In Response to “Care Provider or Service Provider: What Should the Role of Radiation Oncologists Be in the Future?”

To the Editor: In their editorial, Vapiwala et al1 insightfully call for radiation oncologists to reflect on the current perceptions of our professional responsibilities to patients and colleagues as care providers fully engaged in an increasingly complex decision-making process versus service providers, and to consider expansion of our role in the management of expected toxicities and sometimes untoward complications of treatment in the future. We agree with the points the authors have articulately outlined. Moreover, we would like to bolster their interpretation of the efforts put forth by the radiation oncology community, especially with regard to broadening the intellectual capacity of radiation oncologists in the areas of symptom management and palliative care. We believe a major determinant of the inflection point that the authors describe will be in how we decide to train and support the next generation of radiation, medical, and surgical oncologists in terms of becoming more equal partners and care providers for patients with cancer. To this end, the recent formation of the Society of Palliative Radiation Oncology has served to bring together like-minded individuals who believe in the value of deeply engaging in patient management and in educating future radiation oncologists on ways to actualize this value in clinical practice. Our nascent organization lacks an administrative infrastructure and funding, yet it is growing in its membership and cohesiveness. This year, we have organized an inaugural palliative radiotherapy educational symposium, to be held on April 20, 2018 at the Icahn School of Medicine at Mount Sinai. The purpose of this event strives to epitomize that which the editorial authors hope for the future of our field. This symposium’s focus is not on radiation techniques, but rather on how radiation therapy fits into the bigger picture of increasingly complex patient management. Moreover, radiation oncology colleagues in the Veterans Health Administration (VHA) have added to our expanding role and interest in the specific area of palliative radiation oncology and symptom management by initiating the VHA National Palliative Radiotherapy Task Force in 2012. Members of the Veterans Affairs task force have worked within the VHA’s radiation oncology community of 40 active centers to enhance the understanding and use of concepts such as single-fraction radiation for painful bone metastases, patterns of care for radiotherapeutic management of brain metastases, and spinal cord compression. In closing, we are grateful for the attention that