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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2016. Appropriate Use of Advanced Technologies for Radiation Therapy and Surgery in Oncology: Workshop Summary. Washington, DC: The National Academies Press. doi: 10.17226/21859.
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imagesAppropriate Use of images
Advanced Technologies for

RADIATION THERAPY
and
SURGERY IN ONCOLOGY

images

Workshop Summary

Sharyl J. Nass and Margie Patlak, Rapporteurs

National Cancer Policy Forum

Board on Health Care Services

Institute of Medicine

images

THE NATIONAL ACADEMIES PRESS
Washington, DC
www.nap.edu

Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2016. Appropriate Use of Advanced Technologies for Radiation Therapy and Surgery in Oncology: Workshop Summary. Washington, DC: The National Academies Press. doi: 10.17226/21859.
×

THE NATIONAL ACADEMIES PRESS   500 Fifth Street, NW   Washington, DC 20001

This project was supported by Contract No. HHSN261200900003C and Contract No. HHSN263201200074I (Task Order No. HHSN26300052) between the National Academy of Sciences and the Centers for Disease Control and Prevention and the National Cancer Institute/National Institutes of Health, respectively, and by the American Association for Cancer Research, American Cancer Society, American Society for Radiation Oncology, American Society of Clinical Oncology, American Society of Hematology, Association of American Cancer Institutes, AstraZeneca, Bristol-Myers Squibb, Cancer Support Community, CEO Roundtable on Cancer, EMD Serono, Helsinn Healthcare SA, LIVESTRONG Foundation, National Comprehensive Cancer Network, Novartis Oncology, the Oncology Nursing Society, and Pfizer Inc.

International Standard Book Number-13: 978-0-309-38129-1
International Standard Book Number-10: 0-309-38129-0
Digital Object Identifier: 10.17226/21859

Additional copies of this workshop summary are available for sale from the National Academies Press, 500 Fifth Street, NW, Keck 360, Washington, DC 20001; (800) 624-6242 or (202) 334-3313; http://www.nap.edu.

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Suggested citation: National Academies of Sciences, Engineering, and Medicine. 2016. Appropriate use of advanced technologies for radiation therapy and surgery in oncology: Workshop summary. Washington, DC: The National Academies Press. doi: 10.17226/21859.

Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2016. Appropriate Use of Advanced Technologies for Radiation Therapy and Surgery in Oncology: Workshop Summary. Washington, DC: The National Academies Press. doi: 10.17226/21859.
×

images

The National Academy of Sciences was established in 1863 by an Act of Congress, signed by President Lincoln, as a private, nongovernmental institution to advise the nation on issues related to science and technology. Members are elected by their peers for outstanding contributions to research. Dr. Ralph J. Cicerone is president.

The National Academy of Engineering was established in 1964 under the charter of the National Academy of Sciences to bring the practices of engineering to advising the nation. Members are elected by their peers for extraordinary contributions to engineering. Dr. C. D. Mote, Jr., is president.

The National Academy of Medicine (formerly the Institute of Medicine) was established in 1970 under the charter of the National Academy of Sciences to advise the nation on medical and health issues. Members are elected by their peers for distinguished contributions to medicine and health. Dr. Victor J. Dzau is president.

The three Academies work together as the National Academies of Sciences, Engineering, and Medicine to provide independent, objective analysis and advice to the nation and conduct other activities to solve complex problems and inform public policy decisions. The Academies also encourage education and research, recognize outstanding contributions to knowledge, and increase public understanding in matters of science, engineering, and medicine.

Learn more about the National Academies of Sciences, Engineering, and Medicine at www.national-academies.org.

Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2016. Appropriate Use of Advanced Technologies for Radiation Therapy and Surgery in Oncology: Workshop Summary. Washington, DC: The National Academies Press. doi: 10.17226/21859.
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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2016. Appropriate Use of Advanced Technologies for Radiation Therapy and Surgery in Oncology: Workshop Summary. Washington, DC: The National Academies Press. doi: 10.17226/21859.
×

WORKSHOP PLANNING COMMITTEE1

YA-CHEN TINA SHIH (Co-Chair), Professor of Health Economics, Chief, Section of Cancer Economics and Policy, Department of Health Services Research, University of Texas MD Anderson Cancer Center

RALPH R. WEICHSELBAUM (Co-Chair), Daniel K. Ludwig Professor, Chair, Department of Radiation & Cellular Oncology, Director, Ludwig Center for Metastasis Research, University of Chicago

MONICA M. BERTAGNOLLI, Professor of Surgery, Harvard University Medical School, Associate Surgeon, Dana-Farber Cancer Institute, Group Chair, Cancer and Leukemia Group, Brigham and Women’s Hospital

OTIS W. BRAWLEY, Chief Medical Officer, American Cancer Society

ROBERT W. CARLSON, Chief Executive Officer, National Comprehensive Cancer Network

PATRICIA A. GANZ, Distinguished University Professor, University of California, Los Angeles (UCLA), Fielding School of Public Health, David Geffen School of Medicine at UCLA, Jonsson Comprehensive Cancer Center

CAROL A. HAHN, Associate Professor of Radiation Oncology, Duke University Medical Center, Medical Director of Radiation Oncology, Duke Raleigh Hospital, Department of Radiation Oncology, Duke University Medical Center

LORI HOFFMAN-HÕGG, Veterans Health Administration National Oncology Clinical Advisor, Department of Veterans Affairs, Cancer Program Director, Albany Stratton Veterans Affairs Medical Center

JAMES HU, Ronald Lynch Professor of Urologic Oncology, Director, LeFrak Center for Robotic Surgery, Weill Cornell Medical College

THEODORE LAWRENCE, Isadore Lampe Professor and Chair, Department of Radiation Oncology, University of Michigan Medical School

STEVEN PIANTADOSI, Phase One Foundation Endowed Chair and Director, Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center

__________________

1 Institute of Medicine planning committees are solely responsible for organizing the workshop, identifying topics, and choosing speakers. The responsibility for the published workshop summary rests with the workshop rapporteurs and the institution.

Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2016. Appropriate Use of Advanced Technologies for Radiation Therapy and Surgery in Oncology: Workshop Summary. Washington, DC: The National Academies Press. doi: 10.17226/21859.
×

Project Staff

SHARYL J. NASS, Director, National Cancer Policy Forum

PATRICK ROSS, Research Assistant

HANNAH DURING, Senior Program Assistant

Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2016. Appropriate Use of Advanced Technologies for Radiation Therapy and Surgery in Oncology: Workshop Summary. Washington, DC: The National Academies Press. doi: 10.17226/21859.
×

NATIONAL CANCER POLICY FORUM1

MICHAEL CALIGIURI (Chair), Chief Executive Officer, James Cancer Hospital and Solove Research Institute; Director, Ohio State University Comprehensive Cancer Center

PATRICIA A. GANZ (Vice Chair), Distinguished Professor, University of California, Los Angeles (UCLA), Fielding School of Public Health, David Geffen School of Medicine at UCLA, Jonsson Comprehensive Cancer Center

AMY P. ABERNETHY, Chief Medical Officer and Senior Vice President for Oncology, Flatiron Health; Professor, Division of Medical Oncology, Duke University School of Medicine; Director, Center for Learning Health Care, Duke Clinical Research Institute

LUCILE ADAMS-CAMPBELL, Professor of Oncology, Associate Director for Minority Health and Health Disparities Research, Georgetown University Lombardi Cancer Center

KENNETH ANDERSON, Kraft Family Professor of Medicine, American Cancer Society Clinical Research Director, Jerome Lipper Multiple Myeloma Center, Harvard Medical School, Dana-Farber Cancer Institute

LOYCE PACE BASS, Health Policy Director, LIVESTRONG Foundation

MONICA M. BERTAGNOLLI, Professor of Surgery, Harvard University Medical School, Associate Surgeon, Dana-Farber Cancer Institute, Group Chair, Cancer and Leukemia Group, Brigham and Women’s Hospital

OTIS BRAWLEY, Chief Medical Officer, American Cancer Society

CARLTON BROWN, Director of Professional Services, Oregon Nurses Association, and Past President, Oncology Nursing Society

SERGIO CANTOREGGI, Chief Scientific Officer and Global Head of Research and Development, Helsinn Group

ROBERT W. CARLSON, Chief Executive Officer, National Comprehensive Cancer Network

GREGORY CURT, Executive Director, External Scientific and Clinical Relations, U.S. Medical Affairs, AstraZeneca

__________________

1 Institute of Medicine forums and roundtables do not issue, review, or approve individual documents. The responsibility for the published workshop summary rests with the workshop rapporteurs and the institution.

Page viii Cite
Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2016. Appropriate Use of Advanced Technologies for Radiation Therapy and Surgery in Oncology: Workshop Summary. Washington, DC: The National Academies Press. doi: 10.17226/21859.
×

WILLIAM S. DALTON, Chief Executive Officer, M2Gen Personalized Medicine Institute, Moffitt Cancer Center; Chair, American Association for Cancer Research Science Policy & Legislative Affairs Committee

GWEN DARIEN, Executive Vice President, Programs and Services, Cancer Policy Institute, Cancer Support Community

WENDY DEMARK-WAHNEFRIED, Associate Director for Cancer Prevention and Control, University of Alabama at Birmingham Comprehensive Cancer Center

JAMES DOROSHOW, Deputy Director, National Cancer Institute

LORI HOFFMAN-HÕGG, Veterans Health Administration National Oncology Clinical Advisor, Department of Veterans Affairs, Cancer Program Director, Albany Stratton Veterans Affairs Medical Center

SAMIR N. KHLEIF, Director, Georgia Health Sciences University Cancer Center, Georgia Regents University Cancer Center

RONALD M. KLINE, Medical Officer, Patient Care Models Group, Center for Medicare and Medicaid Innovation, Centers for Medicare & Medicaid Services

LEE M. KRUG, Disease Area Head, Immuno-Oncology, Bristol-Myers Squibb

RICHARD A. LARSON, Hematology/Oncology Director, University of Chicago

MICHELLE M. LE BEAU, Arthur and Marian Edelstein Professor of Medicine, Director, Comprehensive Cancer Center, University of Chicago

GRETA MASSETTI, Associate Director for Science, Division of Cancer Prevention and Control, Centers for Disease Control and Prevention

DANIEL R. MASYS, Affiliate Professor, Biomedical Informatics, University of Washington

MARTIN J. MURPHY, Chief Executive Officer, CEO Roundtable on Cancer

RICHARD PAZDUR, Director, Office of Oncology and Hematology Products, Food and Drug Administration

STEVEN PIANTADOSI, Phase One Foundation Endowed Chair and Director, Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center

JENNIFER A. PIETENPOL, Director, Vanderbilt-Ingraham Cancer Center, Benjamin F. Byrd, Jr., Professor of Oncology, Professor of Biochemistry, Vanderbilt University

Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2016. Appropriate Use of Advanced Technologies for Radiation Therapy and Surgery in Oncology: Workshop Summary. Washington, DC: The National Academies Press. doi: 10.17226/21859.
×

MACE L. ROTHENBERG, Chief Medical Officer and Senior Vice President, Clinical Development and Medical Affairs, Pfizer Oncology, Pfizer Inc.

AUGUST SALVADO, Senior Vice President, US Oncology Clinical Development & Medical Affairs, Novartis Oncology

ANDREW SCHIERMEIER, Senior Vice President, Head of Global Oncology, Merck Serono

RICHARD SCHILSKY, Chief Medical Officer, American Society of Clinical Oncology

DEBORAH SCHRAG, Chief, Division of Population Sciences, Professor of Medicine, Department of Medical Oncology, Dana-Farber Cancer Institute, Harvard Medical School

YA-CHEN TINA SHIH, Professor of Health Economics, Chief, Section of Cancer Economics and Policy, Department of Health Services Research, University of Texas MD Anderson Cancer Center

ELLEN V. SIGAL, Chair and Founder, Friends of Cancer Research

RALPH WEICHSELBAUM, Daniel K. Ludwig Professor and Chair, Department of Radiation Oncology, Director, Ludwig Center for Metastasis Research, The University of Chicago Medical Center

GEORGE J. WEINER, Director, Holden Comprehensive Cancer Center, University of Iowa, President, Association of American Cancer Institutes

WENDY WOODWARD, Associate Professor and the Section Chief of Clinical Breast Radiation, Department of Radiation Oncology, University of Texas MD Anderson Cancer Center

National Cancer Policy Forum Staff

SHARYL J. NASS, Forum Director and Director, Board on Health Care Services

ERIN BALOGH, Senior Program Officer

PATRICK ROSS, Research Assistant

HANNAH DURING, Senior Program Assistant (until August 2015)

CYNDI TRANG, Senior Program Assistant (from August 2015)

PATRICK BURKE, Financial Associate

Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2016. Appropriate Use of Advanced Technologies for Radiation Therapy and Surgery in Oncology: Workshop Summary. Washington, DC: The National Academies Press. doi: 10.17226/21859.
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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2016. Appropriate Use of Advanced Technologies for Radiation Therapy and Surgery in Oncology: Workshop Summary. Washington, DC: The National Academies Press. doi: 10.17226/21859.
×

Reviewers

This workshop summary has been reviewed in draft form by individuals chosen for their diverse perspectives and technical expertise. The purpose of this independent review is to provide candid and critical comments that will assist the institution in making its published workshop summary as sound as possible and to ensure that the workshop summary meets institutional standards for objectivity, evidence, and responsiveness to the study charge. The review comments and draft manuscript remain confidential to protect the integrity of the process. We wish to thank the following individuals for their review of this workshop summary:

Stanley W. Ashley, Harvard Medical School

Justin Bekelman, University of Pennsylvania

Jim Hayman, University of Michigan

Ian M. Thompson, University of Texas Health Science Center at San Antonio

Although the reviewers listed above have provided many constructive comments and suggestions, they did not see the final draft of the workshop summary before its release. The review of this report was overseen by Judith R. Lave, University of Pittsburgh. She was responsible for making certain that an independent examination of this report was carried out in accordance with institutional procedures and that all review comments were carefully considered. Responsibility for the final content of this report rests entirely with the rapporteurs and the institution.

Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2016. Appropriate Use of Advanced Technologies for Radiation Therapy and Surgery in Oncology: Workshop Summary. Washington, DC: The National Academies Press. doi: 10.17226/21859.
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Page xiii Cite
Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2016. Appropriate Use of Advanced Technologies for Radiation Therapy and Surgery in Oncology: Workshop Summary. Washington, DC: The National Academies Press. doi: 10.17226/21859.
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Acknowledgments

Support from the many annual sponsors of the Institute of Medicine’s National Cancer Policy Forum is crucial to the work of the forum. Federal sponsors include the Centers for Disease Control and Prevention and the National Cancer Institute/National Institutes of Health. Non-federal sponsors include the American Association for Cancer Research, American Cancer Society, American Society for Radiation Oncology, American Society of Clinical Oncology, American Society of Hematology, Association of American Cancer Institutes, AstraZeneca, Bristol-Myers Squibb, Cancer Support Community, CEO Roundtable on Cancer, EMD Serono, Helsinn Healthcare SA, LIVESTRONG Foundation, National Comprehensive Cancer Network, Novartis Oncology, the Oncology Nursing Society, and Pfizer Inc.

The forum wishes to express its gratitude to the expert speakers whose presentations helped examine the appropriate use of advanced technologies for radiation therapy and surgery in oncology. The forum also wishes to thank the members of the planning committee for their work in developing an excellent workshop agenda.

Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2016. Appropriate Use of Advanced Technologies for Radiation Therapy and Surgery in Oncology: Workshop Summary. Washington, DC: The National Academies Press. doi: 10.17226/21859.
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Page xviii Cite
Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2016. Appropriate Use of Advanced Technologies for Radiation Therapy and Surgery in Oncology: Workshop Summary. Washington, DC: The National Academies Press. doi: 10.17226/21859.
×
Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2016. Appropriate Use of Advanced Technologies for Radiation Therapy and Surgery in Oncology: Workshop Summary. Washington, DC: The National Academies Press. doi: 10.17226/21859.
×

Acronyms

3D three-dimensional
 
ACGME Accreditation Council for Graduate Medical Education
ACO accountable care organization
ADT androgen deprivation therapy
AHRQ Agency for Healthcare Research and Quality
APBI accelerated partial-breast irradiation
APTC Advanced Procedures and Technology Committee
AS active surveillance
ASCO American Society of Clinical Oncology
ASTRO American Society for Radiation Oncology
 
CED coverage with evidence development
CMS Centers for Medicare & Medicaid Services
CON Certificate of Need
CT computed tomography
CTAF California Technology Assessment Forum
 
FDA Food and Drug Administration
 
Gy(RBE) grays (relative biological effectiveness)
Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2016. Appropriate Use of Advanced Technologies for Radiation Therapy and Surgery in Oncology: Workshop Summary. Washington, DC: The National Academies Press. doi: 10.17226/21859.
×
IMRT intensity-modulated radiotherapy
IOM Institute of Medicine
IRCC International Robotic Cystectomy Consortium
 
MDEpiNet Medical Device Epidemiology Network Initiative
MOC Maintenance of Certification
MRI magnetic resonance imaging
 
NCCN National Comprehensive Cancer Network
NCI National Cancer Institute
NCPF National Cancer Policy Forum
NIH National Institutes of Health
NROR National Radiation Oncology Registry
 
ORP open radical prostatectomy
 
PBRT proton beam radiation therapy
PCORnet National Patient-Centered Clinical Research Network of the Patient-Centered Outcomes Research Institute (PCORI)
PSA prostate-specific antigen
 
QALY quality-adjusted life year
QUANTEC Quantitative Analysis of Normal Tissue Effects in the Clinic
 
Rad Px radical prostatectomy
RARP robot-assisted radical prostatectomy
RCT randomized controlled trial
ROI Radiation Oncology Institute
 
SBRT stereotactic body radiation therapy
SEER Surveillance, Epidemiology, and End Results Program
 
UCLA University of California, Los Angeles
Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2016. Appropriate Use of Advanced Technologies for Radiation Therapy and Surgery in Oncology: Workshop Summary. Washington, DC: The National Academies Press. doi: 10.17226/21859.
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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2016. Appropriate Use of Advanced Technologies for Radiation Therapy and Surgery in Oncology: Workshop Summary. Washington, DC: The National Academies Press. doi: 10.17226/21859.
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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2016. Appropriate Use of Advanced Technologies for Radiation Therapy and Surgery in Oncology: Workshop Summary. Washington, DC: The National Academies Press. doi: 10.17226/21859.
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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2016. Appropriate Use of Advanced Technologies for Radiation Therapy and Surgery in Oncology: Workshop Summary. Washington, DC: The National Academies Press. doi: 10.17226/21859.
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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2016. Appropriate Use of Advanced Technologies for Radiation Therapy and Surgery in Oncology: Workshop Summary. Washington, DC: The National Academies Press. doi: 10.17226/21859.
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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2016. Appropriate Use of Advanced Technologies for Radiation Therapy and Surgery in Oncology: Workshop Summary. Washington, DC: The National Academies Press. doi: 10.17226/21859.
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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2016. Appropriate Use of Advanced Technologies for Radiation Therapy and Surgery in Oncology: Workshop Summary. Washington, DC: The National Academies Press. doi: 10.17226/21859.
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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2016. Appropriate Use of Advanced Technologies for Radiation Therapy and Surgery in Oncology: Workshop Summary. Washington, DC: The National Academies Press. doi: 10.17226/21859.
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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2016. Appropriate Use of Advanced Technologies for Radiation Therapy and Surgery in Oncology: Workshop Summary. Washington, DC: The National Academies Press. doi: 10.17226/21859.
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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2016. Appropriate Use of Advanced Technologies for Radiation Therapy and Surgery in Oncology: Workshop Summary. Washington, DC: The National Academies Press. doi: 10.17226/21859.
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In recent years, the field of oncology has witnessed a number of technological advances, including more precise radiation therapy and minimally invasive surgical techniques. Three-dimensional (3D), stereotactic, and proton-beam radiation therapy, as well as laparoscopy and robotic surgery, can enhance clinician's ability to treat conditions that were clinically challenging with conventional technologies, and may improve clinical outcomes or reduce treatment-related problems for some patients. Both patients and physicians seek access to these new technologies, which are rapidly being adopted into standard clinical practice. Such demand is often propelled by marketing that portrays the new technologies as the “latest and greatest” treatments available. However, evidence is often lacking to support these claims, and these novel technologies usually come with higher price tags and are often used to treat patients who might have achieved similar benefits from less expensive, conventional treatment.

The increased cost of novel treatments without adequate assessment of how they affect patient outcomes is a pressing concern given that inappropriate use of expensive technologies is one of the key factors that threaten the affordability of cancer care in the United States. To explore these issues further, the National Cancer Policy Forum (NCPF) of the Institute of Medicine organized a workshop in July 2015. This is the third NCPF workshop in a series examining the affordability of cancer care. Participants explored clinical benefits and comparative effectiveness of emerging advanced technologies for cancer treatment in radiation therapy and surgery and potential strategies to assess the value and promote optimal use of new technologies in cancer treatment. This report summarizes the presentations and discussions from the workshop.

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