Unsealed source: Scope of practice for radiopharmaceuticals among United States radiation oncologists

Abstract Purpose/Objectives To determine the utilization of and barriers to implementation of radiopharmaceutical therapy (RPT) amongst U.S. radiation oncologists. Materials/Methods An anonymous, voluntary 21-item survey directed towards attending radiation oncologists was distributed via social media platforms (Twitter, LinkedIn, Facebook, Student Doctor Network). Questions assessed practice characteristics, specific RPT prescribing patterns, RPT prescribing interest, and perceived barriers to RPT implementation. Non-parametric χ2 test was used for correlation statistics. Results Of the 142 respondents, 131 (92.3%) practiced in the U.S. and were included for this analysis. Respondents were well balanced in terms of practicing region, population size served, practice setting and years in practice. Forty-eight percent (n=63) reported prescribing at least one RPT. An additional 7% (n=8) participate in RPT administration without billing themselves. Among those that actively prescribed RPT, the mean cumulative cases per month was 4.2 (range: 1-5). The most commonly prescribed radionuclides were Radium-223 (40%; mean 2.8 cases/month), Iodine-131 (18%; mean 2.3 cases/month), Yttrium-90 (13%; mean 3.4 cases/month), “other” (8%), Samarium-153 (6%; mean 1.0 cases/month), Strontrium-89 and Phosphorous-32 (2% each; mean 1.8 and 0.4 cases/month respectively). Of those who answered “other”, Lutetium-177 dotatate was most commonly prescribed (8%). No significant (p Most radiation oncologists (56%, n=74) responded they would like to actively prescribe more RPT, while 27% (n=35) were indifferent and 17% (n=22) answered “no.” Perceived barriers to implementation were varied but broadly categorized into treatment infrastructure (44%, n=57), inter-specialty relations (41%, n=53), lack of training (23%, n=30), and financial considerations (16%, n=21). Conclusion Among surveyed U.S. radiation oncologists, a significant number reported prescribing at least one RPT. The majority expressed interest in prescribing additional RPT. Wide-ranging barriers to implementation exist, most commonly inter-specialty relations, treatment infrastructure, lack of training, and financial considerations.