ASTRO - anything interesting?

[OTN]

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I couldn't make the trip this year. Anyone hearing/seeing anything of note?

 

[Krukenberg]

Hope someone is able to report back for the labor supply and demand session

 

[Fpg1245]

Wish I could have gone. The comments on the workforce are pretty much the only thing I am interested in hearing about.

 

[Reaganite]

Very few attendees. Nobody confrontational. Harvard program director referenced "online message boards" 🙂 so its clear they are very interested in what we say. For me, that was really highlight. Otherwise, nothing groundbreaking. Acknowledged there was a maldistribution problem but pretty much said they dont have an easy answer for correcting it. Issue of the number of residency slots was addressed and the highlight was no increase since 2015. Zeitman said apps to harvard are definitely down. Very nice fellow from australia asked if residency slots could be reduced. Response was this is "tricky." Everybody in rad onc is pretty much a white or asian male. More and more people are working for the good ole hospital machine.

 

[nkmiami]

My take on ASTRO - there was increasing excitement about combination of radiation and immunotherapy and it may be beneficial to deliver them concurrently. Also, doses of around 8 Gy with small fields may be more immunogenic (mimics viral damage to the cell) based on preclinical work.

 

[thecarbonionangle]

Basically nothing is going to be done about the job situation. The "leadership" is using the topic to pump out more meaningless papers, then do nothing about it. Places keep expanding (refer to the locked down Stanford thread) shamelessly. This is gonna hurt for us looking for jobs in a few years.

 

[Neuronix]

I thought that Trevor Royce's talk was reasonable in laying out both sides of the issue. It's no secret that the number of residents per year has doubled in the past 20 years. Ben Smith updated his 2010 projections for rad onc undersupply in 2016 to now reflect an oversupply. Dr. Royce put things very plainly that there is a perception among the majority of radiation oncologists in surveys that there is currently an oversupply of radiation oncologists.

Anthony Zeitman has been consistent in his view--when the job market crashes, medical students won't go into the specialty any more and the job market will regulate itself. This was his commentary on Dr. Royce's talk--that positions may go unfilled this year because the number of applicants to positions is about 1:1.

I would agree that there seems to be no mechanism and/or motivation to actually fix this problem. Maybe when it becomes a crisis will people pay attention. I can tell you that the program directors I know personally are still looking to expand and would be happy to have more fellows.

 

[Burt Radnolds]

when the job market crashes, medical students won't go into the specialty any more and the job market will regulate itself. This was his commentary on Dr. Royce's talk--that positions may go unfilled this year because the number of applicants to positions is about 1:1

Wow, this is the pathetic rhetoric some of our leadership continues to adopt and promote??? What a sad sad way of viewing the situation. We have identified a potential problem, we have analyzed the data of said problem to the best of our ability and confirmed that it is real. Obvious solution: Allow the specialty to implode under the weight of its bad decision making rather than promoting a proactive solution.

 

[nkmiami]

When some joint center residents- who spent years in labs/research- are forced in to uro/derm rads, and can longer "choose wisely," maybe opinions will shift.

 

[Gfunk6]

I think the original purpose of this thread was to discuss clinical data presented at ASTRO. I did not attend but my colleague did and took notes.

Note: Everything is condensed in TL;DR format

1. PACIFIC trial (discussed here on dedicated thread) - Durvalumab added to CRT in Stage III NSCLC benefits ORR, PFS, local PFS, DM PFS, and new brain metastases

2. MDACC Phase I/II trial of Ipi + SBRT in patients with metastatic disease - results highly promising, see press release here: Radiation-immunotherapy combination can slow tumor growth for some patients with metastatic late-stage cancer - American Society for Radiation Oncology (ASTRO)

3. RTOG 0526 Phase II of LDR salvage after PSA failure after definitive EBRT ADCP - primary endpoint was <= 10% Gr3 GI/GU toxicity; technically not met (14%); but < 20% "unacceptable" rate

4. Stupp GBM EF-14 TTF HRQOL outcomes - Optune added to Stupp regimen increases overall survival by 5 months; no difference in QoL between standard Stupp and Optune

5. Chinese phase III PMRT standard Fx vs. HypoFx non-inferiority trial -50/25 vs 43.5 Gy at 2.9 Gy / fx given daily over 15 fx (3 weeks); equivalent in all ways at five years + SUPERIOR cosmesis for hypofrac arm

6. GOG 249 pelvic EBRT vs. VBT à carbo/taxol in high intermediate risk endometrial CA - EBRT has way better toxicity (probably because of carbo/taxol in other arm) and pelvic control rates slightly favor EBRT

7. IAEA cervix HDR dose/fx trial - 7 Gy x 4 > 9 Gy x 2 in terms of LC

8, UTSW consolidative RT after 1st line systemic therapy for metastatic NSCLC phase IIR - PFS improved from 4 months to 10 months; no in-field failures

 

[OTN]

Thanks, GFunk, that's what I was looking for.

 

[RadOncMegatron]

When some joint center residents- who spent years in labs/research- are forced in to uro/derm rads, and can longer "choose wisely," maybe opinions will shift.

Oh no you didn't! 👍

 

[Reaganite]

When some joint center residents- who spent years in labs/research- are forced in to uro/derm rads, and can longer "choose wisely," maybe opinions will shift.

Or when they end up at "academic" satellites where the goal is to feed patients to the mother ship where they can "choose wisely," but still get paid 200% of Medicare 😉.

 

[maruchan]

The concept of self regulation is completely illogical. The market has no way to regulate itself. If spots go unmatched, that does not mean they go unfilled. It just means other medical students will SOAP into that spot....

 

[medgator]

The concept of self regulation is completely illogical. The market has no way to regulate itself. If spots go unmatched, that does not mean they go unfilled. It just means other medical students will SOAP into that spot....

With rad onc coming full circle to the FMG haven it was 30+ years ago

 

[medgator]

Or when they end up at "academic" satellites where the goal is to feed patients to the mother ship where they can "choose wisely," but still get paid 200% of Medicare 😉.

Site neutral payments can't come fast enough

CMS finalizes site-neutral payment rule

 

[Mandelin Rain]

With rad onc coming full circle to the FMG haven it was 30+ years ago

That was my thought as well. I wonder how much of an ego stroke it is for academic chairmen to decide between 8 PhDs with 260 step 1 scores, who then go on to educate themselves during the 4 year scut fest known as a typical radonc residency. The quality of candidate is likely to drop off much quicker than the number of spots. At that point, maybe all the nonsense about "residents actually slow us down" will become genuine.

 

[RadOncDoc21]

That was my thought as well. I wonder how much of an ego stroke it is for academic chairmen to decide between 8 PhDs with 260 step 1 scores, who then go on to educate themselves during the 4 year scut fest known as a typical radonc residency. The quality of candidate is likely to drop off much quicker than the number of spots. At that point, maybe all the nonsense about "residents actually slow us down" will become genuine.

The only time a resident ever slowed me down was when I tripped over one in the hallway. I admit, residents H&P’s are way better than mine!