Cancer, Radiation Therapy, and the Market shows how the radiation therapy specialty in the United States (later called radiation oncology) co-evolved with its device industry throughout the twentieth-century. Academic engineers and physicians acquired financing to develop increasingly powerful radiation devices, initiated companies to manufacture the devices competitively and designed hospital and freestanding procedure units to utilize them. In the process they incorporated market strategies into medical organization and practice. This provocative inquiry concludes that public health policy needs to re-evaluate market-driven high-tech medicine and build evidence-based health care systems.
In recent years, the field of oncology has witnessed a number of technological advances, including more precise radiation therapy and minimally invasive surgical techniques. Three-dimensional (3D), stereotactic, and proton-beam radiation therapy, as well as laparoscopy and robotic surgery, can enhance clinician's ability to treat conditions that were clinically challenging with conventional technologies, and may improve clinical outcomes or reduce treatment-related problems for some patients. Both patients and physicians seek access to these new technologies, which are rapidly being adopted into standard clinical practice. Such demand is often propelled by marketing that portrays the new technologies as the "latest and greatest" treatments available. However, evidence is often lacking to support these claims, and these novel technologies usually come with higher price tags and are often used to treat patients who might have achieved similar benefits from less expensive, conventional treatment. The increased cost of novel treatments without adequate assessment of how they affect patient outcomes is a pressing concern given that inappropriate use of expensive technologies is one of the key factors that threaten the affordability of cancer care in the United States. To explore these issues further, the National Cancer Policy Forum (NCPF) of the Institute of Medicine organized a workshop in July 2015. This is the third NCPF workshop in a series examining the affordability of cancer care. Participants explored clinical benefits and comparative effectiveness of emerging advanced technologies for cancer treatment in radiation therapy and surgery and potential strategies to assess the value and promote optimal use of new technologies in cancer treatment. This report summarizes the presentations and discussions from the workshop.
Cancer treatment is complex and calls for a diverse set of services. Radiation therapy is recognized as an essential tool in the cure and palliation of cancer. Currently, access to radiation treatment is limited in many countries and non-existent in some. This lack of radiation therapy resources exacerbates the burden of disease and underscores the continuing health care disparity among States. Closing this gap represents an essential measure in addressing this global health equity problem. This publication presents a comprehensive overview of the major topics and issues to be taken into consideration when planning a strategy to address this problem, in particular in low and middle income countries. With contributions from leaders in the field, it provides an introduction to the achievements and issues of radiation therapy as a cancer treatment modality around the world. Dedicated chapters focus on the new radiotherapy technologies, proton beams, carbon ion, intraoperative radiotherapy, radiotherapy for children, treatment of HIV-AIDS malignancies, and costing and quality management issues.
Radiation Oncology: An Evidence-Based Approach (ROEBA) is a reference book designed to enable radiation oncologists, including those in training, to make diagnostic and treatment decisions on the basis of the best available scientific evidence. Ease of use is ensured by a structured, reader-friendly format that offers rapid access to evidence-based recommendations. ROEBA’s orientation is entirely practical, in that the focus is solely on diagnostic/staging and treatment issues. Detailed diagnostic and therapeutic guidelines are provided for multidisciplinary cancer management as well as radiation therapy techniques. The evidence underlying each recommendation is clearly and concisely explained, and the strength of the recommendations and evidence is systemically graded. Furthermore, diagnostic and treatment algorithms are provided for the commonly diagnosed cancers. This ground-breaking text on radiation oncology is an essential tool for physicians in their daily clinical practice.
Photon Radiation Therapy for Skin Malignancies is a vital resource for dermatologists interested in radiation therapy, including the physics and biology behind treatment of skin cancers, as well as useful and pragmatic formulas and algorithms for evaluating and treating them. Dermatology has always been a field that overlaps multiple medical specialties and this book is no exception, with its focus on both dermatologists and radiation oncologists. It is estimated that between 2010 and 2020, the demand for radiation therapy will exceed the number of radiation oncologists practicing in the U.S. tenfold, which could profoundly affect the ability to provide patients with sufficient access to treatment. Photon Radiation Therapy for Skin Malignancies enhances the knowledge of dermatologists and radiation oncologists and presents them with the most up-to-date information regarding detection, delineation and depth determination of skin cancers, and appropriate biopsy techniques. In addition, the book also addresses radiation therapy of the skin and the skin’s reactions to radiation therapy.
Today, the arsenal of “high-precision” or “targeted” radiotherapy includes a variety of techniques and approaches that, like the pieces of a puzzle, need to be put together to provide the prostate cancer patient with high-level optimized radiation treatment. This book examines in detail the role of these innovative radiation techniques in the management of prostate cancer. In addition, a variety of current controversies regarding treatment are carefully explored, including whether prophylactic treatment of the pelvic lymphatics is essential, the magnitude of the effect of dose escalation, whether a benefit accrues from hypofractionation, and what evidence exists for the superiority of protons or heavy ions. Radiotherapy in Prostate Cancer: Innovative Techniques and Current Controversies is intended for both radiation oncologists and urologists with an interest in the up-to-date capabilities of modern radiation oncology for the treatment of prostate cancer.
Radiation Oncology provides residents, fellows, and clinicians with a practical, evidence-based guide to the current management of difficult cases in radiation oncology. Emphasis is on the management of those clinical challenges commonly seen in practice that the community practitioner would normally handle without outside referral. The book offers comparisons of treatment approaches to difficult situations, allowing the reader to compare their current treatment approach to that of experts and others in the community. Radiation Oncology is organized in seven sections corresponding to the major treatment areas of radiation oncology. Each section includes three cases to illustrate specific clinical challenges for which there is no clear treatment protocol. The case discussion includes an expert opinion on optimal management along with alternatives from a second academic expert's perspective and from a community practitioner's perspective. Radiation Oncology features: Evidence-based approach to difficult management challenges in radiation oncology Expert authors provide evidence assessment and management summaries through presentation of relevant cases Community practitioner reviewers ensure real-world relevance of each discussion Reviews the most relevant literature pertaining to the challenging scenarios clinicians encounter every day Management alternatives allow discussion of the full range of management options and specifics for difficult problems including hardline recommendations
New advances in treatment offer cancer patients more options than ever before. Coping with Chemotherapy and Radiation is an accessible, accurate guide to the latest developments in radiation therapy and chemotherapy. You will find important information on how chemotherapy and radiation treatments work; what to expect from treatments, how to alleviate common side effects, and more.
Developments in radiation oncology have been key to the tremendous progress made in the field in recent years. The combination of optimal systemic treatment and local therapy has resulted in continuing improved outcomes of cancer therapy. This progress forms the basis for current pre-clinical and clinical research which will strengthen the position of radiation oncology as an essential component of oncological care. This book summarizes recent advances in radiotherapy research and clinical patient care. Topics include radiobiology, radiotherapy technology, and particle therapy. Chapters cover a summary and analysis of recent developments in the search for biomarkers for precision radiotherapy, novel imaging possibilities and treatment planning, and advances in understanding the differences between photon and particle radiotherapy. Advances in Radiation Therapy is an invaluable source of information for scientists and clinicians working in the field of radiation oncology. It is also a relevant resource for those interested in the broad topic of radiotherapy in general.
Intensity-modulated radiation therapy (IMRT), one of the most important developments in radiation oncology in the past 25 years, involves technology to deliver radiation to tumors in the right location, quantity and time. Unavoidable irradiation of surrounding normal tissues is distributed so as to preserve their function. The achievements and future directions in the field are grouped in the three sections of the book, each suitable for supporting a teaching course. Part 1 contains topical reviews of the basic principles of IMRT, part 2 describes advanced techniques such as image-guided and biologically based approaches, and part 3 focuses on investigation of IMRT to improve outcome at various cancer sites.
