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Purpose: Interstate variations in Medicaid reimbursements can be significant, and patients who live in states with low Medicaid reimbursements tend to have worse access to care. This analysis describes the extent of variations in Medicaid reimbursements for radiation oncology services across the United States.Methods and Materials: The Current Procedural Terminology codes billed for a course of whole breast radiation were identified for this study. Publicly available fee schedules were queried for all 50 states and Washington, DC, to determine the reimbursement for each service and the total reimbursement for the entire episode of care. The degree of interstate payment variation was quantified by computing the range, mean, standard deviation, and coefficient of variation. The cost of care for the entire episode of treatment was compared to the publicly available Kaiser Family Foundation (KFF) Medicaid-to-Medicare fee index to determine if the pattern of payment variation in medical services generally is predictive of the variation seen in radiation oncology specifically.Results: Data were available for 48 states and Washington, DC. The total episode reimbursement (excluding image guidance for respiratory tracking) varied from $2945 to $15,218 (mean, $7233; standard deviation, $2248 or 31%). The correlation coefficient of the KFF index to the calculated entire episode of care for each state was 0.55.Conclusions: There is considerable variability in coverage and payments rates for radiation oncology services under Medicaid, and these variations track modestly with broader medical fees based on the KFF index. These variations may have implications for access to radiation oncology services that warrant further study. [ABSTRACT FROM AUTHOR]

For elderly patients with glioblastoma multiforme ( GBM), randomized trials have shown similar survival with hypofractionated short-course radiotherapy ( SCRT) compared to conventionally fractionated long-course radiotherapy ( LCRT). We evaluated the adoption of SCRT along with associated factors and survival in a national patient registry. Using the National Cancer Data Base ( NCDB), we identified patients aged ≥70 years with GBM, diagnosed between 1998 and 2011, who received SCRT (34-42 Gy in 2.5-3.4 Gy fractions), or LCRT (58-63 Gy in 1.8-2.0 Gy fractions). Crude and adjusted hazard ratios ( HR) were calculated using Cox regression modeling. 4598 patients were identified, 304 (6.6%) in the SCRT group and 4294 (93.4%) in the LCRT group. Median follow-up was 8.4 months. Median age was 78 versus 75 years, respectively ( P < 0.0001). Patients who received SCRT had higher Charlson-Deyo comorbidity scores versus LCRT (score of ≥2: 16.9% vs. 10.8%, respectively; P = 0.006), and were more likely to be female (53.0% vs. 44.6%, P = 0.005). Patients who received SCRT were less likely to undergo chemotherapy (42.8% vs. 79.3%, P < 0.0001), more likely to undergo biopsy only (34.5% vs. 19.5%, P < 0.0001), and more likely to receive treatment at academic/research programs (49.2% vs. 37.2%, P = 0.0001). Median survival was 4.9 months versus 8.9 months, respectively ( P < 0.0001). The survival detriment with SCRT persisted on multivariable analysis [ HR 1.51 (95% CI: 1.33-1.73, P < 0.0001)], adjusting for age, gender, race, comorbidities, diagnosis year, facility type, surgery, and chemotherapy. In conclusion, hypofractionated SCRT was associated with worse survival compared to conventionally fractionated LCRT for elderly patients with GBM. Patients who received SCRT were older with worse comorbidities, and were less likely to undergo chemotherapy or resection. [ABSTRACT FROM AUTHOR]

Purpose: To report trends in the number and types of applicants and matched trainees to radiation oncology in comparison to other specialties participating in the National Resident Matching Program (NRMP) between 2010 and 2020.Methods and Materials: Data from the NRMP and Electronic Residency Application System (ERAS) were obtained for 18 medical specialties between 2010 and 2020. We assessed the numbers and types of applicants and matched trainees relative to available positions in the NRMP and Supplemental Offer and Acceptance Program (SOAP).Results: In the 2020 NRMP, 122 US MD senior graduates preferentially ranked radiation oncology, a significant decrease from a median of 187 between 2010 to 2019 (interquartile range [IQR], 170-192; P < .001). Across all 18 specialties, radiation oncology experienced the greatest declines in the 2020 NRMP cycle relative to 2010 to 2019, in both the number of ERAS applicants from the United States and Canada (-31%) and the percentage of positions filled by US MD or DO senior graduates (-28%). Of 189 available positions, 81% (n = 154) filled in the NRMP prior to the SOAP, of which 65% (n = 122) were "matched" by US MD senior graduates who preferentially ranked radiation oncology as their top choice of specialty, representing a significant decrease from a median of 92% between 2010 to 2019 (IQR, 88%-94%; P = .002). The percentages of radiation oncology programs and positions unfilled in the NRMP prior to the SOAP were significantly increased in 2020 compared with 2010 to 2019 (programs: 29% vs 8% [IQR, 5%-8%; P < .001]; positions: 19% vs 4% [IQR, 2%-4%; P <.001]). Despite >99% (n = 127 of 128) of US MD or DO senior applicants preferring radiation oncology successfully matching to a radiation oncology position in the 2020 NRMP, 16 of 35 remaining unfilled positions were filled via the SOAP. Radiation oncology was the top user of the SOAP across all specialties participating in the 2020 NRMP, filling 15% of total positions versus a median of 0.9% (IQR, 0.3%-2.3%; P <.001).Conclusions: The supply of radiation oncology residency positions now far exceeds demand by graduating US medical students. Efforts to nullify a market correction revealed by medical student behavior via continued reliance on the SOAP to fill historical levels of training positions may not be in the best of interest of trainees, individual programs, or the specialty as a whole. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate the rate of non-doctoral student authors publishing in an academic journal over time and to analyze the effects student authors have on the scholarly impact of corresponding authors (CAs) by comparing their respective H-index (Hi).Methods and Materials: A database was created of authors who published articles in the International Journal of Radiation Oncology, Biology, Physics in 2006, 2010, and 2014 that included CA, degree, and student author designations. Corresponding authors' His were obtained from Scopus (scopus.com). Student authorship rates were compared between the sampled years. The data were divided into 2 groups: CAs publishing with student authors (SA) and those without (nSA). The CAs' median and mean His with standard deviation and a 95% confidence interval were compared between SA and nSA.Results: A total of 1728 published articles were identified with 1477 unique CAs. The percentage of published articles with student authors increased from 44.4% in 2006, to 52.9% in 2010, to 55.9% in 2014 (P = .0003). In overall analysis, mean Hi was higher for SA as compared with nSA (24.3 vs 22.9), although this did not achieve statistical significance (P = .094). Mean Hi (standard deviation) in 2006, 2010, and 2014 was 27.9 (16.6), 23.6 (16.7), and 18.5 (14.6), respectively. Mean Hi was significantly higher for SA compared with nSA in the years 2006 (29.5 vs 26.6, P = .048) and 2010 (24.9 vs 21.9, P = .038) but not in 2014 (18.5 vs 18.4, P = .963).Conclusion: Student authorship rates in the International Journal of Radiation Oncology, Biology, Physics are increasing. The data suggest that student participation in research may benefit both corresponding and student authors. Creating and expanding research programs to integrate research into medical education may enhance students' experience and encourage interest in radiation oncology. [ABSTRACT FROM AUTHOR]