title: Promoting the Appropriate Use of Advanced Radiation Technologies in Oncology: Summary of a National Cancer Policy Forum Workshop.
abstract: Leaders in the oncology community are sounding a clarion call to promote "value" in cancer care decisions. Value in cancer care considers the clinical effectiveness, along with the costs, when selecting a treatment. To discuss possible solutions to the current obstacles to achieving value in the use of advanced technologies in oncology, the National Cancer Policy Forum of the National Academies of Sciences, Engineering, and Medicine held a workshop, "Appropriate Use of Advanced Technologies for Radiation Therapy and Surgery in Oncology" in July 2015. The present report summarizes the discussions related to radiation oncology.
  
  
  
  The workshop convened stakeholders, including oncologists, researchers, payers, policymakers, and patients. Speakers presented on key themes, including the rationale for a value discussion on advanced technology use in radiation oncology, the generation of scientific evidence for value of advanced radiation technologies, the effect of both scientific evidence and "marketplace" (or economic) factors on the adoption of technologies, and newer approaches to improving value in the practice of radiation oncology. The presentations were followed by a panel discussion with dialogue among the stakeholders.
  
  
  
  Challenges to generating evidence for the value of advanced technologies include obtaining contemporary, prospective, randomized, and representative comparative effectiveness data. Proposed solutions include the use of prospective registry data; integrating radiation oncology treatment, outcomes, and quality benchmark data; and encouraging insurance coverage with evidence development. Challenges to improving value in practice include the slow adoption of higher value and the de-adoption of lower value treatments. The proposed solutions focused on engaging stakeholders in iterative, collaborative, and evidence-based efforts to define value and promote change in radiation oncology practice. Recent examples of ongoing or successful responses to the discussed challenges were provided.
  
  
  
  Discussions of "value" have increased as a priority in the radiation oncology community. Practitioners in the radiation oncology community can play a critical role in promoting a value-oriented framework to approach radiation oncology treatment.
authors.affiliation: Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas; Department of Health Services Research, University of Texas MD Anderson Cancer Center, Houston, Texas. Electronic address: glsmith@mdanderson.org.
authors.forename: Grace L
authors.initials: GL
authors.lastname: Smith
authors.affiliation: Fielding School of Public Health, University of California, Los Angeles, Los Angeles, California; David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California; Jonsson Comprehensive Cancer Center, Los Angeles, California.
authors.forename: Patricia A
authors.initials: PA
authors.lastname: Ganz
authors.affiliation: Department of Radiation Oncology, University of Pennsylvania, Philadelphia, Pennsylvania.
authors.forename: Justin E
authors.initials: JE
authors.lastname: Bekelman
authors.affiliation: Department of Radiation and Cellular Oncology, The University of Chicago, Chicago, Illinois.
authors.forename: Steven J
authors.initials: SJ
authors.lastname: Chmura
authors.affiliation: Department of Public Health Sciences, The University of Chicago, Chicago, Illinois.
authors.forename: James J
authors.initials: JJ
authors.lastname: Dignam
authors.affiliation: Department of Radiation Oncology, Massachusetts General Hospital, Boston, Massachusetts.
authors.forename: Jason A
authors.initials: JA
authors.lastname: Efstathiou
authors.affiliation: Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan.
authors.forename: Reshma
authors.initials: R
authors.lastname: Jagsi
authors.affiliation: Department of Radiation Oncology, Moffitt Cancer Center, Tampa, Florida.
authors.forename: Peter A
authors.initials: PA
authors.lastname: Johnstone
authors.affiliation: Department of Radiation Oncology, University of California, Los Angeles, David Geffen School of Medicine, Los Angeles, California.
authors.forename: Michael L
authors.initials: ML
authors.lastname: Steinberg
authors.affiliation: Division of Urology, The University of Texas Medical Branch, Galveston, Texas.
authors.forename: Stephen B
authors.initials: SB
authors.lastname: Williams
authors.affiliation: Department of Radiation Oncology, Yale University School of Medicine, New Haven, Connecticut.
authors.forename: James B
authors.initials: JB
authors.lastname: Yu
authors.affiliation: Department of Radiation Oncology, Massachusetts General Hospital, Boston, Massachusetts.
authors.forename: Anthony L
authors.initials: AL
authors.lastname: Zietman
authors.affiliation: Department of Radiation and Cellular Oncology, The University of Chicago, Chicago, Illinois.
authors.forename: Ralph R
authors.initials: RR
authors.lastname: Weichselbaum
authors.affiliation: Department of Health Services Research, University of Texas MD Anderson Cancer Center, Houston, Texas.
authors.forename: Ya-Chen
authors.initials: YC
authors.lastname: Tina Shih
mesh_terms: D003365:Costs and Cost Analysis; D003657:Decision Making; D004059:Diffusion of Innovation; D006801:Humans; D015969:National Academies of Science, Engineering, and Medicine, U.S., Health and Medicine Division; D009369:Neoplasms / Q000532:radiotherapy*; D015397:Program Evaluation; D061766:Proton Therapy / Q000191:economics / Q000706:statistics & numerical data / Q000639:trends; D018787:Radiation Oncology / Q000191:economics / Q000295:instrumentation / Q000592:standards*; D011878:Radiotherapy / Q000191:economics / Q000295:instrumentation / Q000592:standards; D050397:Radiotherapy, Intensity-Modulated / Q000191:economics / Q000706:statistics & numerical data / Q000639:trends; D012108:Research Personnel; D013679:Technology, Radiologic / Q000191:economics / Q000592:standards; D014481:United States