Seminars In Radiation Oncology[JOURNAL]
Sun
200 papers
Integrative Medicine for Breast Cancer Survivors.
Bao T
Semin Radiat Oncol · 2026 Jul · PMID 42288374 · Publisher ↗
Breast cancer remains one of the most commonly diagnosed cancers worldwide. Cancer treatments often cause a variety of physical and psychological symptoms that can last beyond the end of therapy. This article reviews the...
Breast cancer remains one of the most commonly diagnosed cancers worldwide. Cancer treatments often cause a variety of physical and psychological symptoms that can last beyond the end of therapy. This article reviews the current evidence on integrative medicine approaches, including diet, exercise, and other modalities studied for managing symptoms often reported by breast cancer survivors. For each symptom, we highlight integrative medicine interventions with the strongest available evidence, including mind-body approaches (eg, mindfulness-based interventions, yoga, and hypnosis), acupuncture, massage therapy, and selected dietary supplements. This symptom-focused framework aims to help clinicians identify integrative interventions that, based on the existing evidence, may be suitable for addressing individual patient concerns.
Integrative Oncology Approaches for Gastrointestinal Symptoms and Risk Reduction in Patients With Digestive Tract Cancers.
Piawah S, Lin OM, Mendiola DM … +4 more , Yom SS, Macaire G, Cheng SW, Atreya CE
Semin Radiat Oncol · 2026 Jul · PMID 42288373 · Publisher ↗
The purpose of this review is to examine lifestyle-related risk factors for digestive tract cancers, outline integrative oncology strategies for managing nutrition and gastrointestinal symptoms during treatment, and summ...
The purpose of this review is to examine lifestyle-related risk factors for digestive tract cancers, outline integrative oncology strategies for managing nutrition and gastrointestinal symptoms during treatment, and summarize post-treatment recommendations for reducing cancer risk. Key modifiable lifestyle factors in both the prevention and survivorship setting include engaging in regular physical activity and consuming a diet rich in plant-based foods with limited red meat and processed foods. The review also centers integrative approaches to manage gastrointestinal toxicities due to radiation therapy and/or chemotherapy, including practical nutrition tips, mindfulness-based interventions, tai chi/qigong, yoga, acupuncture/acupressure, and selected natural products and herbal supplements. We aim to offer clinicians a holistic framework for caring for patients with digestive tract cancers and to provide both clinicians and patients alike with pragmatic, evidence-based integrative strategies that can reduce risk of cancer, complement pharmacologic treatment, and improve survival.
Integrative Oncology and Radiation Therapy: An Essential Evolution.
Mishra KK, Mao J
Semin Radiat Oncol · 2026 Jul · PMID 42288372 · Publisher ↗
Radiation oncology has long paired precision with compassion, technical excellence with daily human connection. Integrative oncology extends that legacy, advancing a shift from reactive symptom management to proactive, c...
Radiation oncology has long paired precision with compassion, technical excellence with daily human connection. Integrative oncology extends that legacy, advancing a shift from reactive symptom management to proactive, coordinated care; from fragmented referrals to integrated pathways; and from isolated pilot efforts to implementation-ready science. In this volume of Seminars in Radiation Oncology international experts reflect on the collective toolbelt of integrative oncology, the maturation of the science, and the exciting opportunity before us in radiation oncology. By integrating complementary approaches alongside conventional treatment, integrative oncology seeks to improve symptom control, functional outcomes, treatment adherence, and quality of life, with emerging evidence supporting benefits in disease-free and overall survival in select settings. Integrative approaches include nutrition and the microbiome, physical activity, mind-body and nature-based interventions, acupuncture and East Asian medicine, Ayurveda, massage and manual therapy, yoga, tai chi, qi gong, music therapy, stress management, sleep medicine, herbs and supplements, psycho-oncology, and supportive care. Across this collection, three central themes emerge: (a) patient-centered care targeting symptoms that matter most to patients and caregivers; (b) data-driven practice grounded in clinical trials, guidelines, and mechanistic science; and (c) operational compatibility with radiation oncology workflows. We hope readers leave with two clear outcomes: practical integrative strategies applicable to patients beginning radiation therapy tomorrow, and a sharper understanding of the research and systems infrastructure required to make integrative oncology a standard and equitable component of care. The work presented here signals a structural evolution -aligning tumor control and survival with symptom science, biologic insight, and whole-person care. In doing so, radiation oncology is uniquely positioned not merely to participate in, but to lead the redefinition of integrative cancer care for the decades ahead.
Clinical Trials of Integrative Oncology Interventions for Radiation Therapy: Emerging Evidence and Opportunities.
Astaphan DJ, Blanco MM, Riviere P … +3 more , Fogh SE, Greenlee H, Gillespie EF
Semin Radiat Oncol · 2026 Jul · PMID 42288371 · Publisher ↗
Integrative oncology interventions for patients undergoing radiation therapy (RT) may relieve symptoms (including procedural anxiety) and improve quality of life, though gaps remain in the evidence base to adequately gui...
Integrative oncology interventions for patients undergoing radiation therapy (RT) may relieve symptoms (including procedural anxiety) and improve quality of life, though gaps remain in the evidence base to adequately guide implementation efforts. In this article we review clinical trials specifically for psychological (ie, mindfulness), physical (ie, exercise, acupuncture), and combination approaches (ie, yoga, tai chi, and qigong), in which several symptom-based clinical outcomes are impacted (ie, fatigue, sleep disturbance, pain, mood, and xerostomia). We identified at least 90 clinical trials and 15 systematic reviews and meta-analyses related to this topic, but note the predominance of early-phase investigations and some heterogeneity in study findings. We also assess opportunities across the radiation treatment continuum, noting most interventions were targeted during active radiation treatment. Future research ought to leverage novel hybrid study designs and multi-center community-based clinical settings (including cooperative groups) to confirm effectiveness and generalizability of findings of existing earlier phase clinical trials. Meanwhile, opportunities to improve clinical trial efficiency such as integrating advanced practice providers and patient-reported outcomes in routine care should be considered. As a field with procedural elements, established symptom trajectories, and often daily patient engagement, radiation oncology is poised to develop and implement interventions that advance symptom science and clinical outcomes for patients with cancer.
Nonpharmacologic Approaches for Pain Management in Patients With Cancer Treated With Radiation Therapy.
He Y, Lam CS, Yu L … +3 more , Chimonas S, Mao JJ, Zhang H
Semin Radiat Oncol · 2026 Jul · PMID 42288370 · Publisher ↗
Radiation therapy (RT) is central to cancer treatment, yet pain from RT-related toxicities remains common and often inadequately controlled with pharmacologic care alone. Integrative medicine modalities are increasingly...
Radiation therapy (RT) is central to cancer treatment, yet pain from RT-related toxicities remains common and often inadequately controlled with pharmacologic care alone. Integrative medicine modalities are increasingly used to complement standard analgesic strategies, but their role in RT-related pain has not been comprehensively synthesized. In this narrative review, we summarize clinical evidence for nonpharmacologic approaches to RT-related pain, including acupuncture, massage, hypnosis, yoga, and exercise. We further include strategies for incorporating these modalities across the RT care continuum, from pretreatment assessment and on-treatment symptom control nonpharmacologic strategies may reduce pain, while some may also reduce analgesic use or improve quality of life, supporting a more proactive, integrative model of pain management in RT. However, further rigorously designed prospective studies focusing on radiation-related pain and care delivery process are needed to examine the specific efficacy and optimal integration in the context of radiation oncology.
Integrative Therapies for Radiation-Related Toxicities in Hematological Malignancies.
Lin RY, Larsen A, Gowin K
Semin Radiat Oncol · 2026 Jul · PMID 42288369 · Publisher ↗
Hematological malignancies are the fourth most common cancer type, with lymphoma as one of the most common hematological malignancies in this group. Radiation therapy plays a critical role in the treatment of hematologic...
Hematological malignancies are the fourth most common cancer type, with lymphoma as one of the most common hematological malignancies in this group. Radiation therapy plays a critical role in the treatment of hematological malignancies, particularly lymphoma, plasmacytoma, and leukemia. Radiation toxicities include side effects such as pain, dermatitis, mucositis, xerostomia, nausea, fatigue, anxiety, and pneumonitis. With emerging therapies in hematology, including chimeric antigen receptor T-cell therapy, bispecific antibodies, and transplant, patients are presented with unique side effects that may impact their ability to tolerate radiation. Integrative therapies, such as mindfulness-based interventions and yoga, have shown to have strong evidence in managing radiation-related fatigue, anxiety, and depression. Acupuncture has shown to be efficacious for radiation-related pain, xerostomia, and anxiety. As survival has continued to increase over the years, survivorship has become crucial. For patients who have undergone radiation, survivorship concerns such as increased cardiovascular risk, psycho-social concerns, secondary malignancy risk, and others may uniquely be addressed with integrative approaches. This review aims to give an overview of the current evidence for integrative therapies in managing toxicities secondary to radiation and improving the survivorship of patients who have received radiation therapy.
Exercise in Oncology Patients: A Call for Strategies to Address the Critical Gap Between Evidence-Based Recommendations and Implementation.
Fogh SE, Greenlee H, Langley B … +3 more , Gillespie EF, Wonders KY, Marshall N
Semin Radiat Oncol · 2026 Jul · PMID 42288368 · Publisher ↗
Physical activity has demonstrated positive impact on cancer outcomes, including survival and quality of life, in patients throughout the trajectory of cancer treatment. Government and leading health organizations have i...
Physical activity has demonstrated positive impact on cancer outcomes, including survival and quality of life, in patients throughout the trajectory of cancer treatment. Government and leading health organizations have included exercise among cancer-prevention guidelines based on substantial evidence demonstrating clear benefits, including reductions in treatment-related side effects, higher chemotherapy completion rates, improved physical fitness and functionality, and increases in health-related quality of life. Despite clear consensus-based recommendations, a gap exists between what is known to benefit patients with cancer and the implementation of an intervention which has consistently demonstrated a positive impact on patient outcomes. It is critical to develop customized programming, reimbursement and thoughtful strategies that consider both patient and provider barriers to implementing exercise as part of cancer treatment.
Herbal Products and Dietary Supplements in Radiation Oncology: Evidence, Safety, and Practical Patient Counseling.
Hou YN, Gubili J, Mao JJ
Semin Radiat Oncol · 2026 Jul · PMID 42288367 · Publisher ↗
Studies show that patients with cancer use herbal products more often than the general population. Lowering the risk of disease recurrence, symptom control, and improving quality of life are often the reasons cited for s...
Studies show that patients with cancer use herbal products more often than the general population. Lowering the risk of disease recurrence, symptom control, and improving quality of life are often the reasons cited for such use. However, a major concern is that few patients communicate with their oncology providers about such use. Although herbal products are perceived as natural and safe, they can lead to adverse effects and interact with prescription medications, including cancer treatments. Herb-drug interactions can render some treatments less effective or potentiate adverse effects of others. Therefore, patient-physician communication is critical to guide safe and appropriate use of herbal products and to minimize potential harm. The About Herbs website, developed and maintained by the Integrative Medicine and Wellness Service at Memorial Sloan Kettering Cancer Center, contains up-to-date, evidence-based information on purported uses, adverse effects and herb-drug interactions for 317 and growing number of herbs, vitamins, and other dietary supplements. The 5 most frequently accessed entries in 2025 were ashwagandha, Boswellia, active hexose correlated compound, reishi mushroom, and turmeric. In this article, we describe their uses and current evidence of effectiveness in oncology settings including radiation treatment.
A Narrative Review of Nature-Based Interventions that Support Mental Health and Well-Being for Adults Affected by Cancer.
Osher GR, Danziger GS, Victorson DE
Semin Radiat Oncol · 2026 Jul · PMID 42288366 · Publisher ↗
People affected by cancer experience significant mental health challenges across the cancer continuum, marked by anxiety, depression, fear of recurrence, and identity disruption. Several evidenced-based integrative oncol...
People affected by cancer experience significant mental health challenges across the cancer continuum, marked by anxiety, depression, fear of recurrence, and identity disruption. Several evidenced-based integrative oncology approaches are recommended to address psychosocial sequelae (eg, mindfulness, yoga, and music therapy), however, less attention has been given to the role of spending safe and meaningful time in natural environments for this purpose. Growing research suggests that nature-based interventions (NBIs) offer meaningful mental health benefits by reducing stress, restoring attention, and increasing opportunities for physical activity and social connection. In this narrative review, we synthesize evidence on the effects of exemplar NBIs delivered to cancer patients and survivor samples to improve mental health, psychosocial outcomes, and physical biomarkers. Findings are organized across the six following NBI modalities: (1) horticultural and gardening interventions, (2) therapeutic landscapes and built design, (3) group-based immersive wilderness experiences, (4) forest therapy interventions, (5) nature-based physical activity, and (6) nature prescriptions. Feasibility and acceptability were demonstrated across NBIs, with reported benefits such as reduced psychological distress, improved mood, sleep, quality of life, self-efficacy, and social connectedness. Evidence remains heterogeneous, with many studies limited by small sample sizes, nonrandomized designs, and variability in intervention dose and outcomes assessed. This narrative review highlights the potential of NBIs to complement existing psychosocial supports to promote resilience and well-being among people affected by cancer.
Integrating Acupuncture in Radiation Therapy and Survivorship.
de la Cruz L, Jaucian-de la Cruz MG
Semin Radiat Oncol · 2026 Jul · PMID 42288365 · Publisher ↗
Radiation therapy is a cornerstone of cancer treatment, but it is often associated with a range of acute and late toxicities that can significantly impact patients' quality of life. Integrative oncology, which combines c...
Radiation therapy is a cornerstone of cancer treatment, but it is often associated with a range of acute and late toxicities that can significantly impact patients' quality of life. Integrative oncology, which combines conventional cancer treatments with evidence-based complementary therapies, is gaining increasing recognition as a means of managing these side effects and improving patient well-being. Acupuncture, a key component of traditional Chinese medicine, has emerged as a promising intervention for a variety of radiation-induced toxicities. This review synthesizes the current evidence for the use of acupuncture in managing common side effects of radiation therapy, including xerostomia, fatigue, pain, nausea and vomiting, and oral mucositis. We also discuss the proposed mechanisms of action of acupuncture, the challenges in acupuncture research, and future directions for the field. The evidence suggests that acupuncture is a safe and effective intervention for several radiation-induced toxicities, and its integration into routine oncology care has the potential to improve patient outcomes and enhance survivorship.
Integrative Oncology for Prostate Cancer: A Narrative Review.
Liou KT, Metri NA, Newton RU … +3 more , Ajay D, Walker EM, Paller CJ
Semin Radiat Oncol · 2026 Jul · PMID 42288364 · Publisher ↗
Prostate cancer is most common malignancy among men in the United States. As men are now living longer with prostate cancer due to advances in treatment, there exists a growing need to manage the long-term physical and p...
Prostate cancer is most common malignancy among men in the United States. As men are now living longer with prostate cancer due to advances in treatment, there exists a growing need to manage the long-term physical and psychological sequelae of this disease, which range from genitourinary dysfunction to cardiometabolic and psychosocial consequences. Over half of men with prostate cancer report unmet needs in symptom management. Integrative oncology, a patient-centered, evidence-informed field combining lifestyle, natural product, and mind-body interventions with conventional treatments, offers a promising approach to prostate cancer symptom management. This review summarizes the current landscape of integrative oncology research in prostate cancer and discusses the clinical implications.
The Role of the Microbiome and Gut Health in Patients With Digestive Tract Cancers.
Hotca AE, Lin OM, Piawah S … +4 more , Mendiola DM, Yom SS, Kuon C, Atreya CE
Semin Radiat Oncol · 2026 Jul · PMID 42288363 · Publisher ↗
The purpose of this review is to provide a practical and clinically relevant overview of the role of the microbiome in the development and treatment of digestive tract cancers. We describe the established associations be...
The purpose of this review is to provide a practical and clinically relevant overview of the role of the microbiome in the development and treatment of digestive tract cancers. We describe the established associations between microbes and malignancy, such as Helicobacter pylori and Fusobacterium nucleatum, in gastric and colorectal cancer, respectively. We also review emerging evidence identifying additional microorganisms that may play a role in digestive tract cancer initiation and progression. We discuss the impact of microbial composition on the efficacy and toxicity of cancer-directed therapies, including radiation therapy and systemic chemotherapy. Beyond outlining gut microbial risk factors, we also highlight interventions on the oral and gut microbiome to prevent or alleviate symptoms associated with dysbiosis, along with proposed strategies to improve therapeutic outcomes in the future. Finally, we examine opportunities to support gut microbial health, including suggestions to reduce exposure to environmental toxins that may increase cancer risk.
Integrative Oncology in Practice: Moving the SIO-ASCO Guidelines From Evidence to Implementation.
Metri NA, Hundal J, Rao S … +1 more , Paller CJ
Semin Radiat Oncol · 2026 Jul · PMID 42288362 · Publisher ↗
The Society for Integrative Oncology (SIO) and the American Society of Clinical Oncology (ASCO) collaboratively developed evidence-based guidelines supporting selected integrative therapies for common cancer-related symp...
The Society for Integrative Oncology (SIO) and the American Society of Clinical Oncology (ASCO) collaboratively developed evidence-based guidelines supporting selected integrative therapies for common cancer-related symptoms, specifically pain, cancer-related fatigue, depression, and anxiety. Despite growing evidence supporting their use, implementation in routine oncology practice remains limited. In this review, we summarize the SIO-ASCO guidelines and examine barriers to their implementation in clinical settings. We then explore strategies to improve guideline adherence using a "carrot and stick" framework that combines incentive-based approaches with accountability mechanisms. Finally, we present practical strategies to integrate the SIO-ASCO guidelines into routine clinical care. We conclude by discussing future directions for implementing integrative oncology in real-world clinical settings. These approaches aim to overcome the barriers associated with guideline adoption in clinical practice, supporting the widespread use of evidence-based integrative therapies across academic and community settings, improving patient symptom management and quality of life, and ensuring equitable access to integrative therapies for all patients. Together, these efforts will help to establish integrative oncology as a standard part of routine cancer care.
Mind-Body Interventions for People With Cancer: Evidence, Innovation, and Implementation.
Conradi HSW, Petersson JN, Deleemans JM … +5 more , Schuman HDM, Savard C, Irving E, Marshall N, Carlson LE
Semin Radiat Oncol · 2026 Jul · PMID 41861455 · Publisher ↗
Many people with cancer (PWC) continue to experience persistent biopsychosocial and existential challenges across the cancer care continuum. Symptoms such as anxiety, depression, cancer-related fatigue and pain, sleep di...
Many people with cancer (PWC) continue to experience persistent biopsychosocial and existential challenges across the cancer care continuum. Symptoms such as anxiety, depression, cancer-related fatigue and pain, sleep disturbance, fear of cancer recurrence, cognitive impairment, and reduced quality of life remain highly prevalent during and after treatment, underscoring the need for interventions that address both psychological and physiological dimensions of distress. Mind-body interventions encompass a diverse group of practices that explicitly target the bidirectional relationship between mental and physical processes and are increasingly incorporated into integrative oncology as adjuncts to standard care. This narrative review synthesizes current evidence on mind-body interventions for improving biopsychosocial outcomes in adult PWC. We review guideline-recommended interventions including mindfulness-based interventions, yoga, tai chi and qigong, relaxation therapies, hypnosis, music therapy, acupuncture, acupressure, massage, reflexology, and aromatherapy; as well as emerging modalities such as psychedelic-assisted therapy, biofield therapies, nature-based interventions, and mindfulness-based approaches for sexual dysfunction. For each intervention, we summarize target symptoms, treatment-phase considerations, and the quality and limitations of the supporting evidence. Finally, we discuss future directions with an emphasis on improving methodological rigor, elucidating mechanisms of action, expanding implementation and access, and extending research across diverse populations and all stages of cancer care, including survivorship and end-of-life contexts.
Expanding the Horizon of Medical Education in Radiation Oncology.
Giuliani M, Ingledew PA
Semin Radiat Oncol · 2026 Apr · PMID 41795325 · Publisher ↗
The care for patients using radiation therapy is, at its core, an educational enterprise. Every radiotherapy treatment course is the product of sustained learning from the healthcare team, the patients and caregivers. Th...
The care for patients using radiation therapy is, at its core, an educational enterprise. Every radiotherapy treatment course is the product of sustained learning from the healthcare team, the patients and caregivers. The educational mandate of radiation medicine is beyond medical residency training, continuing professional development or patient navigation. It sits at the intersection of complex, multi-disciplinary decision making, precise technical delivery and long-term supportive care. Education remains the primary mechanism by which quality care is determined, delivered and improved. This edition of Seminars in Radiation Oncology features a series of articles which are motivated by a common premise: education in radiation oncology deserves the same scientific rigor as our clinical trials and technology assessments. Taken all together, these articles illustrate the breadth and depth of medical education in radiation oncology. They serve as strong examples of scholarship and should stimulate the reader to observe medical education in their own setting, identify potential gaps, and thoughtfully approach ways to improve radiation oncology medical education. Consider this a call to action to our specialty, to expand our horizons and the rigor of radiation oncology medical education research, noting its fundamental place in oncology care.
When the Toolbox Expands: Ethical and Collaborative Imperatives for Functional Radiosurgery.
Ehret F, Kleinberg L
Semin Radiat Oncol · 2026 Apr · PMID 41780116 · Publisher ↗
Abstract loading — click title to view on PubMed.
Global Expert Perspectives on Radiation Oncology Education for Managing Older Adults With Cancer: Current Practice and Future Directions.
Morris L, Turner S, Phillips JL … +1 more , Agar M
Semin Radiat Oncol · 2026 Apr · PMID 41771226 · Publisher ↗
In evidence-based curriculum development, a critical methodological step is conducting a needs-based assessment of key stakeholders to guide learning objectives and targeted educational strategies. Qualitative research o...
In evidence-based curriculum development, a critical methodological step is conducting a needs-based assessment of key stakeholders to guide learning objectives and targeted educational strategies. Qualitative research offers a valuable approach to understanding educational gaps, stakeholder priorities, environmental influences, barriers, and facilitators that may shape curriculum design. In this review, we outline the practical application of qualitative methodology to inform curriculum development in geriatric oncology (GO) within radiation oncology (RO) training, providing a best practice approach to curriculum enquiry that may be transferable to other areas of RO medical education. Learning about geriatric oncology (GO) remains underrepresented in radiation oncology (RO) training, despite the growing proportion of older adults with cancer. Herein, we explore factors perceived to impact current and future delivery of optimal postgraduate geriatric RO education. Ten semi-structured interviews were conducted with senior RO educators from 8 countries to explore factors influencing current and future delivery of postgraduate GO education. Thematic analysis identified 4 key themes: (1) Older adults: The hidden majority; (2) Curriculum reform; (3) What hinders, what helps; and (4) Putting learning into practice. This review provides practical direction for strengthening GO education through curriculum reform, faculty development, and innovative delivery approaches. Beyond GO specifically, we illustrate how a structured qualitative needs assessment can inform stepwise curriculum design in RO more broadly, offering a replicable primer for educators seeking to develop evidence-based training initiatives across other domains of RO education.
An Evaluation of Radiation Oncology Patient Education Materials: Readability, Gaps, and Health Literacy Implications.
Hart R, Lawrie K, Wong R … +3 more , Li W, Giuliani ME, Papadakos J
Semin Radiat Oncol · 2026 Apr · PMID 41762921 · Publisher ↗
This review presents a summary of radiation therapy patient education materials. The purpose is to evaluate the quality, readability, and relevance of print-format pamphlets used to support patients undergoing radiation...
This review presents a summary of radiation therapy patient education materials. The purpose is to evaluate the quality, readability, and relevance of print-format pamphlets used to support patients undergoing radiation therapy; one large, urban academic cancer center is discussed as a reference for key materials. A literature review identified patient information needs, an environmental scan compared the cancer centre's pamphlet collection with those of leading cancer centres, and assessments used the Patient Education Materials Assessment Tool (PEMAT) and the Flesch-Kincaid Grade Level formula. The review revealed gaps in technical content, inconsistent formatting, and readability levels that exceed recommended standards. The review highlights opportunities to improve clarity, consistency, and accessibility by incorporating plain language, standardizing content, and integrating multimedia resources. These findings offer practical guidance for enhancing patient education and health literacy in oncology care and will directly inform ongoing quality improvement efforts, including a broader review of all patient education materials.
Rethinking Competency-Based Medical Education in Radiation Oncology: Early Lessons and Future Directions.
Di Lalla V, Alfieri J
Semin Radiat Oncol · 2026 Apr · PMID 41762920 · Publisher ↗
Competency-based medical education (CBME) represents a global shift in post-graduate medical education over the last few decades. As a specialty requiring precise technical skill and interdisciplinary collaboration in lo...
Competency-based medical education (CBME) represents a global shift in post-graduate medical education over the last few decades. As a specialty requiring precise technical skill and interdisciplinary collaboration in longitudinal patient care, radiation oncology (RO) provides an informative context within which the benefits and challenges of CBME can be explored. In Canada, CBME in RO has been operationalized by the competence by design (CBD) initiative where specialty-specific competencies and entrustable professional activities (EPAs) are used to determine progression in residency training. The assessment of competence in RO is essential and challenging, given both technical and cognitive competencies required for independent practice. By highlighting early lessons learned from CBME implementation in RO, this commentary highlights how these insights can be applied in refining future iterations of educational curricula. By asking the right scholarly questions, the educational community can guide policymakers and improve learning outcomes, ensuring the licensing of competent radiation oncologists that are meeting the demands of the patient populations they care for.
"Ionizing Radiation Is Not in My Toolbox": Ethical Collaboration for Emerging Psychiatric Indications in Radiosurgery.
Flores LE, Gih D
Semin Radiat Oncol · 2026 Apr · PMID 41762919 · Publisher ↗
Recent advances in stereotactic radiosurgery have expanded consideration of non-malignant and functional indications, including emerging applications in psychiatric illness. In response to the review by Ehret et al. we o...
Recent advances in stereotactic radiosurgery have expanded consideration of non-malignant and functional indications, including emerging applications in psychiatric illness. In response to the review by Ehret et al. we offer a multidisciplinary perspective-co-authored by radiation oncology and psychiatry-on the ethical and educational implications of this evolving frontier. While psychiatric radiosurgery remains investigational, its irreversible neural effects and identity-relevant outcomes raise distinct considerations related to informed consent, decisional capacity, and long-term monitoring. We highlight the importance of early psychiatric involvement in trial design, strengthened and capacity-sensitive consent processes, independent interdisciplinary oversight, and longitudinal assessment of neurocognitive and behavioral outcomes. Additionally, we argue that expanding therapeutic indications into psychiatric domains carries implications for radiation oncology education, necessitating foundational literacy in psychiatric diagnosis, treatment paradigms, and the ethical complexities of caring for vulnerable populations. By pairing technical rigor with cross specialty collaboration, the field can ensure that innovation in radiosurgery proceeds within a framework that is both scientifically responsible and ethically sound.
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