62 hour work week for Oncologists? Seems a bit excessive...

[MD46]

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Sure. We all have our own biases. Whoever gets the patients first has the power. Just ask IR and CT surgery about the power Interventional Cards has

I mean if something needs IR guided biopsy patient goes to IR

If needs EBUS or Broch guided goes to Int Pulm

You need a colonoscopy, goto GI

Need a rectal mass , goto colorectal

And so on,

We decide based on the situtation not sure what you are getting at? On the contrary we rely on referrals for cancers..

 

[osprey099]

I mean if something needs IR guided biopsy patient goes to IR

If needs EBUS or Broch guided goes to Int Pulm

You need a colonoscopy, goto GI

Need a rectal mass , goto colorectal

And so on,

We decide based on the situtation not sure what you are getting at? On the contrary we rely on referrals for cancers..

Poster above might be referring to the role med oncs play in tumor board perhaps. But even then, I feel like this is institution dependent and oftentimes, the surgeon dictates when/if a patient should get neoadjuvant therapy or go straight to surgery, not the oncologist.

 

[deleted1111261]

Immunotherapy is generally super well tolerated. I give it to ECOG 3s without blinking an eye. Radiation on the other hand, not so much. Unless we talking protons but even then, tons of side effects

Interesting you say that.

There is basically one study showing protons have lower toxicity (esophageal).

The database analyses show that it’s probably worse for protons, in terms of rectal toxicity. Breast patients tended to have worse skin reactions with protons and many had to switch to photons mid way through.

I’m a RadOnc and my feeling about protons is that it may be good for certain sites and most pediatric diseases, but this has nothing to do with tolerance in an elderly patient. but I would not say that it is less toxic. There is a lot of uncertainty with the beam.

But, the fact that you say this makes me feel protonists and the proton lobby have really done a number marketing their treatment.

 

[MD46]

Interesting you say that.

There is basically one study showing protons have lower toxicity (esophageal).

The database analyses show that it’s probably worse for protons, in terms of rectal toxicity. Breast patients tended to have worse skin reactions with protons and many had to switch to photons mid way through.

I’m a RadOnc and my feeling about protons is that it may be good for certain sites and most pediatric diseases, but this has nothing to do with tolerance in an elderly patient. but I would not say that it is less toxic. There is a lot of uncertainty with the beam.

But, the fact that you say this makes me feel protonists and the proton lobby have really done a number marketing their treatment.

Isnt he talking about Immune therapy which is a systemic treatment, what you are referring to is Proton therapy which is type of radiation?

 

[gutonc]

Isnt he talking about Immune therapy which is a systemic treatment, what you are referring to is Proton therapy which is type of radiation?

it was both/and. I thank @osprey099 was suggesting that protons are less toxic than photons. But, as @RealSimulD points out, that's largely untrue and the thought that it is less toxic is largely due to excellent advertising/lobbying.

 

[osprey099]

Yea I admit I don't really understand protons vs photons. A rad onc I shadowed recently did explain in layman terms: photons is like shining a flashlight on a tumor whereas protons is shining a laser at a tumor.

Certainly protons have been advertised very successfully because folks come from all over the state are willing to transfer their care to our med onc clinic because they're "interested in protons" and our rad onc has the only proton center in the state.

 

[gutonc]

Yea I admit I don't really understand protons vs photons. A rad onc I shadowed recently did explain in layman terms: photons is like shining a flashlight on a tumor whereas protons is shining a laser at a tumor.

Certainly protons have been advertised very successfully because folks come from all over the state are willing to transfer their care to our med onc clinic because they're "interested in protons" and our rad onc has the only proton center in the state.

The reason they're so heavily advertised, and used for questionable indications, is that proton vaults are phenomenally expensive (~$50-100M but can go higher with multiple vaults). So unless they're paid for with philanthropic donations (like at Mayo who got $100M specifically to build their proton facility), most places are using PE money to build their facility. And since PE wants their money back (and more), generally on a timeline of <5 years, they need to treat a LOT of people.

When I was in a leadership position that was part of considering protons, we looked at the closest facility which was at University of Washington. They were having to run 18-20 hours a day in order to break even (AKA, pay off their PE funders) and had to hire extra Rad Oncs to essentially be nocturnists to run the thing overnight.