Building Referral Relationships Outside Oncology for Low-Dose Radiation Therapy

A radiation oncology department that adds low-dose radiation therapy for osteoarthritis may be faced with several problems, and among them is that the physicians who manage these patients are not the ones who usually send patients for radiation. Tyler J. Wilhite, MD, regional vice chair of radiation oncology at University of Pittsburgh Medical Center (UPMC) Hillman Cancer Center and a radiation oncologist in the Department of Radiation Oncology at the University of Pittsburgh, described how his department solved it, and what made the conversations easier than expected.

The approach was unglamorous. Wilhite said the department reached out to physicians in the community and explained how the radiation works, showing them the data. What he found along the way reframed the target audience: while a variety of specialists see these patients, many are managed in primary care, and primary care physicians were often grateful that another treatment option existed for them.

The argument itself rested on 2 properties of the treatment. It is noninvasive, and in his experience it has produced no adverse effects at all; he said he has yet to see one. The second property is that it displaces nothing. Low-dose radiation, he said, fits nicely into the paradigm alongside the other options for arthritis, and does not take away from or compete with anything. That, in his account, is what made the outreach straightforward: once the relationship existed, there was little difficulty in highlighting a treatment that is synergistic with everything else a referring physician is already doing.

Transcript:

CancerNetwork: This [program] brings radiation oncologists into contact with specialists who aren't usually in their referral process, like orthopedics and rheumatology. How crucial is it to involve them, and how do you build those relationships?

At first, we reached out to different physicians in our community and explained how the radiation works. [We] showed them some of the data. There's a variety of specialists who typically see these patients. What I've also found is that many of these patients are managed even just in primary care, and often the primary care physicians are grateful that perhaps there's another treatment option available for these patients.

The low-dose radiation is noninvasive. There are basically no adverse effects—I've yet to see an adverse effect from this treatment, and in looking at some of the clinical trials that have been done, they actually have 0% adverse effects. It's a very nice option.

Rheumatology, orthopedic surgery, all those fields have patients who are, for example, elderly or maybe medically not suitable for other treatments. You might have a patient on blood thinners, where even being on nonsteroidal anti-inflammatory drugs might not be the best thing. The low-dose radiation really fits nicely in the paradigm with all the other options available for arthritis treatment. It really doesn't take away from anything or compete with anything. It just took a little bit of reaching out, building the relationships. But altogether, I'd say it's synergistic with everything else, so there's really not much difficulty in highlighting that to people.