Even though cancer is among the leading causes of death in the United States, due to an aging population and unhealthy environmental factors and lifestyle habits, many materials management professionals may find oncology devices and equipment something of a mystery.

That should come as no surprise. Faced with a confusing array of technological terms that seem like a semantic stew, coupled with the infrequency of capital buys and the belief (or excuse) that clinician preference drives oncology purchasing patterns, materials managers logically limit their exposure to and time spent on cancer treatment technology.

But increased clinician and patient demand for cancer treatment beyond chemotherapy and the high costs of new radiation surgery and therapy technologies is taxing the budgetary controls of hospitals and healthcare facilities to the point that administration turns to materials management for their expertise. And because oncology represents such a lucrative potential revenue stream for healthcare facilities materials managers no longer have the luxury of rubber-stamping clinical decisions and moving on.

Instead, they have to find balance and restore order to two opposing forces: Clinicians that want to treat more patients with the best technology (that typically is more expensive than a facility can afford) vs. administrators that strive to grow and protect the revenue stream while keeping expenses in check.

It’s a familiar dilemma, emerging in such areas as orthopedics, diagnostic imaging (radiology) and cardiology. But the key difference is that materials management’s influence in those areas has been rising. And oncology is shaping up to be the next big budgetary battleground in materials management’s war plan. For that reason, materials managers should acquaint themselves with some basic intelligence on cancer treatment technology before they sit across the conference room table from the oncology team.

What to buy

If the oncology department wants to have as much of the latest technology at its disposal as possible, then what basic equipment needs to be on the initial shopping list and what can be considered optional and can wait until the department can cost justify adding it to the routine?

If anything, it’s important for a facility to make realistic decisions based on demographics, location and financial support.

“Linear accelerators are probably one of the early technologies to bring in,” said Susan Levine, DVM, Ph.D., vice president, technology assessment and editor in chief, Hayes Inc., Lansdale, PA. “A linac can be used for external beam therapy and stereotactic radiosurgery. The field is moving toward image-guided technology that links diagnosis to therapy.

“But it depends so much on the type of hospital and the patient load,” Levine continued. “Certainly, the right equipment can attract referrals and patients. This applies more to the strategic planning of the hospital and the potential patient population you want to reach.” Also, such decisions allow the facility to determine how closely imaging and radiation therapy will work together, as well as relationships between the clinical laboratory and radiology. With all three departments working together–imaging to find the tumor, pathology to test the tumor and oncology to treat the tumor–they can cost justify bringing in certain types of equipment. Of course, a facility must be sited properly to support all this equipment, she added.

A fully equipped radiation therapy department probably contains linear accelerators, image-guided radiation therapy systems, radiation oncology information systems, radiation treatment planning systems and computed tomography (CT) simulation systems, according to Robert Maliff, associate director of ECRI’s Health Systems Group, Plymouth Meeting, PA. However, the essential platform includes [intensity modulated radiation therapy]-capable linear accelerators, a treatment planning system and cr simulation, he noted.

“Image-guided radiation therapy (IGRT) can wait, but is quickly advancing care applications,” Maliff noted. “And radiation oncology information systems are necessary for completely smooth operations, but are not truly necessary to deliver care. Brachytherapy is nice, but volumes indicate that only major providers should really be doing this, let alone the physics, dosimetrist and radiation oncologist support necessary.”

Furthermore, the radiation therapy equipment should be DICOM-compliant, and that means finding out at least how each device complies with at least DICOM RT Image, DICOM RT Dose, DICOM RT Plan, DICOM RT Structure Set and DICOM RT Treatment Record. The information systems and CT simulator should also comply with DICOM CT Store for simulation images, he added. DICOM is an acronym for digital imaging and communications in medicine and is a standard of communication and connectivity protocols for exchanging digital information between imaging equipment and other systems.