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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.
The rising incidence and complexity of cancer care have increased pressure on the radiation oncology (RO) workforce. Despite growing clinical demand, unfilled residency positions have raised concerns about workforce sustainability. Modeling studies predict a shortage of radiation oncologists, emphasizing the need to strengthen medical student recruitment in RO. Trainee interest in RO is influenced by both practical and personal factors. Practical components include alignment with career goals, clinical exposure, mentorship, and work-life considerations. Personal experiences, such as one's own or a family member's experience with cancer, also commonly shape interest. Bland-Meurer and Pfarrwaller frameworks contextualize how these factors interact over time to guide specialty choice. Interventions such as the Radiation Oncology Intensive Shadowing Experience and CARO Underrepresented in Radiation Oncology Mentorship Program target key motivating factors, particularly through mentorship. Recruitment challenges for radiation therapy technologists and medical physicists include training bottlenecks, retention concerns, and increasing workload pressures. Sustaining the RO workforce requires early exposure, mentorship, and targeted interventions for trainees, alongside strategies to support allied radiation professionals. Conceptual frameworks can guide development of interventions that align evolving career needs with specialty characteristics. Integrating oncology education into medical curricula and supporting recruitment and retention across the multidisciplinary RO workforce is critical for sustainable cancer care delivery.
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.
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.
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.
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.
Radiation oncology is critical to modern interdisciplinary cancer care, though exposure to radiation oncology remains limited across the medical education continuum. The practice of radiation oncology requires in-depth knowledge of evidence-based clinical oncology with highly technical and procedural practice competencies. This review defines the spectrum of teaching in radiation oncology, from effective teaching to scholarly teaching to scholarship of teaching and learning to support learners across the succession of medical education environments, spanning undergraduate, graduate, and continuing education with the goal of examining and defining current best practices in scholarly teaching within radiation oncology.
While technological innovation in radiation therapy (RT) continues to accelerate, safe and equitable adoption of emerging tools is reliant on the readiness of the workforce and the robustness of associated educational frameworks. Early experience with disruptive technologies such as intensity-modulated RT (IMRT) has taught us that fragmented or insufficient education can create an implementation barrier. The IDEPTH framework (as illustrated here using the translation of IMRT from development to mainstream implementation) describes how development and implementation of new technologies requires coordinated involvement across academia, industry, professional associations, and clinical organizations. Emerging technologies, such as artificial intelligence (AI)-enabled workflows, magnetic resonance (MR)-integrated RT, adaptive radiotherapy and particle therapy will similarly require comprehensive and scalable approaches to education. Despite progress, significant heterogeneity still exists in access to education, integration into professional curricula, and ongoing requirements for competence. Central to this challenge is that the rate at which technology is developed often outpaces the rate at which curricula, accreditation standards, and certification processes are updated. Closing this gap will be most effectively met by increased emphasis on adaptable competencies such as technological literacy, critical evaluation, and effective human-technology interaction rather than mere device-specific skills. Also, the increasing role of automation means RT must also identify legacy skills whose education emphasis is reduced to allow time and attention to the latest technologies and treatment methods. The creation and maintenance of robust, forward-oriented education systems is crucial if future innovations within radiation oncology are to be integrated in ways that are safe and of high quality.
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.
Biochemical recurrence (BCR) after radical prostatectomy (RP) remains a clinical challenge, with significant heterogeneity in outcomes and optimal management strategies. Salvage radiotherapy (sRT) is the standard approach, yet the role and duration of concurrent hormonal therapy (ADT) are still debated. Four key randomized controlled trials-RTOG 9601, GETUG-AFU 16, RTOG 0534 SPPORT, and RADICALS-HD-have explored the addition of ADT to sRT. While ADT consistently improved progression-free survival metastasis-free survival (MFS) benefit was not consistently observed, and overall survival (OS) gains were limited and primarily confined to patients with higher pre-sRT PSA levels (>0.6-0.7 ng/mL). Toxicity associated with long-term ADT, including metabolic and cardiovascular effects, underscores the importance of patient selection. Emerging tools such as PSMA PET/CT and the Decipher genomic classifier show promise in refining risk stratification. PSMA PET/CT can identify occult metastases and guide treatment planning, while Decipher can help predict who may benefit from ADT. Retrospective and prospective data support their integration into clinical practice. Recent trials evaluating intensified systemic therapy with androgen receptor pathway inhibitors (ARPIs) in combination with sRT suggest potential benefit in high-risk BCR populations, although added toxicity remains a concern. The optimal role and timing of ARPIs in the early salvage setting require further investigation. In conclusion, the decision to add ADT to sRT in BCR patients should be individualized based on PSA kinetics, imaging, and genomic profiling. Shared decision-making and future biomarker-driven trials will be key to personalizing therapy and improving outcomes while minimizing harm.
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.
Equity, diversity and inclusion (EDI) have become foundational principles across healthcare organizations and medical education aiming to address historical systemic biases, promote representation and foster inclusive environments. These efforts have patients benefits including improved care and clinical outcomes, especially in minoritized populations. Despite recent advances, women and minority groups remain underrepresented radiation oncology training programs, leadership roles, and academic positions. Embedding EDI early in medical education and training is essential for diversifying the workforce, reducing barriers to entry, and preparing future physicians to deliver equitable care. Organizational and institutional efforts are also important and require strong leadership commitment, accountability and resource allocation. The paper provides an overview of EDI within medical education, with a focus on radiation oncology, and outlines strategies to advance equity, diversity, and inclusion across the specialty.
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.
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.
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.
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.
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.
Interprofessional education (IPE) is based in the belief that increasing specialization of healthcare has led to no single profession being able to encompass all the knowledge and skills to support comprehensive care, thus requiring the system's reliance on functional healthcare teams. A large academic radiation medicine program built a continuing education program founded in the knowledge that true interprofessional collaboration (IPC) between medical physics, radiation oncology, and radiation therapy is essential for optimal care delivery. The curricular design emphasized the importance of IPC through both concrete instruction on these concepts and through emulation of the collaborative model by course faculty. Participants of the various Program courses reported the value of the interprofessional elements of the course, and the related learnings that influenced their subsequent practice. Little work has examined how the effort required for the delivery of high quality IPE impacts-or may be impacted by-the IPC of faculty who engage in delivering the Program This may include the depth of investment required to truly operate as a functional team, how such investment bred familiarity, and by extension how it reduced the interference of a perceived hierarchy, and improved the ability to collaborate and problem-solve at the front lines. Organizational behavior theories including group cohesion theory, social capital theory, and psychological safety support conceptualization of the value of faculty collaboration, as does the critical framing of the emancipatory role of IPE. This review considers such theories in the context of a successful IPC model, and the value to faculty and the organizations in which they practice, including generation of new ideas, projects and collaborations and took shape in many observable ways.
Periarticular soft tissue disorders, encompassing enthesopathies, tendinopathies, and bursitis, contribute substantially to musculoskeletal pain and disability, particularly in adult populations. This chapter provides a comprehensive overview of the pathophysiology, clinical manifestations, and radiotherapeutic management of major periarticular syndromes, including painful shoulder syndrome, lateral epicondylitis, greater trochanteric pain syndrome, and plantar fasciitis. We detail how these conditions often present as a continuum of overlapping pathology at the enthesis, tendon, and peri‑tendinous structures, frequently driven by repetitive microtrauma, mechanical overload, degenerative changes, and low-grade inflammation. Emphasis is placed on the clinical and imaging features distinguishing key entities such as calcific tendinitis, enthesopathies, and bursitis. Special focus is given to the role of low-dose radiotherapy (LDRT) as an effective treatment option for refractory symptoms unresponsive or contraindicated to conservative management. Contemporary practice patterns, including patient selection, target volume delineation based on imaging, and technical variations between linear accelerator and orthovoltage techniques, are discussed. Data from recent prospective and retrospective studies are summarized, demonstrating notable pain reduction rates and functional improvement with LDRT, and outlining response rates, optimal dosage regimens, timing of re-irradiation, and age-based treatment considerations. The chapter concludes with practical recommendations for integrating radiotherapy into multimodal care pathways for periarticular soft tissue disorders, underscoring its utility in symptom control and functional restoration.
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.