|Ahead of print
Assessing radiation oncology research needs in India: Results of a physician survey
Rohini Kishor Bhatia1, Supriya Sastri (Chopra)2, Vijay Anand Reddy Palkonda3, GV Giri4, Surendranath Senapati5, Ramesh S Bilimagga6, Manjeet Chadha7, Akila N Viswanathan8, Surbhi Grover9
1 University of Rochester School of Medicine and Dentistry, Rochester, USA
2 Tata Memorial Centre, Mumbai, India
3 Apollo Cancer Hospital, Navi Mumbai, India
4 Kidwai Memorial Institute of Oncology, Bangalore, Karnataka, India
5 Acharya Harihara Regional Cancer Centre, Odisha, India
6 Healthcare Global Enterprises Ltd., Bangalore, India
7 Icahn School of Medicine at Mount Sinai, New York, USA
8 Johns Hopkins Hospital, Department of Radiation Oncology and Molecular Radiation Sciences, Baltimore, MD, USA
9 Department of Radiation Oncology, University of Pennsylvania, Philadelphia, PA, USA
|Date of Submission||08-Apr-2019|
|Date of Decision||08-Jun-2019|
|Date of Acceptance||16-Apr-2020|
|Date of Web Publication||20-Jul-2020|
Department of Radiation Oncology, University of Pennsylvania, Philadelphia, PA
Source of Support: None, Conflict of Interest: None
Background: In India, where the annual incidence of cancer is projected to reach 1.7 million by 2020, the need for clinical research to establish the most effective, resource-guided, and evidence-based care is paramount. In this study, we sought to better understand the research training needs of radiation oncologists in India.
Methods: A 12 item questionnaire was developed to assess research training needs and was distributed at the research methods course jointly organized by Indian College of Radiation Oncology, the American Brachytherapy Society, and Education Committee of the American Society of Therapeutic Radiation Oncology during the Indian Cancer Congress, 2017.
Results: Of 100 participants who received the questionnaire, 63% responded. Ninety percent (56/63) were Radiation Oncologists. Forty-two percent (26/63) of respondents had previously conducted research. A longer length of practice (>10 years) was significantly associated with conducting research (odds ratio (OR) 6.99, P = 0.031) and having formal research training trended toward significance (OR 3.03, P = 0.058). The most common reason for not conducting research was “lack of training” (41%, 14/34). The most common types of research conducted were Audits and Retrospective studies (62%, 16/26), followed by a Phase I/II/III Trial (46%, 10/26). Having formal research training was a significant factor associated with writing a protocol (OR 5.53, P = 0.016). Limited training in research methods (54%, 13/24) and lack of mentorship (42%, 10/24) were cited as reasons for not developing a protocol. Ninety-seven percent (57/59) of respondents were interested in a didactic session on research, specifically focusing on biostatistics.
Conclusions: With research training and mentorship, there is a greater likelihood that concepts and written protocols will translate into successfully completed studies in radiation therapy.
Keywords: India, mentorship, radiation oncology education, research
|How to cite this URL:|
Bhatia RK, Sastri (Chopra) S, Palkonda VA, Giri G V, Senapati S, Bilimagga RS, Chadha M, Viswanathan AN, Grover S. Assessing radiation oncology research needs in India: Results of a physician survey. Indian J Cancer [Epub ahead of print] [cited 2020 Aug 9]. Available from: http://www.indianjcancer.com/preprintarticle.asp?id=290281
| » Introduction|| |
Innovation and research are necessary components for delivering cancer care. In India, the annual incidence of cancer is projected to reach 1.7 million by 2020. The need for clinical research to establish effective, resource-guided, and evidenced-based care where currently 1 radiotherapy machine per 2.1 million people exists, is paramount., Current efforts to engage government and private sectors to enhance resources, including projects like the National Cancer Grid, have begun the process. However, we recognize that access to clinical trials and training to conduct research are limited to only few radiation oncology centers in India and a need to educate and train staff for the delivery of effective radiation is necessary.
A 2015 survey of 132 radiation oncologists in India yielded important information in the areas of potential future education and international collaborations, including training in research methods and biostatistics. With this knowledge, we further evaluated what specific challenges and opportunities that exist for research methods' training through a survey of practicing and in-training surveyed radiation oncologists.
| » Methods|| |
A 12-item questionnaire was developed to assess research training needs and was distributed at the research methods course jointly organized by Indian College of Radiation Oncology (AROI), the American Brachytherapy Society (ABS), and Education Committee of the American Society of Therapeutic Radiation Oncology (ASTRO) during the Indian Cancer Congress in November 2017. The questionnaire asked about types of research conducted and the successful completion of research projects, as well as barriers to conducting research, protocol writing, and study development [Appendix A]. Proportions and descriptive statistics of the data were calculated. Univariate logistic regression was used to determine factors associated with conducting research or writing a research protocol.[Additional file 1]
| » Results|| |
Of the 100 participants of the course, 63 filled out paper forms of our 12-question instrument. Characteristics of the survey respondents are described in [Table 1]. Ninety percent of respondents (56/62) were Radiation Oncologists while the remaining specialties included surgical, medical oncology, and palliative care. All specialties were included in analysis.
[Table 2] describes the research practices among our surveyed population. Only 31.2% (19/61) received formal research training (i.e. any workshops or lectures on research methods that the participant has attended) and 43% (26/60) of respondents had previously conducted research. Among these, 57.7% (15/26) were residents and 42.3% (11/26) were consultants.
|Table 2: Descriptive Characteristics of Research Experience among Survey Respondents|
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The most common type of research conducted was Audits and Retrospective studies (62%, 16/26), followed by an Investigator Initiated Phase I/II/III Trial (46%, 10/26). In univariate analysis (UVA), a longer length of practice (≥10 years) was significantly associated with conducting research (odds ratio (OR) 6.99, P = 0.031) and having formal research training trended toward significance (OR 3.03, P = 0.058). The most common reason for not conducting research was “lack of training (statistics, clinical trial structure, process)” (41%, 14/34), followed by “lack of knowledge” (32%, 11/34). A similar portion of residents and consultants had never completed research (55.9% vs 56.0%). Of the residents who did not complete research, 46.7% cited still being in postgraduate education as a reason. Of the consultants who did not conduct research, the most common reason was a focus on clinical practice (53.8%, 7/13) and lack of training (53.8%, 7/13).
Writing a research protocol
Fifty-nine percent (35/59) of respondents had written a research protocol, of whom 77% (27/35) were able to develop that protocol into a study. Having formal research training was a significant factor associated with writing a protocol (OR 5.53, P = 0.016). Limited training in research methods (54%, 13/24), lack of mentorship (42%, 10/24), and insufficient funding (25%, 6/24) were cited as reasons for not developing a protocol. Lack of time was cited as the most common factor (38%, 3/8) for protocols that did not develop into a study. No factors in UVA (including position, length of practice, having conducted research) were significantly associated with successfully writing a research protocol.
Ninety-seven percent (57/59) of respondents were interested in a didactic session on research, specifically focusing on biostatistics (59.6%, 34/57).
| » Discussion|| |
With future projections for the increase in cancer incidence in India, the establishment of educational resources and mentorship to promote innovation are necessary. Our survey noted challenges at various steps along the research continuum, from lack of knowledge to funding and insufficient mentorship with opportunities to improve.
In a recent analysis of global radiation therapy, India's research output has increased three-fold between 2001-2005 and 2011-2015. However, India's overall contribution to worldwide radiation therapy research is small given economic strength, especially in areas like palliative care.
Almost half of all residents surveyed who did not complete research cited a version of “still being in postgraduate training” as a reason for not completing research. Restructuring training programs to allow participation in research opportunities is a critical step in growing capacity. Successful examples of research curriculums have been established in the US, Australia, and New Zealand. In 2005, radiation oncology trainees in Australia and New Zealand were mandated to undertake a piece of original research and submit a manuscript as first author. Out of 116 surveyed residents, 108 (93.1%) were successful in meeting this requirement and over half of them published their paper in a peer-reviewed journal. Most of the research conducted were retrospective studies (63%), similar to our cohort of both faculty and trainees, where 43% (16/37) were audits or retrospective studies. Barriers in this mandatory research requirement included competing clinical commitments and a lack of dedicated research time. Among our survey respondents, 14.7% (5/34) cited “lack of time” as a barrier to writing a research protocol. Like elsewhere, radiation oncology trainees in India are also mandated to conduct research as part of their training. Of residents who did not complete research, 46% were still in training and thus may not have had an opportunity. However, other reasons for only 43% of our cohort reporting of conducted research is unclear—a significant portion of our respondents were still in training at this time and may have not completed their requirement. Also, respondents may have interpreted the survey question as research in addition to that required by training. Though this survey was of limited scope, there is a demonstrated need for further emphasis on training and research support.
Many residents and physicians in low- and middle-income countries (LMICs) find it difficult to maintain clinical responsibilities due to patient workload and limited physician workforce. It is thus critical to create a culture that promotes protected time for research training.
Almost a third of respondents cited lack of mentorship as a reason for not writing a research protocol. Many studies have established mentorship as a key component of a successful academic career. A 2013 survey of radiation oncology faculty in the US noted respondents with a mentor had a higher median h-index (a measurement of publication productivity), more publications, and more citations than those without a mentor. This survey, part of the Radiation Oncology Academic Development and Mentorship Assessment Project (ROADMAP), noted that 92% of respondents agreed that a hypothetical program to match mentors and mentees would be helpful. It will be necessary to evaluate further how to strengthen the role of mentors in the field of radiation oncology in India.
Funding was cited as a limitation for writing a research protocol for 17% of respondents. Funding agencies including the Indian Council of Medical Research (ICMR), Terry Fox, and the Department of Science and Technology (DST) have grants available for early and intermediate scientists. These agencies promote collaborations with different countries and with a focus on combining science and technology with innovative cancer research. Mentorship and support to apply for international grants supporting cross-national partnerships are an integral part of building research capacity. In the same vein, there has been a push to address the gap in research capacity in LMICs to ensure that local knowledge and training are enforced and responsive to research outcomes. Partnering radiation oncology researchers with mentors locally and internationally will allow for knowledge sharing about local resources, innovative use of resources for research projects, and assistance in navigating research waters that have been previously occupied by high-income countries.
This survey was a small sampling of radiation oncology residents and consultants in India, and included in the analysis are 7 members of adjoining but related fields. Limitations of the survey include partially completed surveys by participants. Thus, to achieve the greatest statistical benefit, all specialties were included in analysis..
| » Conclusion|| |
Though this population of physicians was a small portion of total radiation oncologists in India, responses provide an important baseline to begin creation of resources and educational materials targeted toward improving research capacity. With research training, there is a greater likelihood that concepts and written protocols will translate into successfully completed studies in radiation therapy. Results from clinical research will help improve practice and patient outcomes. Our study affirms that radiation oncology curricula in India must place a greater focus on research to not only enhance patient care but also inspire innovation within our field.
The authors would like to thank the Association of Radiation Oncologists of India–Indian College of Radiation Oncology (AROI-ICRO) for their support.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
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[Table 1], [Table 2]