intellectual challenges when seeing new patients

[medgrays]

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would those working in the field please comment on the following: how much of an intellectual/interesting/dynamic challenge is it when seeing new patients and how long do you spend typically planning for a patient's treatment?

I am really excited about perhaps becoming a part of this field (I have a good overview/grasp of it; just looking to fill in some missing gaps). I just heard what I think was probably a negative stereotype: namely that dosimetrists could probably take care of most patients needing treatment; i.e. most RadOnc's work can be aptly summarized by carrying out rarely changing protocols for treating different types of cancer (and by carrying out, I mean having "someone else do it", heh).

Also, how trained are RadOncs at reading/analyzing imaging? Are they almost as good at the different modalities as radiologists?

When treating patients, how often do you develop long term relationships - keeping in touch with the patients even when they go back to the referring doc?

Finally, could you name some neoplastic conditions for which radiation therapy is the primary solution towards remission/cure (with chemotherapy perhaps only supplementing what is primarily cured/treated by radiation)? Is Hodkin's Lymphoma still treated primarily by radiation therapy (if I read correctly)?

 

[Gfunk6]

would those working in the field please comment on the following: how much of an intellectual/interesting/dynamic challenge is it when seeing new patients and how long do you spend typically planning for a patient's treatment?

Prep time varies from a few minutes to an hour or more depending on the patient and complexity of the case. Treatment planning is but one aspect of the new patient consult. First you have to determine if the patient is suitable candidate for radiation. There is a laundry list of relative/absolute contraindications and it also depends on your own comfort level. You also have to closely coordinate w/ your medical and surgical oncology colleagues to provide optimal care. Also, patients in the information age often come with papers, newspaper clippings, and various propaganda and will ask you detailed questions about treatment, side-effects, and alternatives. It will take time to answer their questions adequately. Sometimes when patients come in with rare/weird cancers, PubMed is the first place we look.

I just heard what I think was probably a negative stereotype: namely that dosimetrists could probably take care of most patients needing treatment; i.e. most RadOnc's work can be aptly summarized by carrying out rarely changing protocols for treating different types of cancer (and by carrying out, I mean having "someone else do it", heh).

This is a gross over-simplification of the Radiation Oncologist's role in a patient's care. However, a lot of it has to do with your current lack of exposure to the field so don't sweat it. Protocols for various treatment sites are constantly evolving and frequently vary across institutions. There are also new trials that are always underway to enroll patients. Also you planning is simply one aspect of our job. We have to monitor patients weekly (or more often) for side effects which can be very severe for certain treatment sites like head & neck. We also have to verify treatment set up multiple times during treatment via portal images. All the fancy planning in the world is worthless if the patient is not being positioned properly. Finally, the dosimetrist knows the patient's anatomy and standard tissue dose tolerances. However you know the patient and, as such, are the final authority on approving of the treatment plan and (at times) modifying mid-treatment as needed.

Also, how trained are RadOncs at reading/analyzing imaging? Are they almost as good at the different modalities as radiologists?

All RadOncs I (as a resident in an academic setting) know absolutely look at all patient radiographs personally. However, they frequently work in collaboration with speciality site Diagnostic Radiologists. Unless something is an absolutely bread and butter case (e.g. localized prostate CA) it is silly to trust your own judgement over a radiologist who has been training to read radiographs for 6-7 years. Still, experienced RadOncs are very good at reading oncologic related imaging.

When treating patients, how often do you develop long term relationships - keeping in touch with the patients even when they go back to the referring doc?

Sometimes it depends on your people skills! If they are good, patients will want to f/u with you long term. Many posters could cite attendings who have had relationships with patients for years and years after treatment long after they stopped seeing their other cancer doctors.

Finally, could you name some neoplastic conditions for which radiation therapy is the primary solution towards remission/cure (with chemotherapy perhaps only supplementing what is primarily cured/treated by radiation)? Is Hodkin's Lymphoma still treated primarily by radiation therapy (if I read correctly)?

There are a lot including Lymphoma. A lot of it depends on the stage of the tumor. Earlier stages are generally more amenable to surgery; metastatic disease generally more amenable to palliative chemo. Between those, XRT usually plays a major role. Some examples in the "mid stages" are: head/neck cancers, cervical/endometrial cancer, prostate cancer. Also cancer can be used for non-neoplastic problems like treatment refractory trigeminal neuralgia, heterotopic ossification, keloids, etc.

 

[medgrays]

Thanks so much gfunk for your very helpful comments!

I am considering taking some time off and doing some research. I was looking for some guidance on that issue (http://forums.studentdoctor.net/showthread.php?t=499749). Any tips/pointers? Thanks!