Radiation late toxicities (RLTs) are complications of curative-intent radiotherapy (RT) for head and neck cancer (HNC) and are increasingly relevant due to younger age at diagnosis and improved survival outcomes. We conducted a cohort study of HNC patients who received ≥50 Gy as part of curative treatment between January 2003 and December 2020 at a Canadian quaternary cancer center. Risk factors for severe RLTs (≥RTOG Grade 3) were evaluated using time-to-event analyses. Actuarial rates of RLT and overall survival (OS) were estimated using competing risk and Kaplan–Meier methods, respectively. Cox proportional hazard models identified factors associated with RLT and OS. Among 7622 patients, 12.6% (n = 958) developed RLTs without disease progression, with a 5-year actuarial incidence of 16% (95% CI: 15–16). A survivors subgroup (n = 4650) with ≥2 years of follow-up and no recurrence was also identified. Modifiable risk factors for RLTs included RT technique, dose, neck irradiation, neck dissection, smoking status, and chemotherapy (p ≤ 0.012). Non-modifiable factors included younger age, female sex, and oral cavity primaries (p ≤ 0.012). In multivariable analysis, RLTs were associated with increased mortality (HR = 2.1, 95% CI: 1.8–2.5, p < 0.001), but RLT's impact on OS was lessened among patients referred to the Adult Radiation Late Effects Clinic (ARLEC) (HR = 1.7, 95% CI: 1.3–2.4). RLTs are common and associated with worse survival among HNC survivors. Identification of modifiable risk factors provides opportunities for prevention. Multidisciplinary management of RLTs in specialized clinics may help improve the outcomes in this growing survivorship population. No external funding was utilized for this study.

Background: This study’s objective was to be the first to explore the ethnicity/cultural origins, gender identity, ability/disability, sexual orientation, socioeconomic background, and harassment/discrimination experiences of Canadian radiation oncologists (ROs). Methods: Following a literature review and input from content experts, an ethics-approved national cross-sectional electronic survey was developed in English and French and electronically distributed to all ROs in Canada (n = 598). Descriptive statistics summarized responses. Comparisons between groups were performed using Chi-square tests, and content analysis was performed on open-ended responses. Results: The survey was completed in full by 42.5% of ROs (254/598). Most respondents were male (62.9%), 35–44 years old (39.2%), and heterosexual (94.3%). 41.2% identified as belonging to a racialized group, which is higher than the overall Canadian population (27%), but Black, Indigenous, and Southeast Asian ROs were underrepresented (1.9% vs. 4%, <1% vs. 5% and 1.6% compared to 4%, respectively). A significant subset analysis showed that only 20% (21/105) of racialized ROs were women, whereas Caucasian women comprised 49.3% (74/150) of Caucasian respondents (p < 0.001). While 75.4% of respondents reported job satisfaction, 42.1% reported experiencing workplace discrimination/harassment within the past 5 years; most commonly, this was perpetrated by fellow faculty (31.7%; 58/183) or patients or their family members (31.7%; 58/183). Respondents felt that gender, race/ethnicity, and age were the three top reasons for discrimination/harassment, with double the amount of racialized ROs reporting harassment compared to White ROs (p < 0.001). Nearly half (45.2%; 114/252) did not understand how to report, or felt uncomfortable reporting, workplace discrimination/harassment. Conclusions: This study highlights high harassment and discrimination rates amongst Canadian ROs, especially amongst racialized women, which may affect career satisfaction and attrition rates. Compared to census data, Black, Indigenous, and Southeast Asian ROs were underrepresented, and amongst racialized ROs, racialized women were significantly underrepresented. These findings underscore the need for targeted diversity initiatives, improved mentorship programs, and stronger institutional policies to address harassment and foster an inclusive work environment.

Background: This study characterizes the current representation of sociodemographic groups within Canadian radiation oncology training programs and trainees’ lived experiences. Methods: A 59-item ethics-approved, bilingual survey assessed sociodemographics, training perceptions, mentorship, discrimination/harassment experienced, and open-ended questions. Electronic surveys were distributed to all Canadian radiation oncology residents/fellows. Descriptive statistics summarized survey responses. Categorical groups were compared using chi-squared/Fisher’s exact tests. Thematic analysis was performed on open-ended responses. Results: Between July and December 2023, 98 of 177 (56%) trainees participated: 70% were residents, 52% identified as male, 62% as a racialized minority, and 10% as a sexual minority. Most respondents reported training program satisfaction (83%) and a respectful workplace culture (69%); however, discrimination during training was reported by 38%. Less than half (45%) felt comfortable reporting discrimination/harassment within their workplace. Women were more likely to feel under-represented in-training (46% vs. 13%, p = 0.001) and perceived more discrimination events (64% vs. 19%, p < 0.001). Three themes emerged as follows: importance of offering EDI education, ensuring pathways for reporting learner mistreatment, and creating appropriately diverse selection committees. Conclusions: Although most Canadian radiation oncology trainees reported satisfaction and a respectful culture, key differences between groups were observed. Targeted strategies and stronger institutional policies to improve representation and reduce rates of discrimination/harassment are needed.