Unsealed Source: Scope of Practice for Radiopharmaceuticals Among United States Radiation Oncologists

Utkarsh Shukla; Imran H Chowdhury; Jason M Beckta; Jacob S Witt; Matthew McFarlane; Chelsea J Miller; Kathryn E Huber; Matthew S Katz; Trevor J Royce; Mudit Chowdhary

doi:10.1016/j.adro.2021.100827

Unsealed Source: Scope of Practice for Radiopharmaceuticals Among United States Radiation Oncologists

Adv Radiat Oncol. 2021 Oct 26;7(5):100827. doi: 10.1016/j.adro.2021.100827. eCollection 2022 Sep-Oct.

Authors

Utkarsh Shukla^{1

2}, Imran H Chowdhury^{1

2}, Jason M Beckta³, Jacob S Witt⁴, Matthew McFarlane⁵, Chelsea J Miller^{1

2}, Kathryn E Huber², Matthew S Katz⁶, Trevor J Royce^{7

8}, Mudit Chowdhary^{1

2}

Affiliations

¹ Department of Radiation Oncology, The Warren Alpert Medical School of Brown University, Providence, Rhode Island.
² Department of Radiation Oncology, Tufts University School of Medicine, Boston, Massachusetts.
³ Northeastern Radiation Oncology, PLLC, Mollie Wilmot Radiation Oncology Center, Saratoga Springs, New York.
⁴ Cancer Care Specialists of Illinois, O'Fallon, Illinois.
⁵ Center for Neurosciences, Tucson, Arizona.
⁶ Department of Radiation Medicine, Lowell General Hospital, Lowell, Massachusetts.
⁷ Department of Radiation Oncology, University of North Carolina School of Medicine, Chapel Hill, North Carolina.
⁸ Flatiron Health, New York, New York.

Abstract

Purpose: Our purpose was to determine the utilization of and barriers to implementation of radiopharmaceutical therapy (RPT) among U.S. radiation oncologists.

Methods and materials: An anonymous, voluntary 21-item survey directed toward attending radiation oncologists was distributed via social media platforms (Twitter, LinkedIn, Facebook, Student Doctor Network). Questions assessed practice characteristics, specific RPT prescribing patterns, RPT prescribing interest, and perceived barriers to RPT implementation. Nonparametric χ² test was used for correlation statistics.

Results: Of the 142 respondents, 131 (92.3%) practiced in the United States and were included for this analysis. Respondents were well balanced in terms of practicing region, population size served, practice setting, and years in practice. Forty-eight percent (n = 63) reported prescribing at least 1 RPT. An additional 7% (n = 8) participate in RPT administration without billing themselves. Among those that actively prescribed RPT, the mean cumulative cases per month was 4.2 (range, 1-5). The most commonly prescribed radionuclides were radium-223 (40%; mean 2.8 cases/mo), iodine-131 (18%; mean 2.3 cases/mo), yttrium-90 (13%; mean 3.4 cases/mo), "other" (8%), samarium-153 (6%; mean 1.0 cases/mo), and strontrium-89 and phosphorous-32 (2% each; mean 1.8 and 0.4 cases/mo, respectively). Of those who answered "other," lutetium-177 dotatate was most commonly prescribed (8%). No significant (P < .05) association was noted between practice type, practice location, years of practice, or practice volume with utilization of any RPTs. Most radiation oncologists (56%, n = 74) responded they would like to actively prescribe more RPT, although 27% (n = 35) were indifferent, and 17% (n = 22) said they would not like to prescribe more RPT. Perceived barriers to implementation were varied but broadly categorized into treatment infrastructure (44%, n = 57), interspecialty relations (41%, n = 53), lack of training (23%, n = 30), and financial considerations (16%, n = 21).

Conclusions: Among surveyed U.S. radiation oncologists, a significant number reported prescribing at least 1 RPT. The majority expressed interest in prescribing additional RPT. Wide-ranging barriers to implementation exist, most commonly interspecialty relations, treatment infrastructure, lack of training, and financial considerations.