few questions about radiation oncology field

[stoleyerscrubz]

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I have been reviewing posts on this forum for some time and I am wondering a few things:

1)who helps the patient decide if a patient should have surgery,chemo, or see an oncologist when a patient is diagnosed as having cancer? surgeon, pathologist, family practioner,combination of them?

2)who is reviewing the patient's progress and deciding if there should be a change in procedures as the patient goes through treatment from a radiation oncologist ?

3)Are there mid level practitioners in this field such as CRNA and AA's in Anestesiology, NP's in family medicine, optometrists trying to overlap into opthamolagy, Physical Therapists trying to overlap into PM&R,etc? or perhaps a situation similar to Radiologists lpossibly losing some work to cheaper labor in India. All I saw that was slightly similar to this was in the fact stating "radiation oncology is not a dying field"

4)The FAQ says most of the patients can be helped but if things are not looking good is it the radiation oncologist that will have to talk to the patient about this or do we refer back to the person in question #1?

Sorry for sounding ignorant. I know it is a small field, but I never see these topics discussed on this forum.


You guys are awesome. Thanks

 

[stephew]

Ignorence will not stand! Welcome.

1)who helps the patient decide if a patient should have surgery,chemo, or see an oncologist when a patient is diagnosed as having cancer? surgeon, pathologist, family practioner,combination of them?

well standard of care and also in the best places a multidiscimplanary communicating team.



2)who is reviewing the patient's progress and deciding if there should be a change in procedures as the patient goes through treatment from a radiation oncologist ?

well radonc decides if the radiation needs changing or if they think surgery or chemo or whatever should be revisited they refer back to the relevant doc (and they do the same in return, usually at friday at 4 pm).


3)Are there mid level practitioners in this field such as CRNA and AA's in Anestesiology, NP's in family medicine, optometrists trying to overlap into opthamolagy, Physical Therapists trying to overlap into PM&R,etc? or perhaps a situation similar to Radiologists lpossibly losing some work to cheaper labor in India. All I saw that was slightly similar to this was in the fact stating "radiation oncology is not a dying field"

There are "physician extenders" but there is no "threat" of too much overlap mainly because the planning is done solely by the physician. They are more clinical hands. PAs in fact probably are more involved in surgery that they are in radonc treatmtent planning.

4)The FAQ says most of the patients can be helped but if things are not looking good is it the radiation oncologist that will have to talk to the patient about this or do we refer back to the person in question #1?

That's the crux of the doc/patient relationship. Its very contextual. It depends on who the primary caretaker (in the loose sence) is. I have patients i see for palliation or a small part of their care but who've established much of the relationship with, say, med onc, and vice-versa. Put simply, you can't be squeamish about talking turkey. S

 

[stoleyerscrubz]

This gives me more insight into the dynamics of the physician-patient relationship in radiation oncology. Thanks again.

 

[stephew]

This gives me more insight into the dynamics of the physician-patient relationship in radiation oncology. Thanks again.

glad it helped. all the best,
s

 

[Adawaal]

(and they do the same in return, usually at friday at 4 pm).


ROTFLMAO, steph... This is so true!

Medicine resident trying to get a Rad Onc consult Friday at 4PM: "Why is it you can never find a Rad Onc doc? Do they ever work?"

Medicine resident doing a consult month, any weekday after 10 AM: "What's their damage anyway? Don't they know to call their consults first thing in the morning?"

 

[stephew]

(and they do the same in return, usually at friday at 4 pm).


ROTFLMAO, steph... This is so true!

Medicine resident trying to get a Rad Onc consult Friday at 4PM: "Why is it you can never find a Rad Onc doc? Do they ever work?"

Medicine resident doing a consult month, any weekday after 10 AM: "What's their damage anyway? Don't they know to call their consults first thing in the morning?"

1)not my fault if they didn't learn about the coolness of radonc in time (which includes the possibility of a life)
2)yes hypocracy is everywhere in medicine. docs dont even hear themselves say it.
3)patchell paper on cord compression did a substudy confirming the "oh darn I forgot to call radonc!" on friday thing. So if anyone gets on a high-horse with you about it, remind them then that since they are so on top of it all, you wont be expecting any last minute frantic pages.

 

[Psycho Doctor]

1)not my fault if they didn't learn about the coolness of radonc in time (which includes the possibility of a life)
2)yes hypocracy is everywhere in medicine. docs dont even hear themselves say it.
3)patchell paper on cord compression did a substudy confirming the "oh darn I forgot to call radonc!" on friday thing. So if anyone gets on a high-horse with you about it, remind them then that since they are so on top of it all, you wont be expecting any last minute frantic pages.

cord compressions notoriously come thru to Rad Onc at 5 PM Friday night when the patient came into the ER on Wednesday

 

[pikachu]

This has actually been documented in a Dutch study:

Acta Oncol. 2001;40(1):88-91. Related Articles, Links


Always on a Friday? Time pattern of referral for spinal cord compression.

Poortmans P, Vulto A, Raaijmakers E.

Dr Bernard Verbeeten Instituut, Department for Radiation Oncology, Tilburg, The Netherlands. [email protected]

For patients with spinal cord compression, radiotherapy should be initiated as soon as possible to optimize the chances for restoration of neurological function. The speed of referral in the region of our radiotherapy institution with nine general hospitals was analysed based on a tumour and treatment-related registry. From January 1987 to December 1997, 443 patients were treated. All patients were seen and treated on the day of referral. Significantly more referrals took place on Friday, 30%, compared with 12% on Monday, 17% on Tuesday, 15% on Wednesday, 20% on Thursday, 5% on Saturday and 1% on Sunday (p < 0.002). This difference was the same for patients whether they were formerly treated in our institution (n = 242) or not (n = 201). No significant difference was found between different categories of patients (p = 0.28). These data are discussed with the referring physicians to encourage speed of diagnosis and referral.