Care Provider or Service Provider: What Should the Role of Radiation Oncologists Be in the Future?

As cancer therapies and technologies rapidly proliferate and evolve, clinical decisions about the integration or substitution of one treatment option with another are continually confronted by oncology patients and providers. As members of the cancer care team, radiation oncologists (ROs) can function primarily as service providers at the behest of other specialists or as care providers more fully engaged in the decision-making process with colleagues and patients. As the eras of personalized medicine and patient-centered care merge, which role will the RO of the future choose to play for an individual patient and for the larger cancer community? At the turn of the 19th century, the serendipitous discoveries of x-rays and naturally occurring radioactivity by William Roentgen and Henri Becquerel, respectively, paved the way for radiation to become the world’s first effective antitumor “drug.” This phenomenon in turn sparked the beginnings of multidisciplinary cancer treatment, and the field of radiation oncology was born. Today, approximately two thirds of all patients with cancer may be referred to ROs at some point in their illness.1,2 As advanced surgical techniques and groundbreaking systemic therapies have emerged, so too have innovative technical capabilities pertaining to radiation treatment planning and delivery. Diagnostic image fusion, inverse planning, stereotactic localization, and particle beam therapy are a few examples of the physics-based sophistication that has revolutionized modern-day radiotherapy. For many solid malignancies, incorporation of radiation has promoted the advent of organ preservation, protocols with less-radical resection, and/or dose-reduced chemotherapy. Multimodality approaches can optimize tumor control ideally with minimally overlapping toxicity profiles. Coupled with a deeper understanding of tumor and radiation biology, these advances have enhanced the therapeutic index of radiotherapy such that morbidities previously deemed unavoidable are now minimized if not altogether avoided. As this modern-day integration of surgery, systemic agents, and radiation becomes both more common and more complex, effective communication and care coordination is increasingly requisite at all stages of the therapeutic spectrum, from definitive therapy to palliation.3 Furthermore, advancement beyond the existing treatment paradigms and into more innovative multidisciplinary frontiers, such as radiation and immunotherapy, necessitates the input of all cancer providers. Patients benefit from the perspectives of all involved cancer