ASTRO president outlines plan for greater patient safety, more ‘moonshot’ involvement

Helping radiation oncologists learn from their own medical errors, adopt standardized best practices and participate more prominently in the Obama administration’s “cancer moonshot”: Those three areas of activity currently top the priority list of the American Society for Radiation Oncology (ASTRO).

David Beyer, MD, president and incoming chair of the organization, summarized each Sept. 25 at ASTRO’s annual meeting, which is running in Boston through Wednesday with a total attendance of around 11,000.  

The cancer moonshot, Beyer reminded attendees, is so called to echo John F. Kennedy’s 1961 pledge to put a man on the moon by the end of that decade.

With similar boldness of vision, the cancer moonshot aims to “solve in five years problems that might otherwise have taken us 10 years,” the landing point being “to try and cure cancer,” said Beyer, who in clinical practice serves as medical director for Cancer Centers of Northern Arizona.

Pointing out that ASTRO leadership participated in Vice President Joe Biden’s Moonshot Summit, concurrently hosting a virtual summit on Twitter, Beyer said radiation oncology plays a synergistic role with immunotherapy—and could have as strong a voice in the ongoing moonshot conversation.

“I will tell you that ASTRO is a little disappointed,” Beyer said, explaining that Biden’s blue-ribbon moonshot panel, whose members will guide the government on which research projects to fund, only includes one radiation oncologist.

“We have the brain power here [in ASTRO], and we really would like to get more involvement,” he said. “But if we can’t be on the blue-ribbon panel, we have a number of initiatives that ASTRO has tried to shepherd through so that our members who are working in this space are going to be doing some of this research and, hopefully, getting some of the funding.”

In any case, he added, the moonshot initiative is not fully funded and awaits Congress’s input on budgeting.

“We’ll see if this actually goes where it needs to go. But what a great idea” the cancer moonshot is, Beyer said. “And what a great image: a moonshot. It was the moonshot that got many of us in the ’60s into the science and technology of medicine. It’s time to do it again.”

ROIL-ing the waters  

Beyer next turned to ASTRO’s work to provide a mechanism to capture and share learnings on medical errors and near-misses “in a secure and non-punitive environment.”

That mechanism is called ROILS, for Radiation Oncology Incident Learning System. This launched in 2014, co-sponsored by the American Association of Physicists in Medicine (AAPM), and now has 224 participating facilities that, together, have submitted more than 2,100 incidents.

“I wish we had this in place 15 years ago, because we’ve only lately realized how important it is that we focus on safety,” Beyer said.

Working with a federally recognized patient safety organization (PSO) formed in the wake of the Patient Safety and Quality Improvement Act of 2005, ROILS allows member institutions to safely and anonymously report incidents whether they reach the patient or don’t, Beyer said.

“It’s very analogous to what the FAA does for airplanes that come a little too close in the sky. They ask, ‘Why did this happen?’ That’s what we’re trying to do,” Beyer said. “When something happens, why did it happen? Can we do something so it doesn’t happen next time?”

Beyer said ROILS has already identified and conveyed to ASTRO members a number of processes that lead to errors.

“No surprise—we’ve discovered that when the physician changes the plan, that’s an area where it’s very easy to make a mistake,” Beyer said. “We’re not telling people don’t do it. We’re telling people do it, but recognize this is where mistakes get made.

“And we’re looking at a variety of different areas where we think there is room for improvement.”

Accreditation station

Beyer closed with a quick look at APEX, the ASTRO Accreditation Program for Excellence.

“Part of our drive to push safety is to try to get some standardization on the things that we know work—the processes and best practices that people should be putting into practice in their clinics,” he said. “We want to make sure this is happening across the country.”

As accreditation programs go, APEX “is a toddler. It’s just starting to run,” Beyer said.

Still, it’s already accredited more than a dozen centers and will have topped 30 by the end of the year, he added.

“We’re going to be over 200 by the end of 2017,” Beyer pledged. “We are ramping up at an exponential rate, and we really see this is going to be a huge betterment for patients in the U.S. as we get more and more of the country accredited through APEX.”