Through a glass darkly: predicting the future of radiation oncology

To position ourselves professionally for the inevitable transition to managed care demands serious self-appraisal. Like most procedural medical specialties, radiation oncology is currently ill prepared for a capitated system of payment. To prosper under capitation, we need to increase the utility of radiation therapy per unit cost. This can be achieved by making the following adaptive responses: (a) we must ensure that the needs of medical practice drive the use of costly technology and not vice versa; (b) we must subordinate firmly held beliefs and prejudices to solid scientific data and be prepared to modify our practice when more cost-effective alternative exist; and (c) we must be increasingly conscious of outcome, not process, in deciding among treatment options; and (d) we must acknowledge the need to prioritize the use of finite resources so that the maximum effort is expended on those who have the most to gain from treatment. These changes will permit us to develop guidelines for appropriate use of radiation therapy, and to demonstrate the excellent value of the service we can provide, which is the ultimate key to success. Though the future may at times seem bleak, we can shape it with our actions: the best way to predict the future is to create it.