Non-oncologist Physician Knowledge of Radiation Therapy at an Urban Community Hospital

  • Evan Siau
  • Hernando Salazar
  • Jonathan Livergant
  • Jonathan KleinEmail author


Radiation therapy (RT) is a crucial part of cancer care, but previous work suggests that many non-radiation oncologist physicians are uncomfortable referring for RT. To evaluate training and understanding of RT, the authors sent invitations to complete an online questionnaire to all physicians at a community hospital in Bronx, NY, which asked about oncology training and self-rated and objective knowledge of RT. Out of 247 invited participants, 87 responded (35%). Among responders, 19 were attending physicians (22%) and 66 (76%) were residents. Seventy-two percent of respondents reported caring for > 5 cancer patients in the past month, but 54% reported never referring patients for RT. Sixty-nine percent of respondents stated they received no radiation oncology training in medical school, and 36% reported no general oncology training. Approximately half believed themselves to be “somewhat knowledgeable” about RT indications (48%), benefits (53%), and side effects (55%). Objective assessment mean score was 6.2/12 (median 7) for all respondents; Respondents with internal medicine specialization scored higher than others (mean 7.7 vs 3.5; p < 0.01). Scores did not differ between attending and resident physicians, resident post-graduate levels, or receiving oncology training in medical school. The factors most commonly cited as affecting RT referral decisions were type of cancer, patient wishes, family wishes, poor functional status, and life expectancy. Many physicians are unaware of RT effectiveness or indications, which may affect referral patterns. Previous oncology training was not associated with higher knowledge scores.


Medical education Graduate medical education Continuing medical education Resident education Radiation oncology 



The authors would like to thank all the physicians at SBH Health System who participated in our survey and the departmental staff who provided contact information and assisted with distributing the survey invitation emails. Thanks also to Dr. Rajiv Samant for his help developing the survey questionnaire.

Compliance with Ethical Standards

Ethical Approval

The study and questionnaire were approved by the SBH Health System Institutional Review Board.


  1. 1.
    Perez CA, Brady LW (1998) Principles and practice of radiation oncology. Principles and practice of radiation oncology. Lippincott-Raven, PhiladelphiaGoogle Scholar
  2. 2.
    Kougioumtzopoulou A, Zygogianni A, Liakouli Z, Kypraiou E, Kouloulias V (2017) The role of radiotherapy in bone metastases: a critical review of current literature. Eur J Cancer Care 26(6):e12724CrossRefGoogle Scholar
  3. 3.
    Abshire D, Lang MK (2018) The evolution of radiation therapy in treating cancer. In: Seminars in oncology nursing, vol 34. Elsevier, Amsterdam, pp 151–157Google Scholar
  4. 4.
    Lutz S, Berk L, Chang E, Chow E, Hahn C, Hoskin P, Howell D, Konski A, Kachnic L, Lo S (2011) Palliative radiotherapy for bone metastases: an ASTRO evidence-based guideline. Int J Radiat Oncol Biol Phys 79(4):965–976CrossRefGoogle Scholar
  5. 5.
    Rodrigues G, Macbeth F, Burmeister B, Kelly K-L, Bezjak A, Langer C, Hahn C, Movsas B (2012) Consensus statement on palliative lung radiotherapy: third international consensus workshop on palliative radiotherapy and symptom control. Clin Lung Cancer 13(1):1–5PubMedCrossRefGoogle Scholar
  6. 6.
    Chow E, Zeng L, Salvo N, Dennis K, Tsao M, Lutz S (2012) Update on the systematic review of palliative radiotherapy trials for bone metastases. Clin Oncol 24(2):112–124CrossRefGoogle Scholar
  7. 7.
    Everitt S, Plumridge N, Herschtal A, Bressel M, Ball D, Callahan J, Kron T, Schneider-Kolsky M, Binns D, Hicks R (2013) The impact of time between staging PET/CT and definitive chemo-radiation on target volumes and survival in patients with non-small cell lung cancer. Radiother Oncol 106(3):288–291PubMedCrossRefGoogle Scholar
  8. 8.
    Muijs CT, Pruim J, Beukema JC, Berveling MJ, Plukker JT, Langendijk JA (2013) Oesophageal tumour progression between the diagnostic 18F-FDG-PET and the 18F-FDG-PET for radiotherapy treatment planning. Radiother Oncol 106(3):283–287PubMedCrossRefGoogle Scholar
  9. 9.
    Gold HT, Thwin SS, Buist DSM, Field TS, Wei F, Yood MU, Lash TL, Quinn V, Geiger AM, Silliman RA (2009) Delayed radiotherapy for breast cancer patients in integrated delivery systems. Am J Manag Care 15(11):785–789PubMedPubMedCentralGoogle Scholar
  10. 10.
    Skolarus TA, Miller DC, Zhang Y, Hollingsworth JM, Hollenbeck BK (2010) The delivery of prostate cancer care in the United States: implications for delivery system reform. J Urol 184(6):2279–2284PubMedCrossRefGoogle Scholar
  11. 11.
    Zaorsky NG, Shaikh T, Handorf E, Eastwick G, Hesney A, Scher ED, Jones RT, Showalter TN, Avkshtol V, Rice SR, Horwitz EM, Meyer JE (2016) What are medical students in the United States learning about radiation oncology? Results of a multi-institutional survey. Int J Radiat Oncol Biol Phys 94(2):235–242. PubMedCrossRefGoogle Scholar
  12. 12.
    Bravery BD, Shi K, Nicholls L, Chelvarajah R, Tieu MT, Turner S, Windsor A (2019) Oncology and radiation oncology awareness in final year medical students in Australia and New Zealand. J Cancer Educ.
  13. 13.
    Samant RS, Fitzgibbon E, Meng J, Graham ID (2007) Barriers to palliative radiotherapy referral: a Canadian perspective. Acta Oncol 46(5):659–663PubMedCrossRefGoogle Scholar
  14. 14.
    Samant RS, Fitzgibbon E, Meng J, Graham ID (2006) Family physicians’ perspectives regarding palliative radiotherapy. Radiother Oncol 78(1):101–106PubMedCrossRefGoogle Scholar
  15. 15.
    Vulto A, van Bommel M, Poortmans P, Lybeert M, Louwman M, Baart R, Coebergh JW (2009) General practitioners and referral for palliative radiotherapy: a population-based survey. Radiother Oncol 91(2):267–270PubMedCrossRefGoogle Scholar
  16. 16.
    Olson RA, Lengoc S, Tyldesley S, French J, McGahan C, Soo J (2012) Relationships between family physicians’ referral for palliative radiotherapy, knowledge of indications for radiotherapy, and prior training: a survey of rural and urban family physicians. Radiat Oncol 7(1):73PubMedPubMedCentralCrossRefGoogle Scholar
  17. 17.
    McCloskey SA, Tao ML, Rose CM, Fink A, Amadeo AM (2007) National survey of perspectives of palliative radiation therapy: role, barriers, and needs. Cancer J 13(2):130–137PubMedCrossRefGoogle Scholar
  18. 18.
    Mackillop WJ, Kong W (2016) Estimating the need for palliative radiation therapy: a benchmarking approach. Int J Radiat Oncol Biol Phys 94(1):51–59. PubMedCrossRefGoogle Scholar
  19. 19.
    Huang J, Zhou S, Groome P, Tyldesley S, Zhang-Solomans J, Mackillop WJ (2001) Factors affecting the use of palliative radiotherapy in Ontario. J Clin Oncol 19(1):137–144. PubMedCrossRefGoogle Scholar
  20. 20.
    Ben Mustapha S, Meijnders P, Jansen N, Lakosi F, Coucke P (2019) The status of radiation oncology (RO) teaching to medical students in Europe. Clin Transl Radiat Oncol 17:40–46. PubMedPubMedCentralCrossRefGoogle Scholar
  21. 21.
    Chapman NA, Oultram SC, Jovanovic K (2008) Radiation therapy education for rural and remote GPs. Rural Remote Health 8:2Google Scholar
  22. 22.
    Samant R, Malette M, Tucker T, Lightfoot N (2001) Radiotherapy education among family physicians and residents. J Cancer Educ 16(3):134–138PubMedGoogle Scholar
  23. 23.
    Lutz S, Spence C, Chow E, Janjan N, Connor S (2004) Survey on use of palliative radiotherapy in hospice care. Clin Oncol 22:3581–3586CrossRefGoogle Scholar
  24. 24.
    Lutz ST, Chow EL, Hartsell WF, Konski AA (2007) A review of hypofractionated palliative radiotherapy. Cancer 109(8):1462–1470PubMedCrossRefGoogle Scholar
  25. 25.
    Samant R (2001) Palliative care educational needs of family physicians. J Palliat Care 17(4):277–280PubMedCrossRefGoogle Scholar
  26. 26.
    Samant R, Gooi ACC (2005) Radiotherapy basics for family physicians. Potent tool for symptom relief. Can Fam Physician 51(11):1496–1501PubMedPubMedCentralGoogle Scholar
  27. 27.
    Rose JN, Crook JM (2015) The role of radiation therapy in the treatment of metastatic castrate-resistant prostate cancer. Ther Adv Urol 7(3):135–145. PubMedPubMedCentralCrossRefGoogle Scholar
  28. 28.
    Sundaresan P, King MT, Stockler MR, Costa DSJ, Milross CG (2015) Barriers to radiotherapy utilisation in New South Wales Australia: health professionals’ perceptions of impacting factors. J Med Imaging Radiat Oncol 59(4):535–541PubMedCrossRefGoogle Scholar
  29. 29.
    Halkett GKB, Jiwa M, Meng X, Leong E (2013) Referring advanced cancer patients for palliative treatment: a national structured vignette survey of Australian GPs. Fam Pract 31(1):60–70PubMedCrossRefGoogle Scholar
  30. 30.
    Khan A, Hussain R, Plummer D, Minichiello V (2004) Too many surveys! Eliciting the views of general practitioners for not participating in postal surveys. Aust J Prim Health 10(2):76–81CrossRefGoogle Scholar
  31. 31.
    Livergant J, Howard M, Klein J (2019) Barriers to referral for palliative radiotherapy by physicians: a systematic review. Clin Oncol 31(1):e75–e84CrossRefGoogle Scholar

Copyright information

© American Association for Cancer Education 2019

Authors and Affiliations

  1. 1.Department of Medicine, Mount Sinai Beth IsraelIcahn School of Medicine at Mount SinaiNew YorkUSA
  2. 2.Department of MedicineSBH Health SystemBronxUSA
  3. 3.Division of Radiation OncologyUniversity of British Columbia and BC CancerVictoriaCanada
  4. 4.Department of Radiation OncologyAlbert Einstein College of Medicine and Montefiore Medical CenterBronxUSA

Personalised recommendations