LUMINA Discussion

[elementaryschooleconomics]

https://www.astro.org/ASTRO/media/ASTRO/AffiliatePages/SCAROP/PDFs/Letter_to_Student_Affair_Deans_Dec_3_2021.pdf

Not all heroes wear capes.

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[BobbyHeenan]

Not all heroes wear capes.

I feel like she would respond really well to an over the top edge lord meme response to the tune of "everything I disagree with is misinformation." I think it may be productive in some ways.

 

[RickyScott]

So she was working on this lumina study to eliminate breast xrt, but complaining that sdn is turning students off radonc?

 

[communitydoc13]

why the Canadians have anything to do with the US society

It's de-facto an academic society. As such, international is fine by me. Fits the brand.

If Canada needs more doctors, why hasn’t medical school enrolment increased?

www.ncbi.nlm.nih.gov

The letter is hilarious however. Well written, earnest in tone and wrong in almost every way. Canada's provincial governments control both med school numbers and residency numbers. There is nothing like that dynamic here in the US, where we have a somewhat chaotic response to demographic and market forces, and an incentive for academic places to start and grow residencies. I doubt Canada has ever had anything like US radonc residency expansion as experienced from 2005-2014.

Med school interest in the US reflects what a field is selling. The interest level now if fine. It's the only thing that is correct. The interest level when most of us applied was inflated.

When radonc looked strong, the tone on this board was gleeful if a bit exclusive. Nobody needed a cultivated mentor experience or early med school classroom exposure to find out about it.

Word of mouth and word of SDN typically reflect reality on the ground.

I'm pretty sure that the chair of the Group on Student Affairs at AAMC views the chair of SCAROP with the same regard that the chair of SCAROP views a community radiation oncologist.

Not at all.

 

[thecarbonionangle]

ASTRO and CARO are completely different entities. One is American and one is Canadian. Do we have US rad oncs being head of CARO and meddling in issues that affect them? Dont think so. But please prove me wrong. These are very different countries despite common colonial origins.

 

[RadOncDoc21]

Canadians are different:

 

[Mandelin Rain]

Not all heroes wear capes.

They do wear Birkenstocks and business suits to accept self congratulatory plaques though.

EDIT: "Birkenstocks and Business Suits" will be the name of my new reggae inspired, jam country album. Stay away Willie Nelson.

 

[communitydoc13]

ASTRO and CARO are completely different entities. One is American and one is Canadian. Do we have US rad oncs being head of CARO and meddling in issues that affect them? Dont think so. But please prove me wrong. These are very different countries despite common colonial origins.

True. It is a bit weird....she is an international star and probably more esteemed in general oncology research circles than any American radonc.

Maybe there is an asymmetry of personal reputation and prestige of positions? A US doc of Dr. Liu's stature would have no incentive to head CARO.

Dr. Fei-Fei Liu appointed Scientific Director of CIHR Institute of Cancer Research - Canada.ca

Today, Dr. Michael J. Strong, President of the Canadian Institutes of Health Research, announced that Dr. Fei-Fei Liu has been appointed Scientific Director of the CIHR Institute of Cancer Research for a term of four years, effective September 1, 2022.

www.canada.ca

Also, roughly 250 connections on LinkedIn!

I do wonder how someone like Dr. Liu functions. Multiple international leadership positions, runs a lab, gives TED talks.

Is she seeing patients 3 days a week? Who sees her follow-ups? Is she doing high level, first principle scientific thinking? Is she baller at patient care? Many of us have had esteemed physician scientist chairs.....remember how they functioned?

The point is, the people in leadership are not like me (and presumably much of the board) at all. Not just me, but the overwhelming majority of academics that I know, who are mostly paid to see patients.

The message I got when I was in residency was that there were physician scientists and then everyone else. In a normal field of a normal scale, physician scientists are a tiny portion of the field and the rank and file clinician is much better represented in national organizations.

In radonc, the scale factor hosed us. We are stuck with leaders and in fact organizations that think of us as little people.

 

[elementaryschooleconomics]

THIS is why I can never leave SDN.

These are such niche jokes. I love them.

 

[elementaryschooleconomics]

I do wonder how someone like Dr. Liu functions. Multiple international leadership positions, runs a lab, gives TED talks.

Is she seeing patients 3 days a week? Who sees her follow-ups? Is she doing high level, first principle scientific thinking? Is she baller at patient care? Many of us have had esteemed physician scientist chairs.....remember how they functioned?

This is literally what killed my dreams of staying on the classic MD-PhD academic track.

Once I saw the juxtaposition between the level of respect and admiration these people get, how patients try to seek them out - and what actually happens on the other side, how they actually function in the clinic (or...don't function)...

I was no longer interested.

 

[TheWallnerus]

True. It is a bit weird....she is an international star and probably more esteemed in general oncology research circles than any American radonc.

Maybe there is an asymmetry of personal reputation and prestige of positions? A US doc of Dr. Liu's stature would have no insentive to head CARO.

Dr. Fei-Fei Liu appointed Scientific Director of CIHR Institute of Cancer Research - Canada.ca

Today, Dr. Michael J. Strong, President of the Canadian Institutes of Health Research, announced that Dr. Fei-Fei Liu has been appointed Scientific Director of the CIHR Institute of Cancer Research for a term of four years, effective September 1, 2022.

www.canada.ca

Also, roughly 250 connections on LinkedIn!

I do wonder how someone like Dr. Liu functions. Multiple international leadership positions, runs a lab, gives TED talks.

Is she seeing patients 3 days a week? Who sees her follow-ups? Is she doing high level, first principle scientific thinking? Is she baller at patient care? Many of us have had esteemed physician scientist chairs.....remember how they functioned?

The point is, the people in leadership are not like me (and presumably much of the board) at all. Not just me, but the overwhelming majority of academics that I know, who are mostly paid to see patients.

The message I got when I was in residency was that there were physician scientists and then everyone else. In a normal field of a normal scale, physician scientists are a tiny portion of the field and the rank and file clinician is much better represented in national organizations.

In radonc, the scale factor hosed us. We are stuck with leaders and in fact organizations that think of us as little people.

Your post made me ask myself a seemingly absurd question: why become a radiation oncologist? Is it to take care of patients? Or to be a radiation oncologist?

 

[Fpg1245]

Your post made me ask myself a seemingly absurd question: why become a radiation oncologist? Is it to take care of patients? Or to be a radiation oncologist?

The kind of questions no other specialty has to ask themselves.

 

[Fpg1245]

Not all heroes wear capes.

So this person is upset because they are failing at lying? So the AAMC is gonna do what? Denounce SDN. Forbid med students from looking at it? Do it! I want you to do it!

 

[RadRadRad]

Meanwhile
I’ve got 70+ yr olds with T1bN0 luminal a miserable on hormone blockade being told to suck it up. Have to do 5 years. Not given option of stopping after 2-3 years of intense side effects

 

[Palex80]

Want another one?

 

[RadOncDoc21]

Want another one?

View attachment 375860

Grandma also made a lot more money!

 

[TheWallnerus]

Want another one?

View attachment 375860

You’re taking axillary RT not doing anything in N1/SLN+ early stage breast cancer really well

If I knew your address I’d send you a care basket

 

[OTN]

Not all heroes wear capes.

Canadians and restriction of free speech, a match made in heaven.

Fascinating to see how she thinks she should have a say/impact in the US residency process. How, exactly, does a Canadian radonc get to think they should have any input on the process whatsoever? Where does that power come from? How arrogant does one have to be to think they should be able to weigh in on another country's process for creating specialist physicians?

 

[RickyScott]

Canadians and restriction of free speech, a match made in heaven.

Fascinating to see how she thinks she should have a say/impact in the US residency process. How, exactly, does a Canadian radonc get to think they should have any input on the process whatsoever? Where does that power come from? How arrogant does one have to be to think they should be able to weigh in on another country's process for creating specialist physicians?

Do the Canadians still serve 2 yrs of fellowship? Never met one who doesn’t have a fellowship. FeI feis department has 10+ fellows a yr. She has the largest fellowship program in the world! They could be training dual medonc radon with all that time. Mentor and a gem.

 

[temujim]

Do the Canadians still serve 2 yrs of fellowship? Never met one who doesn’t have a fellowship. FeI feis department has 10+ fellows a yr. She has the largest fellowship program in the world! They could be training dual medonc radon with all that time. Mentor and a gem.

That department also had a pipeline of foreign fellows they would keep on 1-2 years; the fellows sticking around hoping they could get a residency spot in Canada (not likely) or the US (now very likely).

 

[deleted1111261]

because of the shortage they don’t require at many of the sites. Maybe BC and PMH still do?

 

[RickyScott]

because of the shortage they don’t require at many of the sites. Maybe BC and PMH still do?

Do they have a maldistibution issue in places like Saskatchewan.

 

[thecarbonionangle]

Puts on my MROGA sdn hat: we need an “america first” approach to rad onc. No more canadians meddling in our business. They do not let us practice there for the most part and favor their own. We need to do the same. Why should they be able to come here and get a job and take residency spots. Close down most of the alternative pathway. Make US rad onc great again!

 

[Fpg1245]

Do the Canadians still serve 2 yrs of fellowship? Never met one who doesn’t have a fellowship. FeI feis department has 10+ fellows a yr. She has the largest fellowship program in the world! They could be training dual medonc radon with all that time. Mentor and a gem.

Just the sheer waste of time esp for Canadian grads is criminal.

 

[theradiator]

Took the time to read LUMINA today and wish I didn't. This is an uninteresting flaming piece of trash. I read the article and got dumber.

From the abstract: "Clinicopathologic factors alone are of limited use in the identification of women at low risk for local recurrence in whom radiotherapy can be omitted". The authors then go on to use clinicopathologic factors in this study.

The ki67 cutpoint of 13.25% reeks of dichotomania.

If the same exact study was entitled excellent outcomes while eliminating Oncotype Dx by using ki-67 this article would not be published in NEJM. I conclude that Tim Whelan can take a picture of a dumpster fire and publish this in NEJM Images in Clinical Medicine. Must be nice.

5 year data for breast cancer patients receiving 5 years of endocrine therapy is preliminary rather than conclusive. I thought NEJM is supposed to publish practice changing rather than hypothesis generating research. Should have been desk rejected due to low priority, poor quality.

Local recurrence rates in UK and Canada tend to be low compared to US studies because mammographers have less litigation risk and less likely to find DCIS that would count as local failures. In US practice, supplemental follow-up ultrasound and MRI are commonly performed and drive up particularly in situ recurrence rates.

Preliminary data validated on luminal A age >60 and no logical rationale for including ages 55 to 60 except a laser-focused urge to expand the universe of omission candidates.

No mention of partial breast irradiation or endocrine therapy side effects in introduction or discussion. Only that 3 to 6 weeks of RT is "inconvenient, costly and associated with both short and long-term side effects".

Unusually high endocrine therapy adherence suggests that the study population is not representative of the overall population in some way. Almost certainly healthier and more willing to accept medication toxicity.

No mention of other diagnostic or therapeutic interventions to omit in this exceedingly favorable cohort of mostly low grade breast cancers.

So McMaster University, which has been hectoring the medical community on the virtues of evidence based medicine for decades now concludes that randomized trials and Oncotype are unnecessary only if they support a favored agenda to save money for the Canadian government.

 

[taserlaser]

Took the time to read LUMINA today and wish I didn't. This is an uninteresting flaming piece of trash. I read the article and got dumber.

From the abstract: "Clinicopathologic factors alone are of limited use in the identification of women at low risk for local recurrence in whom radiotherapy can be omitted". The authors then go on to use clinicopathologic factors in this study.

The ki67 cutpoint of 13.25% reeks of dichotomania.

If the same exact study was entitled excellent outcomes while eliminating Oncotype Dx by using ki-67 this article would not be published in NEJM. I conclude that Tim Whelan can take a picture of a dumpster fire and publish this in NEJM Images in Clinical Medicine. Must be nice.

5 year data for breast cancer patients receiving 5 years of endocrine therapy is preliminary rather than conclusive. I thought NEJM is supposed to publish practice changing rather than hypothesis generating research. Should have been desk rejected due to low priority, poor quality.

Local recurrence rates in UK and Canada tend to be low compared to US studies because mammographers have less litigation risk and less likely to find DCIS that would count as local failures. In US practice, supplemental follow-up ultrasound and MRI are commonly performed and drive up particularly in situ recurrence rates.

Preliminary data validated on luminal A age >60 and no logical rationale for including ages 55 to 60 except a laser-focused urge to expand the universe of omission candidates.

No mention of partial breast irradiation or endocrine therapy side effects in introduction or discussion. Only that 3 to 6 weeks of RT is "inconvenient, costly and associated with both short and long-term side effects".

Unusually high endocrine therapy adherence suggests that the study population is not representative of the overall population in some way. Almost certainly healthier and more willing to accept medication toxicity.

No mention of other diagnostic or therapeutic interventions to omit in this exceedingly favorable cohort of mostly low grade breast cancers.

So McMaster University, which has been hectoring the medical community on the virtues of evidence based medicine for decades now concludes that randomized trials and Oncotype are unnecessary only if they support a favored agenda to save money for the Canadian government.

You are right about the healthy population here and high medication compliance. I remember quite well when I was a resident and this trial was accruing. It competed directly against accruing for our local APBI trial which had near similar eligibility criteria. Not only that, the Ki-67 was by central review not at our centre, which was a pain in the ass. It was only the exceptionally rare patient that wished to pursue enrollment.

APBI here as an alternative is such a no brainer than 5 years of ET, when it comes to toxicity for the average patient.

 

[Palex80]

Took the time to read LUMINA today and wish I didn't. This is an uninteresting flaming piece of trash. I read the article and got dumber.

From the abstract: "Clinicopathologic factors alone are of limited use in the identification of women at low risk for local recurrence in whom radiotherapy can be omitted". The authors then go on to use clinicopathologic factors in this study.

The ki67 cutpoint of 13.25% reeks of dichotomania.

If the same exact study was entitled excellent outcomes while eliminating Oncotype Dx by using ki-67 this article would not be published in NEJM. I conclude that Tim Whelan can take a picture of a dumpster fire and publish this in NEJM Images in Clinical Medicine. Must be nice.

5 year data for breast cancer patients receiving 5 years of endocrine therapy is preliminary rather than conclusive. I thought NEJM is supposed to publish practice changing rather than hypothesis generating research. Should have been desk rejected due to low priority, poor quality.

Local recurrence rates in UK and Canada tend to be low compared to US studies because mammographers have less litigation risk and less likely to find DCIS that would count as local failures. In US practice, supplemental follow-up ultrasound and MRI are commonly performed and drive up particularly in situ recurrence rates.

Preliminary data validated on luminal A age >60 and no logical rationale for including ages 55 to 60 except a laser-focused urge to expand the universe of omission candidates.

No mention of partial breast irradiation or endocrine therapy side effects in introduction or discussion. Only that 3 to 6 weeks of RT is "inconvenient, costly and associated with both short and long-term side effects".

Unusually high endocrine therapy adherence suggests that the study population is not representative of the overall population in some way. Almost certainly healthier and more willing to accept medication toxicity.

No mention of other diagnostic or therapeutic interventions to omit in this exceedingly favorable cohort of mostly low grade breast cancers.

So McMaster University, which has been hectoring the medical community on the virtues of evidence based medicine for decades now concludes that randomized trials and Oncotype are unnecessary only if they support a favored agenda to save money for the Canadian government.

Someone should post this on Twitter. @RealSimulD ???

 

[deleted1111261]

DONE!

And I emailed Dr. Whelan with a nicer version of these questions.

 

[SneakyBooger]

Have we kicked the Canadians out of ASTRO yet?

 

[yesmaster]

Drake makes up for Justin Bieber.

Lululemon makes up for Crocs.

David Palma makes up for Fei Fei Liu.

 

[communitydoc13]

Drake makes up for Justin Bieber.

Hmmm. Don't know here. Might be compounding the problem. I'll give you Oscar Peterson, Neil Young and Leonard Cohen.

But, Canada Sh%t the bed regarding music with Nickelback.

Obviously, you're right on the other two.

 

[OTN]

Hmmm. Don't know here. Might be compounding the problem. I'll give you Oscar Peterson, Neil Young and Leonard Cohen.

But, Canada Sh%t the bed regarding music with Nickelback.

Obviously, you're right on the other two.

I'm not a Drake fan (he was absolute trash live), but I will give them Arcade Fire, Rush, Death from Above 1979, The New Pornographers, Tegan and Sara, and the Broken Social Scene.

Barenaked Ladies, Bryan Adams, and Crash Test Dummies as well, but they really didn't make it too far out of the 90s.

 

[deleted1111261]

Music is one thing.

Comedy is where my people (Canadian) overrepresent.

 

[RickyScott]

I'm not a Drake fan (he was absolute trash live), but I will give them Arcade Fire, Rush, Death from Above 1979, The New Pornographers, Tegan and Sara, and the Broken Social Scene.

Barenaked Ladies, Bryan Adams, and Crash Test Dummies as well, but they really didn't make it too far out of the 90s.

isnt it ironic?

 

[BobbyHeenan]

I'm not a Drake fan (he was absolute trash live), but I will give them Arcade Fire, Rush, Death from Above 1979, The New Pornographers, Tegan and Sara, and the Broken Social Scene.

Barenaked Ladies, Bryan Adams, and Crash Test Dummies as well, but they really didn't make it too far out of the 90s.

Great list.

Leonard Cohen as well.

The comedy thing I agree with. They punch above weight there.