Three Perspectives: The Approach of Neoadjuvant Treatment of Rectum Cancer According to Medical Oncologists, Radiation Oncologists, and Surgeons

Purpose Two treatment modalities are considerable for radiation therapy: short-course radiotherapy and immediate surgery or chemoradiation with 5-Fluorouracil based chemotherapy with delayed surgery. In this study, we try to evaluate the real-life treatment approaches of medical, radiation, and surgical oncologists for neoadjuvant treatment of rectal cancers. Method The online survey form was established via Google Forms. The survey was taken voluntarily by medical oncologists, radiation oncologists, surgical oncologists, and general surgeons. Results One hundred eighty-three of the participants were medical oncologists while 36 were radiotherapists and 36 were surgeons. Most of the study population preferred long-course radiation therapy and chemotherapy which was consisting eighty-five percent. Two-thirds of the participants apply chemotherapies before operation. The most frequent chemotherapy cycles for the pre-operative setting were ‘three’ or ‘four-or-more’ with the percent of 27,8 and 25,1 respectively. Medical oncologists had a significantly higher tendency of offering chemotherapy between radiation therapy and surgery compared with the other groups. The optimal time of surgery was different between groups. There was no difference among groups between surgery and the ‘watch & wait’ strategy. A significant difference was observed between groups in offered neoadjuvant chemotherapy regimens. Conclusion In our study, we found the new pre-operative chemotherapy regimen with short-course radiotherapy was slowly adopted in current practice. Also, medical oncologists tend pre-operative chemotherapy compared with other groups. The optimal surgery time for patients receiving neoadjuvant treatment is still controversial.

Composition of the Current Academic Radiation Oncology Workforce in Comprehensive Cancer Centers

PURPOSE: The landscape of the profession of academic radiation oncology is constantly changing. We sought to determine the demographic makeup of the current academic radiation oncology workforce. MATERIALS AND METHODS: Internet web site searches of the 51 National Cancer Institute–designated Comprehensive Cancer Centers (CCCs) were conducted in September 2019. The Scopus database was subsequently searched in December 2019 to ascertain the h-index for each radiation oncologist. Geographic location was economically stratified (New York, California, Massachusetts, Illinois, and Washington DC) as previously reported. Race and binary sex were attributed by authors using publicly available information. Univariate analysis involved the chi-square test; a multivariable model considered several factors including rank and sex. RESULTS: Of 993 radiation oncologists at CCCs, 53.6% are junior faculty, 24.8% associate professors, and 21.7% full professors. The average radiation oncologist at a CCC has been a physician for 19.7 (standard deviation = 11.3) years; 4.7% (47/993) are under-represented minorities. 24.6% of men and 15.5% of women were full professors, a statistically significant difference ( P = .001). Of the 51 department chairs, 11.8% are women and 5.6% are under-represented minorities. There are fewer female than male program directors in the most economically stratified locations ( P = .02). The mean h-index for all faculty is 17.6 (standard deviation = 16.9), and significantly differs between junior faculty (8.21), associate professors (18.46), and full professors (40.05; P < .0001). It also differs between men (19.35) and women (14.11). On multivariable analysis, sex, academic rank, and a secondary advanced degree were independently significant correlates of h-index. CONCLUSION: Among academic radiation oncologists at CCCs, under 5% are under-represented minorities, men are significantly over-represented among senior faculty, and women have significantly lower h-indices than men.

Gender, Productivity, and Philanthropic Fundraising in Academic Oncology

Background: Philanthropic donations are important funding sources in academic oncology but may be vulnerable to implicit or explicit biases toward women. However, the influence of gender on donations has not been assessed quantitatively. Methods: We queried a large academic cancer center’s development database for donations over 10 years to the sundry funds of medical and radiation oncologists. Types of donations and total amounts for medical oncologists and radiation oncologists hired prior to April 1, 2018 (allowing ≥2 years on faculty prior to query), were obtained. We also obtained publicly available data on physician/academic rank, gender, specialty, disease site, and Hirsch-index (h-index), a metric of productivity. Results: We identified 127 physicians: 64% men and 36% women. Median h-index was higher for men (31; range, 1–100) than women (17; range, 3–77; P=.003). Men were also more likely to have spent more time at the institution (median, 15 years; range, 2–43 years) than women (median, 12.5 years; range, 3–22 years; P=.025). Those receiving donations were significantly more likely to be men (70% vs 30%; P=.034). Men received significantly higher median amounts ($259,474; range, $0–$29,507,784) versus women ($37,485; range, $0–$7,483,726; P=.019). On multivariable analysis, only h-index and senior academic rank were associated with donation receipt, and only h-index with donation amount. Conclusions: We found significant gender disparities in receipt of philanthropic donations on unadjusted analyses. However, on multivariable analyses, only productivity and rank were significantly associated with donations, suggesting gender disparities in productivity and promotions may contribute to these differences.