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sorry should have read the FAQs
Future of Rad Onc?
- Thread starter samtang
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no prob.
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The future of rad onc is very bright, and surgeons are fighting their best to keep us at bay.
Urologists are trying to keep their prostatectomys although more and more people opt for IMRT and proton.
ENT Heck and Neck Tumors have already lost the battle... no more vocal cord surgeries... IMRT will preserve voice.
Gamma knife, cyberknife, stereotactic surgery, neurosurgeons are trembling with fear.
But more work needs to done in GI cancers, especially pancreas.
Urologists are trying to keep their prostatectomys although more and more people opt for IMRT and proton.
ENT Heck and Neck Tumors have already lost the battle... no more vocal cord surgeries... IMRT will preserve voice.
Gamma knife, cyberknife, stereotactic surgery, neurosurgeons are trembling with fear.
But more work needs to done in GI cancers, especially pancreas.
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well...while i dont think there is any issue with the furture of radonc, I think Johns assessment as it stands above is a little bit of kilter; these issues are extremely complext from both a medical and financial/political standpoint.
Strictly leaving aside the later, medically speaking only, prostatecomies, laryngeal surgery, and neurosurgery are ALWAYS going to play a big role. It is really not usually "them or us". Neurosurgeoonns etc are not at all "trembling with fear" as (again leaving aside the role they play WITHIN radiosurgery and the financial and political relatioship with have with these disciplines) they will ALWAYS have a medically necessary and relevant place in medicine and its hardly going to diminish substantially due to radiosurgery. There are also still vocal cord surgeries.
While "more work needs to be done in pancreatic cancer" is true, you might as well say that "more work needs to be done in heart disease"; well yes, but in medicine that's just one of countless areas under development. So to in radonc. Why pick out GI cancer? When you get more experinece you'll see that these fields are now, and only etting more multidisciplinary as time goes on. That's the great thing about being in a comprehensive cancer center- we work very intimately that way.
Strictly leaving aside the later, medically speaking only, prostatecomies, laryngeal surgery, and neurosurgery are ALWAYS going to play a big role. It is really not usually "them or us". Neurosurgeoonns etc are not at all "trembling with fear" as (again leaving aside the role they play WITHIN radiosurgery and the financial and political relatioship with have with these disciplines) they will ALWAYS have a medically necessary and relevant place in medicine and its hardly going to diminish substantially due to radiosurgery. There are also still vocal cord surgeries.
While "more work needs to be done in pancreatic cancer" is true, you might as well say that "more work needs to be done in heart disease"; well yes, but in medicine that's just one of countless areas under development. So to in radonc. Why pick out GI cancer? When you get more experinece you'll see that these fields are now, and only etting more multidisciplinary as time goes on. That's the great thing about being in a comprehensive cancer center- we work very intimately that way.
D
deleted4401
I think the head & neck cancers are far more complicated that that ... And, I think that surgery is still standard managment, with chemoRT being a more than reasonable alternative ...
Being at a place where the ENT surgeons are absolutely amazing and after having given a talk on larynx preservation along with one of the head & neck onco-surgeons, I'd have to say that it is definitely not clear cut. In fact, I think there are more than enough questions left unanswered ...
Structurally preserving a larynx through chemo/IMRT is hardly the same as functionally preserving a voice. Also, treating a larynx cancer with surgery hardly precludes having a voice, and modern post-laryngectomy QOL surveys have shown this to be the case. QOL surveys are equivocal on whether it improves a patients' QOL to have undergone chemoRT and 'spared' the larynx vs. having a 'voice preserving' surgery performed by an expert H&N oncologist. This is quite a different different procedure than a TL/neck dissection performed out in the community, and also quite different than the procedure performed >20 years ago, in the era of the VA Larynx study.
I understand epidemiological data is retrospective and merely hypothesis generating, but it is thought provoking that if you look at the SEER data as definitive chemoRT has transitioned to a primary therapy for larynx cancer, mortality has crept up. One can come up with many possible and plausible reasons why this is being seen, but the elephant in the room is obvious ...
And prostate ... again, it's not that easy! If, in fact, all modalities are 'equal' for favorable risk disease, it has more to do with tailoring treatment to a patient's individual needs and desires. I know a few rad-oncs that have had RPPs performed on themselves. I'm not sure what I'd choose for myself. The other thing - unless we start performing the prostate biopsies ourselves, practice patterns will probably plateau. It's up to the urologist to send us the referrals, you know? Another obvious concern is reimbursements. Urologists are skimping on surgery b/c they can make more moolah through technical fees from owning a linac. If the reimbursements come back down, they'll start cutting more.
I think saying that rad-onc has the surgeons 'trembling' is about as accurate as saying that radiation will become obsolete over the next few decades. It's going to have to be multimodality therapy to achieve the best outcomes, at least for the next few decades.
Anyone fill out that ARRO survey? Very interesting questions about the our field turning more like med-onc (a primary service, inpatients, administering biological modulators, etc.) or more like IR (where the patient is a prepped body and you are a hired gun). I kinda like it the way it is ... And I certainly don't want to be responsible for giving Erbitux!
-S
Being at a place where the ENT surgeons are absolutely amazing and after having given a talk on larynx preservation along with one of the head & neck onco-surgeons, I'd have to say that it is definitely not clear cut. In fact, I think there are more than enough questions left unanswered ...
Structurally preserving a larynx through chemo/IMRT is hardly the same as functionally preserving a voice. Also, treating a larynx cancer with surgery hardly precludes having a voice, and modern post-laryngectomy QOL surveys have shown this to be the case. QOL surveys are equivocal on whether it improves a patients' QOL to have undergone chemoRT and 'spared' the larynx vs. having a 'voice preserving' surgery performed by an expert H&N oncologist. This is quite a different different procedure than a TL/neck dissection performed out in the community, and also quite different than the procedure performed >20 years ago, in the era of the VA Larynx study.
I understand epidemiological data is retrospective and merely hypothesis generating, but it is thought provoking that if you look at the SEER data as definitive chemoRT has transitioned to a primary therapy for larynx cancer, mortality has crept up. One can come up with many possible and plausible reasons why this is being seen, but the elephant in the room is obvious ...
And prostate ... again, it's not that easy! If, in fact, all modalities are 'equal' for favorable risk disease, it has more to do with tailoring treatment to a patient's individual needs and desires. I know a few rad-oncs that have had RPPs performed on themselves. I'm not sure what I'd choose for myself. The other thing - unless we start performing the prostate biopsies ourselves, practice patterns will probably plateau. It's up to the urologist to send us the referrals, you know? Another obvious concern is reimbursements. Urologists are skimping on surgery b/c they can make more moolah through technical fees from owning a linac. If the reimbursements come back down, they'll start cutting more.
I think saying that rad-onc has the surgeons 'trembling' is about as accurate as saying that radiation will become obsolete over the next few decades. It's going to have to be multimodality therapy to achieve the best outcomes, at least for the next few decades.
Anyone fill out that ARRO survey? Very interesting questions about the our field turning more like med-onc (a primary service, inpatients, administering biological modulators, etc.) or more like IR (where the patient is a prepped body and you are a hired gun). I kinda like it the way it is ... And I certainly don't want to be responsible for giving Erbitux!
-S
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Anyone want to hazard a guess about the economic outlook?
I'm guessing remuneration will go down significantly; it happened to the orthopods after they enjoyed their heyday in the 80's, and it's going to happen to the radonc's. all it takes is a small number of greedy MDs to abuse the system to invoke serious backlash. PP'ers will then lean on new hires to squeeze out more $ for themselves, and soon we'll all be regarded like plastic surgeons (I can practically see the tv show on TNT already: hot-shot young doctors making big bucks and living crazy lifestyles, set amidst the backdrop of very sick patients. talk about drama...) seriously, how long do you think they'll let us live high on the hog? mark my words, the golden goose's days are numbered...
I'm guessing remuneration will go down significantly; it happened to the orthopods after they enjoyed their heyday in the 80's, and it's going to happen to the radonc's. all it takes is a small number of greedy MDs to abuse the system to invoke serious backlash. PP'ers will then lean on new hires to squeeze out more $ for themselves, and soon we'll all be regarded like plastic surgeons (I can practically see the tv show on TNT already: hot-shot young doctors making big bucks and living crazy lifestyles, set amidst the backdrop of very sick patients. talk about drama...) seriously, how long do you think they'll let us live high on the hog? mark my words, the golden goose's days are numbered...
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1) The economic future of medicine in general has been beaten to death elsewhere, so I'll avoid hijacking this thread and refer you to any of a dozen threads on the subject throughout SDN. Suffice to say, the perception of "greedy MDs" living it up at their patients' expense is something that all of the middle-men in health care economics work very hard to encourage. Not that it doesn't happen, but do you really think MDs are the cause of health costs spiralling out of control? If so, I'd respectfully suggest that you haven't spent the requisite amount of time filling out insurance papers for your patient. Someone got paid to come up with those forms, and someone gets paid to process them...
2) I'm amused by the thought of rad oncs being relegated to "Dr. 90210" status, when the general public and even our colleagues have no idea what we do (I was paged twice last year by surgery/medicine residents requesting stat MRIs. "Oh, you're not the folks that do that? Sorry.") Also, I have yet to meet a patient who came in to get elective radiation. Equating cancer care with the boutique practices you allude to above seems a bit of a stretch.
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First of all even if physicans salaries drop significantly they will still be making enough to support their families and live comfortably. Most people do not go into medicine because of the money but if the money fell too low then the quality of doctors and health care would drop. Although America lets this happen to the educational system I do not think they will stand for this to happen to the health care system.
