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Introduction: There has been a groundswell of discussion and activism surrounding gender diversity. Given the growing importance of this issue, a working group was established under the Faculty of Radiation Oncology (FRO) of the Royal Australian and New Zealand College of Radiologists' (RANZCR) Economics and Workforce Committee (EWC) to review the current status of gender diversity within radiation oncology (RO) in Australia and New Zealand. Methods: De‐identified data were provided from two recent FRO workforce censuses conducted in 2014 and 2018 with permission from the EWC. Further data were provided via direct correspondence with staff at the RANZCR and the Trans‐Tasman Radiation Oncology Group (TROG), the major RO research group in Australasia. The data were collated in February 2021. Results: Our results showed that compared to females, male radiation oncologists were more likely to be engaged in full‐time active clinical work, hold a postgraduate degree and obtain a consultant or fellowship position following graduation. Male fellows were more likely to have leadership positions within RANZCR and TROG and self‐identify as holding any leadership position. The 2018 census revealed that within the trainee cohort, there was almost an equal number of male and female trainees as well as an equal number of male and female trainees holding a postgraduate degree. Conclusion: This review is an important first exploration into gender diversity across Australia and New Zealand's RO workforce. Whilst our study indicates that gender disparities exist, there are some indications that this may be equalizing out over time. [ABSTRACT FROM AUTHOR]

Keywords: diversity; equity and inclusion; gender; radiation oncology; workforce EN diversity equity and inclusion gender radiation oncology workforce 212 215 4 03/29/23 20230301 NES 230301 Women are an integral part of the radiation oncology workforce in Australia, New Zealand and Singapore, representing 40% of the workforce in 2018.[1] Women radiation oncologists within the Royal Australian and New Zealand College of Radiologists (RANZCR) make significant contributions across all domains: clinical, research/academia, education, policy and advocacy. In the Australian public sector, incremental pay increases occur according to accrued time in service and career gaps such as unpaid parental leave can delay pay increases. The gender wage gap among medical specialists: a quantitative analysis of the hourly pay of publicly employed senior doctors in New Zealand. [Extracted from the article]

Purpose: Radiation oncologists need to have more than sound clinical and technical competencies. To optimize care for patients and advance all aspects of radiation oncology (RO), radiation oncologists must also be effective leaders. Embedding systematic leadership education into RO training programs is challenging. This study examined RO residents' perspectives and preferences relating to leadership education. Such data inform the integration of universal leadership learning into RO training in Australia and New Zealand and identify priority areas to facilitate successful leadership development initiatives in RO training programs worldwide.Methods and Materials: Semistructured telephone interviews were conducted with 13 RO residents across 8 Australian training departments and all stages of training. Data from transcriptions of taped interviews were coded by at least 2 researchers and collected to saturation. Qualitative thematic analysis was conducted using an iterative inductive process to develop codes into themes and subthemes. Representative quotes were collated to illustrate subthemes.Results: Four key themes related to leadership education were identified and labeled as follows: (1) recognition, credibility, and value of education; (2) logistics of formal learning; (3) real-world opportunities ("seeing and doing"); and (4) one size does not fit all. Residents unanimously reported that formal leadership education was important and that aspects of becoming a good leader could be learned. Organizational and cultural factors emerged as either barriers or facilitators to learning. There was strong support for interactive methods of learning, and role-modeling by senior colleagues was identified as having a major effect on junior learners.Conclusions: This study offers insight into RO residents' perspectives of and preferences for their own leadership development. The findings have practical implications for the design of effective RO leadership programs and bring the RO field one step closer to the ultimate goal of enhancing leadership capability for all RO professionals. [ABSTRACT FROM AUTHOR]

Introduction: There has been no systematic attempt to enhance leadership capacity within radiation oncology as an integrated component of training. This pilot study examines an intervention to introduce basics of leadership learning to radiation oncology trainees.Methods: A case-based learning tool was designed for delivery via trainees' personal electronic devices. Eight typical workplace case scenarios representing leadership challenges were followed by multiple choice questions, key learning points and hyperlinks to relevant resources. Cases were automatically sent every few days over 4 weeks and participants' responses anonymously collated by the delivery platform (QStream). In addition, an online survey was sent at completion of the program to capture trainees' perspectives on the utility of this tool.Results: Thirty-seven of 45 (82%) trainees participated: 21 females and 16 males. Twenty-six of 37 (70%) starting the program completed it. Sixteen (62% of 'completers') responded to the post-program survey. Fourteen of 16 (87.5%) agreed to the program and helped them identify ways they were already exhibiting leadership. Eleven of 16 (68.8%) agreed they had acquired knowledge that could assist them in being better leaders. Fifteen of 16 said the program made them consider future leadership possibilities in radiation oncology. Fourteen of 15 enjoyed the digital format. Most suggestions for improvement linked to a desire for more interactivity in learning these skills.Conclusion: Piloting an online tool designed to introduce foundation leadership concepts to radiation oncology trainees has provided useful feedback to guide further development in this area. Although this method had high feasibility, it revealed the need for additional interactive methods for leadership learning. [ABSTRACT FROM AUTHOR]

Introduction: Radiation therapy is a core component of curative and palliative cancer treatment; however, its indications and benefits remain poorly understood across the medical profession.Methods: An electronic survey focussing on curriculum content, teaching and assessment in radiation oncology and plans for curriculum change was developed. The Faculty of Radiation Oncology, Royal Australian and New Zealand College of Radiology (RANZCR) distributed the survey to all 24 Australian and New Zealand medical schools. The survey was conducted from November 2017 to January 2018 following ethics approval.Results: Sixteen of the 24 (67%) medical Faculties in Australia and New Zealand responded. Ninety-four percent of Faculties had no formal radiation oncology curriculum. Most Faculties (87%) dedicated <15% of the total medical course to oncology, of which the majority (63%) dedicated <10% to radiation oncology. At least 50% of Faculties did not offer formal radiation oncology teaching to all students. When offered, students' exposure to radiation oncology was often <5 days over the entire course (44%). The majority of medical schools (73%) are planning curriculum changes in the next 5 years; however, most have no intention of changing radiation oncology teaching.Conclusion: Radiation oncology continues to be underrepresented in medical curricula throughout Australia and New Zealand with no plans for improvement by Faculties. This study supports the need for formal advocacy for improving radiation oncology education in medical schools and will form the basis of new national recommendations for radiation oncology curriculum development. [ABSTRACT FROM AUTHOR]

Introduction: The Australian and New Zealand Radiation Oncology Training Program has undergone major changes to align with pedagogical principles and best-evidence practice. The curriculum was designed around the Canadian Medical Education Directives for Specialists framework and involved structural programme changes and new in-training assessment. This paper summarises the work of programme design and implementation and presents key findings from an evaluation of the revised programme.Methods: An independent team conducted the evaluation during the last year of the first 5-year curriculum cycle. Opinions were sought from trainees, supervisors and directors of training (DoTs) through online surveys, focused interviews and group consultations. One hundred nineteen participated in surveys; 211 participated in consultations. All training networks were represented.Results: The new curriculum was viewed favourably by most participants with over 90% responding that it 'provided direction in attaining competencies'. Most (87/107; 81%) said it 'promotes regular, productive interaction between trainees and supervisors'. Adequacy of feedback to trainees was rated as only 'average' by trainees/trainers in one-third of cases. Consultations revealed this was more common where trainers were less familiar with curriculum tools. Half of DoTs/supervisors felt better supported. Nearly two-third of all responders (58/92; 63%) stated that clinical service requirements could be met during training; 17/92 (18.5%) felt otherwise. When asked about 'work-readiness', 59/90 (66%) respondents, including trainees, felt this was improved.Conclusion: Findings suggest that the 'new' curriculum has achieved many of its aims, and implementation has largely been successful. Outcomes focus future work on better supporting trainers in using curriculum tools and providing useful feedback to trainees. [ABSTRACT FROM AUTHOR]

Representatives from countries and regions world-wide who have implemented modern competency-based radiation- or clinical oncology curricula for training medical specialists, met to determine the feasibility and value of an ongoing international collaboration. In this forum, educational leaders from the ESTRO School, encompassing many European countries adopting the ESTRO Core Curriculum, and clinician educators from Canada, Denmark, the United Kingdom, Australia and New Zealand considered the training and educational arrangements within their jurisdictions, identifying similarities and challenges between programs. Common areas of educational interest and need were defined, which included development of new competency statements and assessment tools, and the application of the latter. The group concluded that such an international cooperation, which might expand to include others with similar goals, would provide a valuable vehicle to ensure training program currency, through sharing of resources and expertise, and enhance high quality radiation oncology education. Potential projects for the Global Radiation Oncology Collaboration in Education (GRaCE) were agreed upon, as was a strategy designed to maintain momentum. This paper describes the rationale for establishing this collaboration, presents a comparative view of training in the jurisdictions represented, and reports early goals and priorities. [ABSTRACT FROM AUTHOR]

Introduction This paper reports the key findings of the first Faculty of Radiation Oncology survey of trainees dealing with experiences and perceptions on work practices and choice of specialty. Methods The survey was conducted in mid 2012 using a 37-question instrument. This was distributed by email to 159 current trainees and advertised through the Radiation Oncology Trainees Committee and other channels. There were six email reminders. Respondents were reassured that their responses were anonymous. Results The overall response rate was 82.8%. Gender was balanced among respondents with 67 (51.5%) being male and 63 (48.5%) being female. The most common age bracket was the 31 to 35 years range. There were similar proportions of trainee responders in each of the five years of training. A substantial number of trainees held other degrees besides medical degrees. The large majority were satisfied with radiation oncology as a career choice and with the Training Network within which they were training. Interest in oncology patients, lifestyle after training and work hours were given as the major reasons for choosing radiation oncology as a career. Nearly half of trainees were interested in undertaking some of their training in a part-time capacity and working part time as a radiation oncologist in the future. Over 70% of trainees stated they were working 36-55 clinical hours per week with additional non-clinical tasks, after-hours work and on-call duties. Nearly half of all trainees reported having one or less hours of protected time per week. Nonetheless, 40% of respondents indicated they had enough time to pursue outside interests. Radiation treatment planning and maintaining currency in general medicine were considered the most difficult aspects of training in radiation oncology. Most respondents were keen on the concept of fostering a research mentor. In terms of views on practice after completion of training, the majority were interested in pursuing a fellowship, and nearly all expressed an interest in maintaining an element of academic practice. The large majority of respondents preferred to work in an urban department as a component of their practice after training and nearly all wanted a component of public sector practice. There were only four per cent who preferred to work only within the private sector. Job availability was a concern for 94% of trainees, which far outweighed any other concerns. Conclusions Trainees in radiation oncology are generally satisfied with their choice of specialty and their training. Most trainees are interested in fellowship positions, links with academia and largely public sector work in the future. Job availability for the future is their major concern. [ABSTRACT FROM AUTHOR]

Objective This cross-sectional study aimed to identify the prevalence and correlates of supportive care needs in testicular cancer (TC) survivors. Methods Men who had completed active anti-cancer treatment for TC between 6 months and 5 years previously showing no evidence of recurrence were recruited from 14 Australian cancer centers (September 2009-February 2011). Participants completed a self-report questionnaire measuring sociodemographics, disease, and treatment information, supportive care needs (CaSUN), psychological distress (DASS21) and health-related quality of life (HRQoL; SF36v2). Results Of the 486 eligible TC survivors invited to participate, 244 completed the questionnaire. Sixty-six percent reported one or more unmet supportive care needs. The mean number of unmet needs was 4.73 (SD = 7.0, Range = 0-34). The most common unmet needs related primarily to existential survivorship issues (e.g., life stress) and relationships (e.g., sex life). Younger age and presence of chronic illness other than TC were significantly associated with higher number of unmet needs. The number of unmet needs was more highly correlated with psychological distress and HRQoL than unmet need strength. Conclusions The majority of TC survivors reported one or more unmet needs. Unmet needs regarding existential survivorship issues were frequently reported by TC survivors despite their favorable prognosis. Relationships unmet needs were less prevalent but still more common than in breast and gynecological cancer survivors. These findings appear to be related to the young age of TC survivors. As a higher number of unmet needs is significantly associated with psychological morbidity and impaired HRQoL, interventions addressing this constellation of issues are needed. Copyright © 2013 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

Summary Curative radiotherapy, with or without concurrent chemotherapy, is recognized as a standard treatment option for muscle-invasive bladder cancer. It is commonly used for two distinct groups of patients: either for those medically unfit for surgery, or as part of a 'bladder preserving' management plan incorporating the possibility of salvage cystectomy. However, in both situations, the approach to radiotherapy varies widely around the world. The Australian and New Zealand Faculty of Radiation Oncology Genito-Urinary Group recognised a need to develop consistent, evidence-based guidelines for patient selection and radiotherapy technique in the delivery of curative radiotherapy. Following a workshop convened in May 2009, a working party collated opinions and conducted a wide literature appraisal linking each recommendation with the best available evidence. This process was subject to ongoing re-presentation to the Faculty of Radiation Oncology Genito-Urinary Group members prior to final endorsement. These Guidelines include patient selection, radiation target delineation, dose and fractionation schedules, normal tissue constraints and investigational techniques. Particular emphasis is given to the rationale for the target volumes described. These Guidelines provide a consensus-based framework for the delivery of curative radiotherapy for muscle-invasive bladder cancer. Widespread input from radiation oncologists treating bladder cancer ensures that these techniques are feasible in practice. We recommend these Guidelines be adopted widely in order to encourage a uniformly high standard of radiotherapy in this setting, and to allow for better comparison of outcomes. [ABSTRACT FROM AUTHOR]

Changes in the practice of radiation oncology have been significant over the last decade and continue to develop at an exciting rate. These advances range from our understanding of the increasingly important role of radiotherapy in the adjuvant and definitive settings to huge technological progress in the areas of tumour delineation, treatment planning, delivery and verification. In many cases, benefits have resulted from the ability of modern radiotherapy to deliver high doses with great accuracy and increasing safety in a highly individualized manner. This has impacted favourably on the management of all major malignancies as discussed in this paper. A good understanding of what can be achieved with modern radiotherapy has never been more important in ensuring an effective multidisciplinary approach to cancer management. [ABSTRACT FROM AUTHOR]

Summary The aim of this study was to evaluate the attitudes and experiences of staff towards radiation oncologists who work part-time. A questionnaire was sent to all radiation oncologists, radiation oncology registrars and radiation therapists, and a nursing and clerical representative working in all radiation oncology departments throughout Australia and New Zealand. Of 1242 questionnaires, 446 (35.9%) were returned. Of these, 323 out of 435 respondents (74.2%) supported the concept of a radiation oncologist working part-time. The main barriers to part-time work were inadequate provision of cover, the inability to be contacted when not rostered on, and perceived reduced quality of patient care. The majority of respondents supported part-time employment in radiation oncology. However, the conclusions made from this survey are limited by the poor response rate. For a successful part-time career in radiation oncology, the following points need to be ensured: (i) an equitable pro-rata workload that encompasses both clinical and non-clinical duties; (ii) a clear and well-publicised timetable that is strictly adhered to with special emphasis on completing work prior to non-rostered days; (iii) clear mechanisms in place to deal with patient or other queries on non-rostered days; (iv) a mechanism for being contacted for urgent problems; and (v) good communication between the part-time radiation oncologist, other staff and patients. [ABSTRACT FROM AUTHOR]

Many oncology health professionals (HPs) report communicating with carers as complex; and receive limited carer-relevant training. We developed an online HP education program for supporting and managing carer involvement (eTRIO). We aimed to assess whether HPs' self-efficacy in carer communication, knowledge, and decision-making preferences improve following eTRIO. Satisfaction and implementation potential were assessed. This type 1 hybrid effectiveness-implementation study used a pre-post single arm intervention design. HPs completed baseline measures, the eTRIO online module, and measures at 1- and 12-weeks post-intervention. Measures included: self-efficacy in carer communication (13-items), applied knowledge (7-items), preference for carer involvement in decisions (1-item). Fifteen of participants completed feedback interviews which underwent thematic analysis. User analytics were collected and analysed. Fifty-six HPs completed baseline measures, 42 completed post- and follow-up measures. At baseline mean self-efficacy score was 88. HPs showed a statistically significant increase in self-efficacy post-intervention (mean = 105.8, CI [12.99, 20.47]), maintained at 12-weeks (mean = 101.1, CI [8.00, 15.72]). There were no changes in knowledge or decision-making preferences. Program engagement and satisfaction were high, 86.7% participants rated eTRIO as very/extremely helpful. eTRIO provided HPs with confidence to effectively engage with carers and manage complex situations such as family dominance. These gains are noteworthy, as conflict with families/carers contributes to HP burnout. • Health professionals (HPs) typically receive limited education in communicating with carers. • eTRIO is an online communication training program including videos, interactive activities. • 42 cancer HPs evaluated eTRIO as useful, comprehensive; user engagement and satisfaction was high. • HP's self-efficacy in communicating with cancer carers increased after eTRIO. • Gains in self-efficacy were maintained 3-months post eTRIO completion. [ABSTRACT FROM AUTHOR]

Abstract: Purpose: To assess whether online adaptive radiotherapy for bladder cancer is feasible across multiple Radiation Oncology departments using different imaging, delivery and recording technology. Materials and methods: A multi-centre feasibility study of online adaptive radiotherapy, using a choice of three “plan of the day”, was conducted at 12 departments. Patients with muscle-invasive bladder cancer were included. Departments were activated if part of the pilot study or after a site-credentialing visit. There was real time review of the first two cases from each department. Results: 54 patients were recruited, with 50 proceeding to radiotherapy. There were 43 males and 7 females with a mean age of 78years. The tumour stages treated included T1 (1 patient), T2 (35), T3 (10) and T4 (4). One patient died of an unrelated cause during radiotherapy. The three adaptive plans were created before the 10th fraction in all cases. In 8 (16%) of the patients, a conventional plan using a ‘standard’ CTV to PTV margin of 1.5cm was used for one or more fractions where the pre-treatment bladder CTV was larger than any of the three adaptive plans. The bladder CTV extended beyond the PTV on post treatment imaging in 9 (18%) of the 49 patients. Conclusions: From a technical perspective an online adaptive radiotherapy technique can be instituted in a multi-centre setting. However, without further bladder filling control or imaging, a CTV to PTV margin of 7mm is insufficient. [Copyright &y& Elsevier]

Purpose: We sought to determine whether short-term neoadjuvant androgen deprivation (STAD) duration influences the optimal time point from which Phoenix fail (time to biochemical failure; TTBF) should be measured. Methods and Materials: In the Trans-Tasman Radiation Oncology Group 96.01 trial, men with locally advanced prostate cancer were randomized to 3 or 6 months STAD before and during prostatic irradiation (XRT) or to XRT alone. The prognostic value of TTBF measured from the end of radiation (ERT) and randomization were compared using Cox models. Results: Between 1996 and 2000, 802 eligible patients were randomized. In 436 men with Phoenix failure, TTBF measured from randomization was a powerful predictor of prostate cancer–specific survival and marginally more accurate than TTBF measured from ERT in Cox models. Insufficient data were available to confirm that TTBF measured from testosterone recovery may also be a suitable option. Conclusions: TTBF measured from randomization (commencement of therapy) performed well in this trial dataset and will be a convenient option if this finding holds in other datasets that include long-term androgen deprivation data. [Copyright &y& Elsevier]