ASTRO vs. ACRO

[MidwestRadOnc]

Which part? The Workforce thing?

There's really nothing more to tell. I'm not kidding, from the outsider perspective, that's the sum total of what happened.

Panel presentation took place, was recorder, was available online. 1-2 weeks later taken down without notice. Accidentally discovered by someone trying to watch it. ASTRO contacted, response as above ("compliance"), no additional clarifications have ever been offered, panel presentation deleted forever.

Now, if you want to talk about Grassy Knoll theories....

The conspiracy as in what was their motive.

They took JFK and MLK out because they wanted the Vietnam War. What did ASTRO want?
(by the way, the next time you are in Dallas, go stand on the X then look up towards the window where the magic bullet came from. If you've ever shot a rifle before, it's the biggest LOL moment ever).

---

Members don't see this ad.

 

[communitydoc13]

If you go back in the literature, this debate has been ongoing for like 25 years. Have the anti-RCT folks won through regulatory capture?

Of course they have.

Regarding ROCR, it's the carve outs. I'm fine with case based payment that is completely neutral (also fine with geographic scaling as is typical for Gvt payments).

I cannot recall what time frame ROCR designates as a treatment episode? This is also important. 90 days is way too long in the present environment. In this era, I typically have 1-2 patients that I am actively treating more frequently than this (usually single fraction tx, low cost and exceptionally high value) for patients close to or on hospice. It is not a huge outlay, but it is nice to be paid for work.

Regarding protons, I've spoken ad-nauseum about this and am personally very skeptical of the science. However, independent (well relatively) of the science, there are good reasons to oppose a proton carve out.

1. It will promote proton utilization and growth. In the setting of cost concerns nationally for all cancer care, I cannot think of a lower value proposition. At best, protons may at some point be a marginal improvement over photon treatment. The cost is much more than marginally higher.

2. It will promote direct to consumer advertising and more aggressive attempts at market capture by present proton users (consolidation).

3. It will impact employment dynamics for physics and RTT staff both in the short term and long term. It may contribute to physics scarcity in the community.

It is important as a community that we consider our priors with regard to proton therapy. This is a pretty simple intellectual exercise.

What are protons not?

They are not a dose escalation tool.
They are not an improved conformality tool in small spaces.
They are not a tool for hypofractionation.

What are protons?

A tool to reduce exit dose and low dose bath.
A tool to maximize revenue, workforce and infrastructure.

If a small trial caught "magic in a bottle" regarding improved PFS for protons, I would probably not believe it.

 

[NotMattSpraker]

Which part? The Workforce thing?

There's really nothing more to tell. I'm not kidding, from the outsider perspective, that's the sum total of what happened.

Panel presentation took place, was recorder, was available online. 1-2 weeks later taken down without notice. Accidentally discovered by someone trying to watch it. ASTRO contacted, response as above ("compliance"), no additional clarifications have ever been offered, panel presentation deleted forever.

Now, if you want to talk about Grassy Knoll theories....

LOL Tupac and Kennedy sitting on, you know, that island... watching The Great Workforce Session.

 

[NotMattSpraker]

What are protons not?

They are not a dose escalation tool.
They are not an improved conformality tool in small spaces.
They are not a tool for hypofractionation.

Okay so, getting the weeds here, but I love to nerd out about this stuff.

Timmerman says it on our podcast with him, protons should have been a tool for dose escalation and/or hypofractionation. Makes sense on paper. I think he even says treating breast is stupid lol.

Glatstein actually wrote this back in the 90s, but the concept then was protons should be leveraged for adjuvant therapy after surgery or for chemoradiation. Basically, from a high level, where we worry about toxicity, there is your proton opportunity.

One would think ROCR would be a huge opportunity for them if they leaned in hard to hypofractionation and dose escalation. None of this is new. We all know why they lobbied to be out. Just another interesting angle to think about.

 

[elementaryschooleconomics]

The conspiracy as in what was their motive.

They took JFK and MLK out because they wanted the Vietnam War. What did ASTRO want?
(by the way, the next time you are in Dallas, go stand on the X then look up towards the window where the magic bullet came from. If you've ever shot a rifle before, it's the biggest LOL moment ever).

Well...

I was, honestly, EXTREMELY surprised they even posted it in the first place.

Remember, this is an organization that built RO-Hub, and then proceeded to overtly censor/delete posts that showed any form of criticism.

They're like...Elementary School Game of Thrones. They think they're playing 4D chess, but they're over in a corner, eating crayons.

If you go look at the authors on the March 2023 Workforce paper...we know those people. Some of those people have well-known opinions that may not be in complete alignment with what ASTRO thinks.

So ASTRO had some of these people hold a live, public panel, where other conference attendees could see and interact with them. Live, and in public.

Anyone with half a brain - anyone NOT eating crayons - would know that there would be some level of discussion that would not be in complete alignment with the "ASTRO preferred narrative".

See, if you're trying to maintain your dystopian empire, you maintain the illusion of freedom. What ASTRO should have done is allow a lively, spirited debate to let RadOncs think they're "being heard".

You either don't record that session at all, or you record it but don't post it. Then, the debate becomes a memory, and people feel good for "being heard", but no change happens. It's like...dystopia 101.

What you do NOT do is actually record and post this debate for anyone to watch, anytime.

That's it, that's the conspiracy and what ASTRO gets out of it. ASTRO cannot tolerate anyone even saying "maybe we might have trained like, 10 too many RadOncs". That goes against the party line.

Better delete it.

 

[communitydoc13]

Okay so, getting the weeds here, but I love to nerd out about this stuff.

Timmerman says it on our podcast with him, protons should have been a tool for dose escalation and/or hypofractionation. Makes sense on paper. I think he even says treating breast is stupid lol.

Glatstein actually wrote this back in the 90s, but the concept then was protons should be leveraged for adjuvant therapy after surgery or for chemoradiation. Basically, from a high level, where we worry about toxicity, there is your proton opportunity.

One would think ROCR would be a huge opportunity for them if they leaned in hard to hypofractionation and dose escalation. None of this is new. We all know why they lobbied to be out. Just another interesting angle to think about.

I just don't think our thought leaders understood protons very well. They saw a one dimensional dose depth curve (in an era where two and four field treatment plans were common) and were like "damn".

But then, our physicists learned how to take advantage of MLCs, inverse planning and a very good understanding of photon dosimetry. Meanwhile they could not apply these things to protons in the same way (because the dosimetry is not nearly as well understood).

Are you going to complete with a photon SBRT plan with a 140% hotspot with protons when it comes to conformality? When it comes to dose escalation limited by adjacent structures?

Protons value is contextualized by how well we do photons, just like XRTs value is contextualized by how well we do systemic therapy.

 

[medgator]

One would think ROCR would be a huge opportunity for them if they leaned in hard to hypofractionation and dose escalation. None of this is new. We all know why they lobbied to be out. Just another interesting angle to think about.

Instead we get 79.2/44 fx for prostate with a mandatory $3k spacer gel

 

[RadOncDoc21]

They're like...Elementary School Game of Thrones. They think they're playing 4D chess, but they're over in a corner, eating crayons