As I’m sitting here thinking. I can’t think of another scenario in another specialty where the doctor goes “I’ve got a longer treatment, and a treatment with more side effects… which one would you like.” I mean this is the way we rad oncs should couch it. But again I can’t ponder a good analogy for other doctors. I’m sure it exists.
Exactly what I say. I have had multiple people with acute urinary obstruction and Foley placement under 28 fractions.
Actually don't see much of the gu issues, more GI which is what the data suggests.
It’s too bad “constraints” also don’t constrain preparation (ie the whole “sim package”) and expansion margins
Haha… that’s me honestly! Do I really need to keep my mean 1.3 Gy off the distal penile bulb, or my 101.3% hotspot below 0.00045 cc’s?
I mean... anyone can say "in my experience", but data are data. That being said, I also think it would be reasonable to mention the cost difference -again, letting patients choose for themselves.
Had 2 physician colleagues in the past several months. Both chose conventional.
Funny what makes a fraction-number sweet spot. The number 28 chosen simply so when divided into 70 there wouldn’t be a repeating decimal (versus eg 30 fractions), and would be less fractions than a normie 6 weeks but still allow one to bill 6 OTVs!
Who needs to run any oncology trials? We can ask you and your buddies! 😀
Absolutely why not. While we're huffing and puffing: Trial data is often not extrapolatable to private practice or for that matter replicated with certainty. But I like your enthusiasm sir. Keep it up.Who needs to run any oncology trials? We can ask you and your buddies!
I wouldn't say I am "huffing and puffing"... I don't have a dog in this fight. Just knocking you for claiming that your unverifiable anecdotal evidence is more credible than randomized data (which we are all guilty of from time to time)... but you jump the shark, claiming that anyone who doesn't practice like you is "greedy".
I proudly treat relatives and colleagues with 44 x 180. Otherwise, abt half pts are 70/28. Definetly more acute urinary symptoms which was shown in the original trials. Don’t really see acute rectal issues in either.
70.2 / 26 fx is also pretty popular
This can work both ways, and I really, really dislike when we start to question each other's motives with zero evidence or knowledge about the physician involved. However, that ship has sailed, so:
yes my workload is vastly decreased because... I save 2 weekly visits from my "workload" for that patient? You're kidding me right?
Honestly could surmise KP, VA and other capitated centers or academic places with wait-lists would be incentivized to offer the quicker, more toxic tx... Fraction shaming works both ways.
Why? This isnt breast cancer where the benefit and superiority of hypofractionation is very clear based on the data.
So all about efficacy and nothing about toxicity, eh comrade? I guess the flat daily per diem makes it easier to just give everyone their Rx without a discussion, amirite?
How do you know it costs significantly more to do conventional. My guess is that hypofraction costs significantly more because many of the places pushing it are charging 5-10 x cms rates. See prior thread on ny presbyterian reimbursed 98k from medicare advantage plan.
Grasping at straws are we? New England centers with a death grip on payors excluded.. Your average freestanding center in Kansas loses money with every hypofrac.
What if I don’t like the feeling I get if I feel like I have allowed the patient to choose a treatment resulting in more patient complaints. What am I supposed to do about that. “Hey, self… ignore yourself.”
Rad oncs going to rad onc!
You should have seen what they said when smoking was thought to be bad. "Tobacco is good! Friends.. doctors prefer camels, you'll be fine, its toasted!" but those dying smokers.. "rubbish, why talk about quitting until everyone agrees it really is bad.." Reference
You can talk about it all you want! I suppose. But everyone is a hypocrite until proven otherwise. Usually the people vocally against smoking in the 80s were not secret smokers who were actively trying to get other people to stop smoking so they could secretly have all the cigs to themselves.
Not equivalent from a toxicity standpoint and not even cheaper depending on pps-exempt vs hopps vs Medicare PFS site of service
I have said how I get paid personally and how it does not impact my pay whatsoever. I tell patients routinely my goal is driven to give them the info and make the best informed choice. Second opinions also welcomed though maybe 1 in 200 do so.
GTFO.... Hopps tells me how you bill, it doesn't tell me how you get paid bro
You saying hypofx doesn't affect your pay whatsoever? Record your pay today (X'). Try five fraction breast and prostate for every breast and prostate patient for two years, and measure your pay at the end of that period. Your new pay, X'', after two years will be and/or fluctuate between X'-X' ≤ X'' ≤ X'-1 dollars. I bet big money. I bet even bigger money you did 5 fraction breast on not more patients countable on two hands last year. Bet even bigger bigger money you didn't do a 5 fraction breast ENI last year. Be honest. And if I'm winning money on last two bets, why.
I'm rvu based too. I could be outta the game so much sooner if I 33d the breasts and 38d the lungs like the local 21c. I can't really say I sleep better...
Yeah yeah yeah. But. If you follow the natural line of reasoning of these statements/thoughts/sentiments embedded in this sentence, it leads to:
ha I'm trolling you and everyone who says hypofrac should be "routinely offered." That's almost a weasel phrase. Is hypofractionation a class solution or not. And if it is, it should be imminently obvious then that the least fractions necessary "to get the job done" should always be used... not just "routinely offered."
