This study reports the findings of the 2022 Royal Australian and New Zealand College of Radiologists (RANZCR) workforce census, providing an updated overview of the New Zealand (NZ) radiation oncology workforce. The purpose was to assess workforce demographics, distribution, training, and service capacity, and highlight challenges that have persisted since the 2018 census. METHODS:A survey was distributed to all practicing radiation oncologists and trainees in NZ. Data were collected on demographics, qualifications, workload, practice setting, subspecialty involvement, training experiences, and the perceived impact of COVID-19. Responses were collated and descriptive analyses performed. RESULTS:The census recorded a workforce with a median age of 51 years (range 33-71), and 43% female representation. Most worked across both public and private sectors, with high reported working hours. Brachytherapy practice participation declined compared with previous censuses. Among trainees, concerns included workload, job availability, and work-life balance, with many indicating a preference for part-time and/or urban practice. COVID-19 was associated with delays in service delivery, though the majority reported no exam or fellowship disruptions. Anticipated increases in hypofractionation use were noted. CONCLUSIONS:The 2022 census highlights a workforce under strain from high clinical demand, limited growth, and looming retirements. Key challenges include inequitable representation of Māori and Pasifika clinicians, declining subspecialty capacity, and risks of burnout. Coordinated national workforce planning, with a focus on recruitment, retention, equity, and flexible models of training and employment, will be essential to ensure sustainable radiation oncology services in NZ. This census therefore reinforces the urgent need for coordinated national workforce planning to safeguard the future of radiation oncology services in NZ.

BACKGROUND:Mepitel film decreases the severity of radiation dermatitis in breast cancer patients, but its application is resource-intensive. Many departments therefore use StrataXRT, a gel that patients apply themselves. We compared the protective effects of Mepitel film and StrataXRT on radiation dermatitis during and immediately after radiation therapy. METHODS:This phase III multicentre randomised intra-patient-controlled clinical trial recruited breast cancer patients receiving radiation therapy following mastectomy in three New Zealand Hospitals. Lateral and medial aspects of the chest wall were randomised to either Mepitel film or StrataXRT. Overall skin reaction severity was measured using RISRAS and RTOG once a week during treatment and for 4 weeks after treatment completion. The primary outcome was moist desquamation (with a non-inferiority margin of 7.5%); secondary outcomes were overall skin reaction severity, patient tolerability, satisfaction and cost. RESULTS:Between June 2021 and May 2024, 93 patients were recruited, and 80 patients completed the trial. The absolute difference in moist desquamation rates was 6% lower under Mepitel film (p = 0.413, 95% CI -5%, 18%). Overall skin reaction severity was significantly lower for Mepitel film (Researcher RISRAS: p = 0.022; RTOG: p = 0.011). Mepitel film was cheaper to apply but was less well tolerated, with poor skin adherence being an issue for many patients. CONCLUSION:The study did not show non-inferiority for StrataXRT; overall skin reaction severity and costs were significantly lower under Mepitel film; however, StrataXRT was better tolerated. TRIAL REGISTRATION:ACTRN12621000124831.

AIMS:To explore the development of clinical registries in New Zealand, examine the New Zealand neuro-oncology system and assess factors relevant to establishing a national brain tumour registry in New Zealand. METHODS:A literature review was conducted on the establishment of clinical registries in New Zealand. Key registries were consulted to gain insights into their construction and function. Consultation with neuro-oncology clinicians was conducted to ascertain the structure of New Zealand's neuro-oncology system and to identify relevant considerations for registry development. RESULTS:Analysis of five clinical registries highlighted preferences for: 1) simple, single-tiered registry structures, 2) utilisation of existing registry infrastructure, and 3) inclusion of essential data fields only. Consultation with neuro-oncology clinicians revealed that New Zealand's neuro-oncology system comprises five neurosurgical centres through which brain tumour patients receive care via a consistent pathway. From a clinical perspective, important considerations include the wider New Zealand healthcare system, the Treaty of Waitangi (Te Tiriti o Waitangi), Māori data sovereignty and establishing a registry governance framework. CONCLUSIONS:Establishing a national brain tumour registry in New Zealand will require attention to registry structure, existing registry infrastructure, key data fields, integration with the healthcare system, Māori data sovereignty and governance, with adherence to Te Tiriti o Waitangi.

INTRODUCTION:Accessing radiation therapy is a challenge for rural cancer patients. This study explored the rates of receiving radiation therapy for rural Māori and non-Māori New Zealanders with breast, prostate or lung cancer compared with their most urban counterparts. METHOD:Rates of receipt of radiation therapy per 100,000 population were calculated using radiation treatment data from 2014 to 2020, obtained from the Radiation Oncology Collection and resident population estimates from StatsNZ. Rurality was assigned by the Geographical Classification for Health (GCH). RESULTS:For females with breast cancer, receipt of radiotherapy was lower for those over 75 living in smaller cities (U2) and for non-Māori aged 45-64 living rurally. For prostate cancer, there was higher receipt of radiotherapy by rurality in those under 65. For lung cancer, radiotherapy rates were higher in rural patients under 65, particularly females and non-Māori, but lower receipt of curative radiotherapy was observed for the most rural (R2/R3) Māori females and males over 75. Irrespective of rurality, Māori receipt of radiotherapy was lower than non-Māori in the youngest age groups for breast and prostate cancer, while Māori aged 45-74 with breast cancer, and Māori females and males with lung cancer in almost all age groups and GCH categories, had higher rates of radiotherapy than their non-Māori counterparts. CONCLUSION:This study observed some rural-urban differences in receipt of radiation therapy for the three cancers studied, though with evidence of variability by age group and cancer type, and significant differences between Māori and non-Māori.

INTRODUCTION:The aim of this study was to describe the research productivity among RANZCR Radiation Oncology (RO) trainees. METHODS:Publicly available data on RO fellows, who were awarded the RANZCR fellowship between July 2014 and June 2023, was extracted from the RANZCR Annual Reports. Fellows who had qualified overseas and did not undertake full RANZCR training were excluded. A PubMed search was performed for publications by each fellow in the 5 years prior, and 6 months, after the estimated completion of training. Research productivity was defined as the number of first-author and any-author publications per trainee. RESULTS:In total, 168 eligible RO fellows were included in this study. 104 (62%) and 118 (70%) fellows had first-author and any-author publications during training, respectively. A total of 203 first-author and 308 unique any-author publications were identified, with mean first-author and any-author publications per trainee of 1.21 (SD = 2.37) and 2.02 (SD = 3.71), respectively. Trainee research was most commonly published in JMIRO (34% of first-author and 27% of any-author publications). There were significant differences in the number of first-author publications by gender (P = 0.04) and training jurisdictions (P = 0.03). There were also differences in the number of any-author publications by gender (P = 0.002) and training jurisdictions (P = 0.03). There was a significant increase in any-author publications over the 9-year study period (P = 0.005). CONCLUSION:This is the first study evaluating research productivity among RO fellows during training. We identified disparities in research productivity by gender and training jurisdictions. This offers opportunities to tailor efforts to better support a vibrant and productive research culture across the RO training program.

INTRODUCTION:To evaluate the scope of practice and role in cancer management for radiation oncologists in Australia, New Zealand, and Singapore (ANZ).METHODS:A 27-question survey was emailed to all practicing radiation oncologists listed on the RANZCR database in mid-2021.RESULTS:There was a 54% response rate. Respondents reported managing symptoms associated with radiation therapy (96%), cancer-related symptoms (86%), writing narcotic and analgesic prescriptions (76%), being involved in palliative care (57%), prescribing non-cytotoxic systemic therapy (45%), and admitting patients (41%). Just over 20% wanted to expand their scope of practice, but for those who were unable to, insufficient time (35%), inter-specialty political difficulties (14%), and lack of support from the organisation (12%) were the major reasons. Over half of respondents (56.4%) thought they provided an opinion on the overall role of cancer management. Just under 20% provided a radiation therapy opinion only and <1% provided radiation therapy at the request of the referring clinician. The remainder reported a combination of these. Over 80% of respondents thought their ideal role was to be involved in overall cancer management and 20% believed they should be providing an opinion on radiation therapy only. The ideal role matched the actual role in over 87% of respondents and most respondents thought radiation oncology training enabled an opinion on overall cancer management. Over 90% of respondents were satisfied with their current role in cancer management. Radiation oncologists felt they were perceived as independent clinicians and the large majority (87%) thought radiation oncologists should be part of a multidisciplinary team rather than leaders in cancer management.CONCLUSION:This study has revealed a broad but expected scope of practice for ANZ radiation oncologists with the large majority providing an opinion on overall cancer management or radiation therapy and their ideal role matching their actual role.

INTRODUCTION:There has been a groundswell of discussion and activism surrounding gender diversity. Given the growing importance of this issue, a working group was established under the Faculty of Radiation Oncology (FRO) of the Royal Australian and New Zealand College of Radiologists' (RANZCR) Economics and Workforce Committee (EWC) to review the current status of gender diversity within radiation oncology (RO) in Australia and New Zealand.METHODS:De-identified data were provided from two recent FRO workforce censuses conducted in 2014 and 2018 with permission from the EWC. Further data were provided via direct correspondence with staff at the RANZCR and the Trans-Tasman Radiation Oncology Group (TROG), the major RO research group in Australasia. The data were collated in February 2021.RESULTS:Our results showed that compared to females, male radiation oncologists were more likely to be engaged in full-time active clinical work, hold a postgraduate degree and obtain a consultant or fellowship position following graduation. Male fellows were more likely to have leadership positions within RANZCR and TROG and self-identify as holding any leadership position. The 2018 census revealed that within the trainee cohort, there was almost an equal number of male and female trainees as well as an equal number of male and female trainees holding a postgraduate degree.CONCLUSION:This review is an important first exploration into gender diversity across Australia and New Zealand's RO workforce. Whilst our study indicates that gender disparities exist, there are some indications that this may be equalizing out over time.

AbstractIntroductionDeep inspiratory breath‐hold (DIBH) has become standard in radiotherapy for left‐sided breast cancer to reduce the heart dose. This study evaluated breath‐hold stability and reproducibility using Elekta's Active Breathing Coordinator™ (ABC) and its effectiveness and feasibility in left‐sided breast cancer patients undergoing radiotherapy.MethodsEligible patients were planned with free breathing (FB) and DIBH protocols. DIBH treatment was considered if the mean heart dose (MHD) was ≥2 Gy on the FB plan. Those who proceeded with DIBH treatment were enrolled for the pilot study. Electronic portal images of DIBH treatment beams were taken using the movie‐exposure mode for breath‐hold stability and reproducibility analysis. DIBH effectiveness in heart dose reduction and impact on simulation and treatment durations were compared with FB protocol.ResultsOut of 56 eligible patients, 15 proceeded with DIBH treatment. The mean difference of patient setup within a single breath‐hold was 0.4 mm; between different breath‐holds of the same beam 1.1 mm and between different days 2.6 mm. DIBH reduced the MHD by 47% and the mean left anterior descending artery (LAD) dose by 35%. DIBH took longer time than FB in simulation and treatment. At least 14% of the eligible patients did not tolerate DIBH during simulation.ConclusionsABC leads to stable and reproducible breath‐holds and results in significant heart dose reductions. It may not be tolerated by all patients and has resource implications.

Women are an integral part of the radiation oncology workforce in Australia, New Zealand and Singapore, representing 40% of the workforce in 2018. Women radiation oncologists within the Royal Australian and New Zealand College of Radiologists (RANZCR) make significant contributions across all domains: clinical, research/ academia, education, policy and advocacy. Alarmingly, the Australian Government’s Taxation Statistics from 2018 to 2019 report that the average taxable income for women radiation oncologists was half that of men and the median taxable income was only one third. Could this gender disparity be accounted for by differences in full-time equivalent (FTE) hours worked? In the 2018 RANZCR Workforce Census, self-reported work hours were not markedly different between women and men, with a median of 40 versus 45 actual hours and 34 versus 37 clinical hours per week reported by women and men, respectively. However, these findings reflect work performed, not necessarily hours of paid work, raising the possibility that women perform more non-paid work in radiation oncology than men. A New Zealand study of 3510 medical specialists (including radiation oncologists) employed in public district health boards used census and taxation data to demonstrate that the age-adjusted hourly wage was 10% lower for women than for men, despite the hourly wage being higher overall for specialists who worked fewer hours. Another factor potentially contributing to the pay disparity might be remuneration arrangements. It has been previously reported that women Australian medical specialists are more likely to work exclusively in the public sector and less likely to have mixed public–private roles than men. Unpublished data from the RANZCR workforce survey found that 60% of women versus 49% of men reported having fixed incomes rather than incentivebased or mixed-source incomes. In the Australian public

Aims: Treatment decisions for older patients with breast cancer are complex and evidence is largely extrapolated from younger populations. Frailty and co-morbidity need to be considered. We studied the baseline characteristics and treatment decisions in older patients in Christchurch with breast cancer and assessed survival outcomes and prognostic/discriminatory performance of several tools. Materials and methods: We searched the Canterbury Breast Cancer Registry and identified patients aged 70 years or older at diagnosis with invasive, non-metastatic breast cancer between 1 June 2009 and 30 June 2015. We retrieved demographics, treatment and outcome information. Overall survival and breast cancer-specific survival were estimated. Tools analysing performance status and comorbidity were assessed for their prognostic and discriminatory power. Results: In total, 440 patients were identified. Primary surgery was carried out for 362 patients (82.3%): breast-conserving surgery in 114 (of whom 88.6% received radiation therapy); mastectomy in 248 (of whom 24.6% received radiation). Hormone therapy was given for 265 (71.1%) patients with oestrogen receptor-positive cancers. Two hundred and seventy-four (62.3%) patients received full standard treatment, which was associated with significantly improved 5-year survival and 5-year breast cancer-specific survival. The median estimated overall survival was 8.2 years (95% confidence interval 7.3-9.1 years). Of those who died, 71.3% of deaths were due to causes other than breast cancer or unknown causes. The comorbidity-adjusted life expectancy (CALE) showed partial prognostic accuracy. CALE, Charlson and Eastern Cooperative Oncology Group tools all showed discriminatory value. Conclusion: In this population-based series of older patients with breast cancer, showing high levels of primary and adjuvant treatment, patients were more likely to die of causes other than breast cancer. Performance status and comorbidity tools showed prognostic and discriminatory potential in this population supporting their use in treatment decision making. CALE showed the most potential to improve treatment decisions but requires validation in this population to improve prognostic accuracy. (C) 2022 The Royal College of Radiologists. Published by Elsevier Ltd. All rights reserved.

The adoption of hypofractionation across multiple tumour sites has been slow despite robust evidence. There is considerable unwarranted variation in practice, both within and between jurisdictions. This has been attributed to inconsistencies in guidelines, physician preference, lack of technology and differing financial incentives. Unwarranted variation in the use of hypofractionation has a tremendous effect on cost to both patients and the healthcare system. This places an unnecessary burden on patients and poorly utilises scarce healthcare resources. A collaborative effort from clinicians, patients, healthcare providers and policymakers is needed to reduce unwarranted variation in practice. This will improve quality of care both for patients and at broader healthcare system level.

INTRODUCTION:Stage III melanoma is associated with poor outcomes. We studied the characteristics and outcomes of patients with resected Stage III melanoma before the routine use of adjuvant immunotherapy. Some of these patients received adjuvant nodal radiation with modern radiation techniques.METHODS:We retrieved data of patients with resected Stage III melanoma treated in Christchurch over 10 years. Overall survival (OS), melanoma-specific survival (MSS), recurrence-free survival (RFS) and nodal recurrence-free rate (NRFR) were determined, and the association of these outcomes with tumour and treatment factors was investigated.RESULTS:We identified 178 patients (110 male and 68 female), of whom 61 received adjuvant radiation. The median age was 66.6 years, and the median follow-up was 2.7 years. First recurrences occurred in 108 (61%) patients. There were 42 (24%) nodal field relapses and 103 (58%) distant relapses. One-half of nodal relapses in patients treated with adjuvant radiation were infield. The 5-year OS, RFS, MSS and NRFR were 46.4%, 26.8%, 53.7% and 69.6%, respectively. Adjuvant radiation was associated with improved RFS and no OS benefit. T4 disease and extranodal spread were associated with poorer OS, while extranodal spread and >3 involved nodes were associated with worse RFS.CONCLUSION:Patients treated with adjuvant radiation remain at moderate risk of regional and high risk of distant relapse, despite the use of modern radiation techniques. Adjuvant radiation was associated with improved local control but infield recurrence rates remained a problem. The role of combined adjuvant radiation and immunotherapy in improving these outcomes requires further investigation.

The aim of this project was to determine research priorities, barriers, and enablers for adult primary brain tumour research in Australia and New Zealand. Consumers, health professionals, and researchers were invited to participate in a two-phase modified Delphi study. Phase 1 comprised an initial online survey (n = 91) and then focus groups (n = 29) which identified 60 key research topics, 26 barriers, and 32 enablers. Phase 2 comprised two online surveys to (1) reduce the list to 37 research priorities which achieved consensus (>75% 2-point agreement) and had high mean importance ratings (n = 116 participants) and (2) determine the most important priorities, barriers, and enablers (n = 90 participants). The top ten ranked research priorities for the overall sample and sub-groups (consumers, health professionals, and researchers) were identified. Priorities focused on: tumour biology, pre-clinical research, clinical and translational research, and supportive care. Variations were seen between sub-groups. The top ten barriers to conducting brain tumour research related to funding and resources, accessibility and awareness of research, collaboration, and process. The top ten research enablers were funding and resources, collaboration, and workforce. The broad list of research priorities identified by this Delphi study, together with how consumers, health professionals, and researchers prioritised items differently, and provides an evidence-based research agenda for brain tumour research that is needed across a wide range of areas.

This paper outlines the New Zealand (NZ) responses to the biennial facilities surveys of The Royal Australian and New Zealand College of Radiologists (RANZCR), Faculty of Radiation Oncology (FRO) from 2011 to 2019.

Purpose: First developed in Canada in the 1990s, Rapid Access Palliative Radiation Therapy (RAPRT) clinics have subse-quently spread internationally to expedite treatment for near end-of-life patients, sparing them the need for multiple visits to the department. A "classical" RAPRT clinic is herein defined as "a dedicated clinic specifically established to enable (ideally) same day consultation, planning for, and delivery of palliative radiation treatment." The aim of this work was to determine the current status of these clinics in Australia and New Zealand (ANZ). Methods and Materials: A phone survey of all 100 Australian and 10 NZ radiation therapy centers was conducted in March and April 2021. The Chief Medical Officers of the 2 large private practices (GenesisCare and Icon) also approved the survey and answered on behalf of their 57 centers. A single page questionnaire was used, seeking information on the logistics and clinical details of past and present RAPRT clinics, and reasons why other centers do not have one. Results: The survey response rate was 100%. There are only 3 current RAPRT clinics (2.7%). The dominant treatment indica-tion is bone metastases (85%-90%), with most patients receiving single fractions (60%-90%), but commencement on the same day is variable (35%-90%). Five other clinics (4.5%) closed after 4 months to 7 years, but the clinical features were similar. By far, the most common reason (95%) given by the 107 centers without a current RAPRT clinic was that these patients are accommodated using existing resources. Conclusions: Classical RAPRT clinics have not been widely embraced in ANZ. There are alternative strategies such as the Advanced Practice Radiation Therapist model and techniques to avoid the conventional computed tomography-simulation step, which may also expedite treatment for palliative patients. Crown Copyright (C) 2021 Published by Elsevier Inc. All rights reserved.

INTRODUCTION:Patients dying a short time after receiving palliative radiation are unlikely to have received benefit and may experience harm. To monitor the potential for avoidable harm, 30-day mortality following palliative radiation has been recommended for use as a quality indicator and the Royal College of Radiologist have recommended a rate of lower than 20%. At the Canterbury Regional Cancer and Haematology Service in Christchurch, New Zealand (CRCHS), we investigated 30-day mortality and evaluated the prognostic value of the TEACHH model in our population.METHODS:Palliative treatments from two, two-year periods (2012/2013 and 2016/2017) were retrospectively reviewed. We analysed 30-day mortality and several influencing variables. Patients were divided into three groups using the TEACHH model (type of cancer, performance status, age, prior palliative chemotherapy, prior hospitalizations and hepatic metastases).RESULTS:There were 1744 patients; 30-day mortality was 10% and was higher in patients with lung cancer (17% vs. 8% in non-lung cancer patients, P < 0.0001), patients having less than five fractions (13% vs. 9%, P: 0.0199) and patients in TEACHH group B/C (21% in C, 11% in B and 2% in group A, P < 0.0001). The majority of treatments (84%) used five fractions or less.CONCLUSIONS:The mortality rate is within the suggested quality indicator, and the decreasing mortality with increasing fractionation demonstrates suitable selection of patients for longer treatment regimens. The TEACHH model can be used to increase precision in estimating prognosis, identifying patients who should not receive treatment and conversely identifying those for whom a prolonged fractionation schedule may be appropriate.

Purpose: Obesity is increasing in incidence in New Zealand. Maintaining locoregional control after breast cancer surgery is important, as this can improve overall survival. Although obesity has been associated with poorer survival in breast cancer, the correlation with locoregional control is less well evaluated and was the subject of this evaluation. Methods and Materials: We used the New Zealand breast cancer registry to identify patients treated with breast conservation with body mass index (BMI) recorded. We retrieved patient demographic, tumor characteristic, and treatment-related information. We assessed local and locoregional control outcomes in addition to breast cancer and overall survival outcomes. Results: Patients (2513) were identified. The median follow-up was 5.25 years. Of these patients, 38% were obese with a BMI of >= 30 kg/m(2), 32% were overweight with a BMI of 25.0 to 29.9 kg/m(2), and 29% were either normal or underweight with a BMI of <= 24.9 kg/m(2). Most patients were postmenopausal (65%). The median tumor size was 16.0 mm (0.2-80 mm) and the majority were grade 2 or 3 tumors (45% and 33%). The majority (66%) were pathologically node negative and lymphovascular invasion was seen in 24%. There were 81% with estrogen receptor positivity and 358 (14.2%) were Her-2 positive. Local relapse free survival at 5 years was 91.5% (95% confidence interval [CI], 90.3-92.7) and at 10 years was 78.5% (95% CI, 75.9-81.1). Local relapse free rate at 5 years was 96.8% (95% CI, 96.0-97.6) and 10 years was 93.9% (95% CI, 92.5-95.3). We did not find BMI to be associated with local or locoregional relapse, disease free, breast cancer specific, or overall survival. Conclusions: Obesity was not associated with inferior locoregional control or survival outcomes. This supports the practice of continuing to offer breast conserving treatment to women regardless of BMI. (C) 2019 Published by Elsevier Inc.

AIMS:Hypofractionated radiation treatment (HFRT) following breast conservation surgery (BCS) has similar efficacy to conventionally fractionated radiation treatment (CFRT). This study updates outcomes for patients treated with HFRT in Christchurch, New Zealand, and reports on the pattern, timing and method of detection of recurrences to inform follow-up practice.METHODS:Between 2004 and 2006, 273 women with early breast cancer were treated with HFRT (42.5 Gray (Gy) in 16 fractions). Details of demographics, tumour characteristics, treatments, any recurrence (local, nodal or distant), follow-ups and date of death were collected. The primary endpoint was local recurrence rate (LRR); secondary endpoints were local recurrence-free survival (LRFS) and overall survival (OS).RESULTS:With a median follow-up of 12.9 years, 17 women developed a local recurrence. LRR at 5 and 10 years were 3.1% and 5.3%, respectively. Five-year LRFS was 91.7% and ten-year LRFS was 83.5%. The OS at five years was 93.7% and at ten years was 87.7%. For the 41 patients with a first recurrence at any site, 75.6% were symptomatic, 22% were screen detected with radiology and 2.4% were incidental findings. None of the first recurrences were detected when asymptomatic on clinical examination in follow-up clinics.CONCLUSIONS:The rate of local recurrence following HFRT for BCS is low. No asymptomatic recurrence was detected by routine clinic follow-up. The utility of regular clinical examination for the detection of recurrence is low and this should inform follow-up strategies.

AIM:This paper outlines the results of the Royal Australian and New Zealand College of Radiologists (RANZCR) Faculty of Radiation Oncology (FRO) 2018 workforce census. Here we report the responses of New Zealand radiation oncologists and trainees in order to understand characteristics of the New Zealand radiation oncology workforce.METHOD:The workforce census was conducted online during July-September 2018. Distribution was by Survey Monkey to all radiation oncologists (fellows, life members, educational affiliates, retired) and trainees on the RANZCR membership database, including members from Australia, New Zealand and Singapore. All responses were aggregated for analysis. This paper addresses only responses from New Zealand members. The census was designed to explore issues relevant to the New Zealand workforce, and questions from previous workforce censuses were repeated in order to monitor trends.RESULTS:The response rate for New Zealand radiation oncologists was 73.3% (44/60). The majority (67%) were male. The average age was 50.8 years. Three-fifths (59.5%) reported New Zealand ethnicity. One-third obtained their specialist qualifications outside of Australia and New Zealand. Most worked in the public sector only (63.4%), with only two in exclusive private practice. Most radiation oncologists attained a consultant post immediately on completion of training, but there were 26 who pursued an overseas fellowship. Most worked one full-time equivalent or greater (FTE), with 17.5% working less than 1.0 FTE. Radiation oncologists reported working a median of 50.0 hours per week, with half working over 10 hours above their contracted hours. Most time was spent on clinical duties with minimal time spent on research. Radiation oncologists reported seeing an average of 235 new patients per year (median: 230). Leadership positions were held by 21/43 respondents. Within 15 years, 55% of the current workforce reported an intention to retire, including 30% of those currently practising highly specialised brachytherapy. Females in the workforce were less likely to work fulltime and spent less time in research and management activities. All trainees reported full-time work, although 50% expressed a desire for part-time training. Half of the trainees reported working 6-10 hours on call, and 60% reported two or less hours of protected teaching per week. Despite this, 90% of trainees were satisfied with their career choice.CONCLUSIONS:Radiation oncology is a small specialty in New Zealand, with a significant reliance on overseas-trained specialists. The specialty continues to work significant overtime hours while time spent on research and non-clinical duties remains low. The growth in staffing between the 2014 and 2018 census has been low. Trainee numbers do not appear sufficient to meet the demand for replacing staff, due to retirements and the reduction of hours. Radiation intervention rates are low in New Zealand, but growth would be reliant on an expansion of the workforce beyond simply replacing staff losses. The radiation oncology workforce in New Zealand remains vulnerable, and careful consideration must be given to expansion and retention to ensure a viable workforce for the future.

INTRODUCTION:Metastatic spinal cord compression (MSCC) can be debilitating and painful and carries a poor prognosis. There is increasing evidence that MSCC can be treated with single-fraction radiotherapy. The Rades score is designed to assist in identifying better prognosis patients who may benefit from longer radiotherapy courses. This study aims to study patterns of care for MSCC at a single center in New Zealand, and assess the Rades score and other variables as predictors of survival.METHODS:An audit of patients receiving palliative radiotherapy for MSCC at a single center over a 5- year period (2010-2014) was performed. Independent variables and the Rades score were gathered for each patient for statistical analysis to investigate associations between potential prognostic factors, treatments and survival.RESULTS:A total of 83 patients underwent analysis. Median overall survival was 14 weeks. Twenty Gray in five fractions (20 Gy/5) was the most frequently delivered radiotherapy course (89%). The simplified Rades score effectively stratified patients with Group 3 patients having significantly better survival with 40% surviving to 6 months compared to Group 1 and 2. Cancer type, receiving chemotherapy and receiving surgery were also significantly associated with survival.CONCLUSION:Overall survival at our centre is consistent with other published series. The Rades score is valid for predicting more prolonged survival in our population and could be used in selecting patients for longer radiotherapy courses.