Gynecological Cancer

PV QA 4 - Poster Viewing Q&A 4

TU_16_3473 - Understanding the Underutilization of Cervical Brachytherapy for Locally Advanced Cervical Cancer

Tuesday, October 23
2:45 PM - 4:15 PM
Location: Innovation Hub, Exhibit Hall 3

Understanding the Underutilization of Cervical Brachytherapy for Locally Advanced Cervical Cancer
T. M. Ma1, M. M. Harkenrider2, C. M. Yashar3, A. N. Viswanathan IV4, and J. S. Mayadev5; 1Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, 2Department of Radiation Oncology, Stritch School of Medicine, Loyola University Chicago, Maywood, IL, 3University of California San Diego, San Diego, CA, 4Johns Hopkins Hospital, Department of Radiation Oncology and Molecular Radiation Sciences, Baltimore, MD, 5University of California San Diego, La Jolla, CA

Purpose/Objective(s): To understand the reasons behind current low utilization of brachytherapy for locally advanced cervical cancer in the US.

Materials/Methods: A 17-item survey was emailed to the entire American Brachytherapy Society (ABS) list serve as active members in 2018. Responses of practitioners who are attending physicians practicing in the US were included in the analysis. Descriptive statistics of the responses were tabulated to determine relative frequency distributions.

Results: Among a total of 135 respondents, 89 were attending physicians practicing in the US and 81 completed the entire survey. Most respondents received training in cervical brachytherapy during residency (93.3%), with 14.6% completing a brachytherapy fellowship and 38.2% receiving further training (i.e. ABS course or hands-on experience) as attending physicians. Over half (56.3%) of respondents treat 10 or fewer patients with intact cervical brachytherapy annually and 39.1% have treated 50 or fewer patients to date. About 84.5% of respondents agree/strongly agree that cervical brachytherapy is underutilized, 47.6% disagree/strongly disagree that residents are receiving adequate training for brachytherapy. About 76.2% of respondents agree/strongly agree that inadequate maintenance of brachytherapy skills is a major obstacle to brachytherapy use and 71.4% agree/strongly agree that increased time requirement constitutes a major obstacle. About 97.6% of respondents will recommend brachytherapy as one of the treatment modalities for the majority of patients with cervical cancer if given access or time, 88.6% agree/strongly agree that they received adequate training and 75.9% always perform their own brachytherapy. One-third (31.0%) routinely refer cervical cancer patients to other radiation oncologists for brachytherapy. The two most common scenarios for which IMRT/SBRT boost is recommended in lieu of brachytherapy are palliative intent (34.5%) and inability to place a uterine tandem (24.1%). The majority (71.3%) of respondents report no barriers to performing brachytherapy themselves, while the two most common barriers reported being time required to perform brachytherapy (9.2%) and lack of referral for cervical cancer cases (9.2%).

Conclusion: The underutilization of brachytherapy in cervical cancer is widely recognized by ABS members with inadequate training during residency and inadequate maintenance of skills being possible major contributing factors. Even among ABS members, there are identifiable barriers and underutilization of brachytherapy in the treatment of cervical cancer. Continued advocacy for brachytherapy is needed given its survival benefit. Future initiatives in enhancing access to brachytherapy training in residency and virtual or in person post-residency may help increase the utilization of brachytherapy, enhance user skillset for optimal treatment for locally advanced cervical cancer.

Author Disclosure: T. Ma: Employee; Department of Oncology, Johns Hopkins University School of Medicine. student; Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University School of Medicine. M.M. Harkenrider: Radiation oncology program director and Trustee; Chicago Radiological Society. C.M. Yashar: Partner; Kaiser Permanente. Advisory Board; Cianna Medical, MicroChips. Travel Expenses; MicroChips. Board Member; American College of Radiation Oncology. Cancer Committee Chairman; University of California San Diego. President; American Brachytherapy Society. Chair, CEP; Univeristy of California San Diego. Chair of Committee; University of California San Diego. Vice Chief of Staff; University of California San Diego. A.N. Viswanathan: None. J.S. Mayadev: Co-chair of the phase I committee; NRG Oncology.

Ting Martin Ma, PhD

Biography:
Dr. T. Martin Ma is currently completing his internship in Internal Medicine at University of Washington Medical Center. He obtained his MD and PhD at the Johns Hopkins University School of Medicine. He will be starting his PGY-2 training in radiation oncology at UCLA in 2019. His clinical interest include gyn/prostate brachytherapy,CNS malignancies and advanced imaging.

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