At the third Capitol briefing from the Society of Interventional Radiology (SIR), Susan Sedory, executive director for SIR, along with a panel of experienced interventional radiologists, presented the case for interventional oncologists to become more involved with mainstream cancer treatment, emphasising the need to educate policy makers, financiers, and patients alike on the evolution of targeted cancer and pain medicine offering minimally invasive options. “The advent of these image-guided, organ-sparing procedures that are done through a tiny pin hole on the skin have changed the landscape of how we treat cancer,” summarised William Alago, panellist and interventional radiologist at Memorial Sloan Kettering Cancer Center, New York, USA.
Alago and Sedory, as well as fellow panel members David Prologo (Emory School of Medicine, Atlanta, USA), Alexander Kim, and Theresa Caridi (both Medstar Georgetown University Hospital, Washington, USA) advocated for increased Capitol support of interventional oncology as a discipline through breifing the audience on the Enhancing Opportunities for Medical Doctors Act.
The bill, also known as HR 1167, was introduced to the House in 2017. According to Sedory, the bill looks to support three areas: new primary education in certain medical fields, of which interventional radiology is one; rural hospitals, which desperately need more physician opportunities to fill open positions; hospitals associated with any brand new medical school. Of importance, Sedory stated that this bill does not seek to increase graduate medical education funding, but instead seeks the opportunity to reallocate unused money.
“As interventional radiologists, we are not having trouble filling our spots, in fact, we are over-subscribed. What we want to do—instead of creating new spots—is to assign some of these unspecified positions to the new dedicated pathway trainees in interventional radiology”, Prologo explained.
Interventional oncology has “an identity issue”
Yet the primary ambition of the SIR briefing—alluded to time and time again throughout the panel’s discussion—encompassed the issue of education: all five speakers agreed that there is currently a lack of knowledge regarding minimally invasive therapies, and patient access to these techniques is suffering as a result.
such minimally invasive treatments to cancer were available for everyone, Alago replied: “No, they are not unfortunately, and part of the mission of our society is to educate [the public] as well as our own referring oncologists about the effectiveness of some of these procedures. As we grow as a speciality, we have seen that more people are actually demanding these type of treatments because of their nature. At large academic centres it has been easier to get the message across so patients can access the care and options that are available; at smaller centres, it has been more of a struggle. I think as people become more aware, inevitably, the breadth and scope of our procedures will grow, and there will be more access for patients who need them.”
In agreement, Kim stated that patient access to interventional oncology procedures is the biggest limitation within this field of medicine today. He commented: “The biggest barrier is patient’s understanding that interventional radiologists can provide therapy that could relieve them of their pain. We need to spread the word of other therapies available outside of the standard medical fields that people may be familiar with.”
Caridi alluded to a particular question that was raised at a previous SIR session: “If I am a patient, what should I ask when I go to my doctor?” She said that although the key phrase is “minimally invasive”, simply for the patient to understand that there is a less invasive option to surgery, and to ask accordingly, is half the battle.
“The majority of patients have never heard of the minimally invasive therapeutic options that are available.“
In terms of patients on pain medication that are seeking other treatment options, Caridi said: “For a lot of patients, it is not about opioid addiction, it is the side effects that come alongside pain medication. Although I am not doubting how miraculous they can be, opioids are known to cause severe constipation, and the patient is uncomfortable for other reasons. So, while pain medication can be very effective, it can be utilised in conjunction with what we do.” Certainly, in the context of the opioid epidemic, the panellists are in accordance that the sooner patients can stop taking pain medication, the better. Stressing the independence from opioids that minimally invasive procedures afford was one of their key messages, and one of the most persuasive arguments in terms of gaining audience approval.
Summarising the issue of patient access and education concerning an awareness of interventional radiology, Kim said: “We have an identity issue. Unless you are a savvy patient who does a lot of internet research and can look into specific diseases and treatments, the majority of patients have never heard of the minimally invasive therapeutic options that are now available.
“The reason that this bill is so important is that it will allow us […] not only to increase the number of interventional radiologists in areas that are relatively under served, but also to have a bigger voice within medicine, giving people the opportunity to become more familiar with the therapeutic options that they have today,” Kim noted.
Minimal cost of interventional oncologic procedures an attractive argument for gaining potential financiers’ support
When questioned by an audience member on the costs of these minimally invasive procedures, Prologo explained two major areas in which interventional radiology most significantly affects cost. “The amount of money that we spend on inpatients […] can be extremely expensive, but we can save hundreds-of-thousands of dollars by decreasing the pain to a manageable level in one short outpatient procedure,” said Prologo. Furthermore, as minimally-invasive therapies offer an alternative to surgery, he said: “We can cure someone of their cancer using a needle through a small puncture site that gets covered by a band aid—which is a lot cheaper than the pain medication, the potential complications, and the hospitalisations that can be associated with surgery.”
Speaking specifically about the beneficial economic impact of interventional radiology, Alago added: “In the advent of these procedures, people can get back to work, even some of the people that do heavier work, it is amazing.”
However, Caridi alluded to an example where the treatment option is not drastically less expensive compared to surgical options—the minimally invasive treatment of uterine fibroids. Irrespective of cost, she noted that an advantage of interventional techniques is that they remain patient-centred, as she stressed the importance of patient satisfaction regarding utilisation of the least invasive option available to a patient.
With regards to how interventional radiology has impacted the treatment of cancer specifically, Caridi described the array of minimally invasive techniques used today. She defined embolization for the audience—“essentially blocking the blood supply to the tumour”—and explained how it can be done by delivering chemotherapy directly to the tumour via small catheters in the blood stream, emphasising that it is a relatively pain free procedure. Further techniques mentioned included ablative therapies (usually with a curative intent), and irreversible electroporation.
“It is quite amazing, after 19 years of practice, I have seen the landscape transform itself into something that is so powerful and able to change the lives of cancer patients in a minimally invasive fashion,” enthused Alago of the evolution he has witnessed over his career.
Sedory concluded the briefing, highlighting that the society’s aim remains to spread awareness of this evolving medical field, and to educate patients on exactly what treatment options are available to them. However, she noted that the health systems are very supportive and understanding of the current array of minimally invasive therapies as they continue to evolve in a specialty that has been around for 50 years. Lastly, she stressed the importance of the bill: “Although the exact number of unspecified spots [able to be reallocated] is unknown, it remains around 1,300; a number that would certainly be impactful.”