An article by Smith et al,¹ published recently in the Journal of Clinical Oncology, forecasts an impending shortage of radiation oncologists, suggesting that the number of residents in training from 2014 through 2019 must double to meet demand. The authors modeled demand through 2020 (see table) by multiplying current utilization rates for radiation therapy—based on the US National Cancer Institute’s Surveillance Epidemiology and End Results database for the years 2003 through 2005—by population projections from the US Census Bureau.
The projected supply of radiation therapists was derived from the current number of radiation oncologists and active residents. The authors project that demand for radiation therapy is expected to grow 10 times faster than supply between 2010 and 2020.
Table. Projected Number of Patients Receiving Radiation Therapy in 2010 and 2020
Sociodemographic forces are behind the anticipated increase in demand: Between 2010 and 2020, the number of US residents who are 65 or older (a demographic group with higher cancer rates) is expected to increase from 40 million to 55 million. A similar increase in the number of people belonging to those ethnic minorities that exhibit higher cancer-incidence rates also is expected to inflate the number of patients requiring radiation therapy from 470,000 in 2010 to 575,000 in 2020.
The breast, prostate, lung, oral cavity and pharynx, colorectum, and esophagus are the disease sites projected to be most commonly treated with radiation in 2010 and 2020. The sites predicted to show the greatest growth in radiation treatment are the prostate, stomach, liver, lung, and pancreas. The number of minority members treated with radiation therapy is projected to increase by 45%.
The authors note that several questions should be addressed before steps are taken to increase the supply of radiation oncologists dramatically: How much of the increased demand can the current supply of radiation oncologists accommodate? How will changes in practice patterns, such as hypofractionated therapy, affect throughput? What impact will the increased planning burdens of newer technology have on the number of patients a radiation oncologist can treat? Can the increased use of physician assistants and/or advanced practice registered nurses extend the supply of radiation oncologists?