequences on patients’ recruitment in innovative therapy facilities of several scenarios for the expected clinical benefit and the specificities of the demand and the offer. It was applied to carbon ions and protons radiotherapy and tested in the French context: carbon ion radiotherapy facility project and two existing protons facilities, Medicyc (Nice) with indications limited to eye melanoma and the ICPO (Paris) within renovation with an additional gantry. Materials/Methods: The demand consisted on selected indications, each of them associated with a proton and/or a carbon ions therapeutic protocol that are classified in ‘‘priority levels’’ according to the expected benefit and its level of proof compared to alternative standard therapies. Each protocol specified several requirements: gantry versus fixed beams and treatment room immobilization duration. The offer included 4 centers: ICPO, MediCyc and two potential locations for a carbon ion center, Lyon (ETOILE) and/or Caen (Asclepios). Each of the treatment rooms were characterized by their medical and technical equipment and by a treatment time capacity. The impact of the distance for patient recruitment led to the definition of sub-areas with specific geographic attraction towards each centre and in which the incidence of each indication was estimated. Two scenarios for the recruitment area were simulated: one limited to France and one extended to Europe (Table 1). The multi-step allocation process starts with a random draw of a patient in the highest priority levels’ protocol, identifies room(s) available, applies if required the geographic attraction factors as to propose a room allocation to the patient, who will finally accept or not to be recruited according the expected benefit and the distance factors. Results: Major quantitative and qualitative consequences were reported. For instance, the increase of high priority indications obtained by the extension to Europe and the equipment of all the rooms with a gantry was also associated to a significant reduction of the total recruitment due to protocols’ characteristics. The modification of the expected benefit or attraction values or led to an extension of the indications only in the ‘‘France scenario’’. The location of the carbon ion centers did not impact the recruitment with only one center, but the simulation of both centers resulted in significant qualitative differences for their respective recruitment. Conclusions: The recruitment model may be an important contribution to support decision making in a context on uncertainties and competition for innovative therapies. Table 1 France
Europe
ETOILE Priority Group % 1 2 4 5 7 N
Asclepios
ETOILE
Asclepios
Ref.
1 shift
Low attract.
Gantries
Ref.
Ref.
1 shift
Low attract.
Gantries
Ref.
18 27 55
39.8 48.8 11.3
26.6 73 0.4
16.6 26.3 57%
66.5 33 0.5
99 0.4 0.4
63 36.5 0.5
67 32.7 0.3
65 34.4 0.5
0.1 888
0.1 399
14.3 18.6 40 2 25 1038
0.1 603
904
651
425
644
641
648
Author Disclosure: P. Pommier, None; J. Borras, None; M. Baron, None; E. Amsallem, None; F. Feschet, None.
2652
Integrating Radiation Oncology Into the Medical School Curriculum: Initial Results of the Oncology Education Initiative
D. Singh, P. J. Slanetz, A. E. Hirsch Boston University School of Medicine, Boston, MA Purpose/Objective(s): Multidisciplinary cancer care requires integration of teaching across established educational boundaries. As exposure to oncology and radiation oncology is limited in the undergraduate medical education curriculum, we introduced an Oncology Education Initiative. We report on the addition of structured multidisciplinary oncology education to the required radiology core clerkship at our Institution. Materials/Methods: We conducted an institutional based cohort study of fourth-year medical students rotating through a required clerkship in radiology at our Institution beginning with the class of 2007. An educational questionnaire measuring perceived quality of oncology education prior to and following exposure to a structured didactic program. Results: Of the 149 fourth-year students, 82 (55%) have completed the clerkship to date. While 28 of 82 (34%) of students reported having limited exposure to cancer care in the clinical years, 76 of 82 (93%) were motivated to learn more about the subject and 69 of 82 (84%) reported a better understanding of the multidisciplinary nature of cancer care following this oncology education initiative. Seventy-four of 82 (90%) felt that the radiology clerkship was an opportune time to receive oncology and radiation oncology teaching. As a result of the initiative, nearly one third of the students not applying for a radiation oncology residency elected to rotate through the department for advanced on-site training in the field. Conclusions: Systematic exposure to multidisciplinary oncology education as part of a radiology core clerkship provides an excellent opportunity for integrated teaching of oncologic principles and patient management. This type of experience addresses an important yet underrepresented component of undergraduate medical education. Author Disclosure: D. Singh, None; P.J. Slanetz, None; A.E. Hirsch, None.