Training in RadOnc AND systemic therapy

[bronchogenic]

If a RadOnc trainee wanted to expand one's skillset to also be able to administer systemic therapy (without doing IM + Heme/Onc) would something like a Neuro-Oncology fellowship be the fastest way?

From Stanford's neuro-oncology fellowship page:
"We will also consider applicants who have completed training in medical oncology, pediatric oncology, neurosurgery, or radiation oncology on a case by case basis."
https://med.stanford.edu/neurology/divisions/neurooncology/fellowship.html

Could anyone weigh in on the advantages/disadvantages of doing something like this? The motivation would at least partly lie in a fascination with radiation oncology, but also wanting an "out" or at least additional options in case the job market/demand for RT became untenable.

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[mpdoc2]

If a RadOnc trainee wanted to expand one's skillset to also be able to administer systemic therapy (without doing IM + Heme/Onc) would something like a Neuro-Oncology fellowship be the fastest way?

From Stanford's neuro-oncology fellowship page:
"We will also consider applicants who have completed training in medical oncology, pediatric oncology, neurosurgery, or radiation oncology on a case by case basis."
https://med.stanford.edu/neurology/divisions/neurooncology/fellowship.html

Could anyone weigh in on the advantages/disadvantages of doing something like this? The motivation would at least partly lie in a fascination with radiation oncology, but also wanting an "out" or at least additional options in case the job market/demand for RT became untenable.

There's very few chemotherapy meds for neuro-oncology.

 

[RadOncDoc21]

There's very few chemotherapy meds for neuro-oncology.

Temodar, Avastin and Steroids. If you want to be bold, I guess PCV but that's really all there is.

Similar to gyn onc chemo meds with cisplatin and carbotaxol. I am starting to see carbotaxol be used for everything now a days.

 

[Reaganite]

What med onc group is seriously gonna hire a rad onc who did a neuroonc fellowship to do full fledged medical oncology? I have worked with some non med onc "neurooncs" and all they give is temodar .

 

[Palex80]

Temodar, Avastin and Steroids. If you want to be bold, I guess PCV but that's really all there is.

Similar to gyn onc chemo meds with cisplatin and carbotaxol. I am starting to see carbotaxol be used for everything now a days.

Expect this to happen with Novolumab for NSCLC soon too...

 

[seper]

I don't want to give chemo.


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[medgator]

I don't want to give chemo.


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Pretty much.

Our "moat" is safe IMO. Radiation isn't going out of business or style. We still have an important role in both curative and palliative management of cancer despite the feelings posted in the OP.

 

[rebelpig]

If a RadOnc trainee wanted to expand one's skillset to also be able to administer systemic therapy (without doing IM + Heme/Onc) would something like a Neuro-Oncology fellowship be the fastest way?

From Stanford's neuro-oncology fellowship page:
"We will also consider applicants who have completed training in medical oncology, pediatric oncology, neurosurgery, or radiation oncology on a case by case basis."
https://med.stanford.edu/neurology/divisions/neurooncology/fellowship.html

Could anyone weigh in on the advantages/disadvantages of doing something like this? The motivation would at least partly lie in a fascination with radiation oncology, but also wanting an "out" or at least additional options in case the job market/demand for RT became untenable.

U could become an oncologist giving radiation and chemo in certain simple subspecialties: prostate, lung or head/neck, even gynea, but definitely not for lymphoma or breast, it is just too complicated and difficult to manage.

As a so-called "clinical oncologist" trained under UK system who is not giving chemotherapy right now. In my own practice, the indications/timing of radiation are quite often controlled by med onco especially in the palliative setting. There are always numerous 3-4 lines chemo and clinical trials out there, and they just simply want to use up all the bullets in their hands.

 

[Krukenberg]

U could become an oncologist giving radiation and chemo in certain simple subspecialties: prostate, lung or head/neck, even gynea, but definitely not for lymphoma or breast, it is just too complicated and difficult to manage.

As a so-called "clinical oncologist" trained under UK system who is not giving chemotherapy right now. In my own practice, the indications/timing of radiation are quite often controlled by med onco especially in the palliative setting. There are always numerous 3-4 lines chemo and clinical trials out there, and they just simply want to use up all the bullets in their hands.

If this is true then hopefully the increased emphasis on palliative care training during heme/onc fellowships will mean earlier involvement of palliative RT


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[medgator]

U could become an oncologist giving radiation and chemo in certain simple subspecialties: prostate, lung or head/neck, even gynea, but definitely not for lymphoma or breast, it is just too complicated and difficult to manage.

As a so-called "clinical oncologist" trained under UK system who is not giving chemotherapy right now. In my own practice, the indications/timing of radiation are quite often controlled by med onco especially in the palliative setting. There are always numerous 3-4 lines chemo and clinical trials out there, and they just simply want to use up all the bullets in their hands.

Again, this all depends on referral patterns. An educated pulmo can call you for hemoptysis from a mass, a GYN onc can call you for uterine bleeding, etc. It doesn't have to be that way.

 

[prometheus1]

U could become an oncologist giving radiation and chemo in certain simple subspecialties: prostate, lung or head/neck, even gynea, but definitely not for lymphoma or breast, it is just too complicated and difficult to manage..

In my experience, usually the prostate systemic therapy (ADT etc) is managed by us (Radonc) or Urology, depending on if the patient gets definitive RT or RP (ADT after RP for certain patients, N1 etc). I don't imagine I will ever want or need to actively manage docetaxel, but all the hormonal therapies are all feasible for us I think, and I suspect they may be changing in the years to come.

Once the patient is M1, I will send the patient to medonc. If the patient comes from medonc, then I will also let them go ahead and control systemics, if they so choose. If the patient comes from urology already on systemics, I basically co-manage systemics (usually just a decision for duration and where the patient gets injected) with urology or let them manage of they want, which is not often.

What do you all do?

 

[BobbyHeenan]

In my experience, usually the prostate systemic therapy (ADT etc) is managed by us (Radonc) or Urology, depending on if the patient gets definitive RT or RP (ADT after RP for certain patients, N1 etc). I don't imagine I will ever want or need to actively manage docetaxel, but all the hormonal therapies are all feasible for us I think, and I suspect they may be changing in the years to come.

Once the patient is M1, I will send the patient to medonc. If the patient comes from medonc, then I will also let them go ahead and control systemics, if they so choose. If the patient comes from urology already on systemics, I basically co-manage systemics (usually just a decision for duration and where the patient gets injected) with urology or let them manage of they want, which is not often.

What do you all do?

This is very similar to my practice.

If the uro has already given ADT, I'll let him/her continue to administer the shot/pills while I give input about length of therapy, etc. If they're high risk or have indications for ADT and no one has given it yet, I'll just take over that management and start it. Our med oncs have made it clear they're only interested in managing M1 patients.

 

[medgator]

This is very similar to my practice.

If the uro has already given ADT, I'll let him/her continue to administer the shot/pills while I give input about length of therapy, etc. If they're high risk or have indications for ADT and no one has given it yet, I'll just take over that management and start it. Our med oncs have made it clear they're only interested in managing M1 patients.

Likewise, although if a med onc sees a high-risk patient upfront for some reason, they will usually start it and I'll just do the XRT and hand it back to them for the long-term ADT.