Med oncs are the lynchpins of oncology and radiation and surgery is just one of their tools to fight disease

[BruiservonWillebrand]

Andy Minn's Cell paper has "immune checkpoint blockade" in the title. I am not sure this is the best example of radiation oncology focused research or of someone not caught up in the immunotherapy hype. If they do discover the next big systemic therapy, or even just an adjuvant for immunotherapy, I am sure a med onc would happily prescribe it.

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[Krukenberg]

Andy Minn's Cell paper has "immune checkpoint blockade" in the title. I am not sure this is the best example of radiation oncology focused research or of someone not caught up in the immunotherapy hype. If they do discover the next big systemic therapy, or even just an adjuvant for immunotherapy, I am sure a med onc would happily prescribe it.

And his Nature paper?

 

[solitarius]

Wow, really sorry to see all this happening to your field.

Academia doesn't respect RadOnc: No new research, new breakthroughs, new value created for the medical ecosystem, no difficult surgeon lifestyle, or managing dying patients on the wards. People working into their 80s without breaking a sweat? Where in medicine does that happen?

RadOnc had a sweet gig, attracted all the rent-seekers, and all the rent has been extracted. I can think of quite a few MD classmates who went into RadOnc because they thought it was Cush, easy $.

Derm is probably next.

To be fair, most basic research in oncology is not conducted by medical oncologists. It is conducted by basic scientists who have an interest in cancer, and this research happens to benefit the field of medical oncology significantly more than radiation oncology or surgery due to the nature of our treatments. We certainly need to dedicate a significantly larger effort to study how radiation functions with targeted agents (and a thousand other cellular nuances). But medical oncology as a field is really not driving basic cancer research- they just reap the benefit of having the ability to prescribe these drugs. Who says we can't prescribe more of these agents if we show indications for use with radiation (like ADT)? As a field, we should fight for this.

In regard to the funding comment, I have had 4 radiation-specific grants funded by non-radiation societies/federal government (0 rejected) and 2 of 2 rejected by radiation-specific societies this year. It would be nice if our leadership could fund our own research better.

True, most medOncs don't do research. True, basic scientists do cancer research. But academic MD/PhDs are doing a lot of pharma-funded translational / basic science research.

Isn't the elephant in the room here the referral pattern? If rad oncs received all the referrals first then we would be the folks on top - am I wrong? It's SO FRUSTRATING that we are 2-3 steps removed from the patient. Most our patients run through med onc, urology, ENT, pulm, neurosurgery, gyn onc, etc. before they see us. If we were the hub ie direct referral line from family medicine, outpt IM, OB/GYN, etc. then we would be the major players. As it is, everything runs through med onc. Isn't ridiculous that it goes family medicine --> pulm --> med onc --> cardiothoracic surgery --> rad onc for someone who ends up getting SBRT?!?!

Our national leaders in academics who are genuinely incredibly gifted and smart should not stand for this and try to change this referral pattern. They should go to AAFP to broker a deal to directly refer to rad onc.

Naive to assume primary care wants to know when to send someone to RadOnc. They want to dump that entire problem list to someone else. MedOnc is the cancer PCP. Despite your longest onc training, are you wiling to play that role?

Your best bet is to be more active at Tumor Boards.

Reading through some of these threads is so disheartening, not because of residency expansion, but because it seems that most of the people who show up in threads complaining about job market/residency expansion then go on to bash radiation oncology as a field and suggest that what we do could be done by anybody. (I don't want to go reference it, but suggestions for radiology, etc.) This is madness! (NB: We should reduce residency spots back to 120 per year, but not the point of this post.)

Guys, we get more oncology training than ANY other oncology professional. Even if you do 12 months of research, your 36 months of clinical oncology training is more than Med Onc, Surg Onc, IR, etc. etc. We do AMAZING things. We literally cure Stage I lung cancer with the only side effect being some slight fatigue. We are an essential component of curative and palliative treatment in over half of all oncology patients. Stand up for yourselves, and fight for our field. Cardiologists don't beat them selves up and go online and talk about how the CT surgeons are the lynchpins of cardiac care, etc. We are freakin' oncologists AND physicians, act like it.

Rant over.

Advocate for yourself at Tumor Board!

Cardiology has completely outplayed CT surgery. If anyone is crying, it's the surgeons!

 

[RTx]

If you read earlier in this thread, it’s well laid out. RT is and always has been very effective at tumor kill, there is always more dose to give- normal tissue is always the limiting factor. Thus all the breakthroughs have been modernizing treatment delivery- unfortunately not something that other doctors have any clue about and many don’t care to know and would rather go on believing radiation is radiation despite technique, dose or intent. Had a medonc once tell me we couldn’t treat a single non-regional metastatic node in a patient because we wouldn’t be able to fit it in a “box” with the primary disease.

There are plenty of PCPs who would rather avoid multiple consults for their patients satisfaction. Ask ENT and urology they see tons of PCP referrals. The idea that medonc are the gatekeepers is also not good for patients when clinics are so backed up- esp for straight forward things where chemo has no role.

As far as value to the health care ecosystem??! That’s because RT is cost/efficient meanwhile new targeted agents and immunotherapy are extremely costly. Sure it generates revenue but is it really good for the overall societal burden of healthcare cost?

 

[radoncgrad2019]

Wow, really sorry to see all this happening to your field.

Academia doesn't respect RadOnc: No new research, new breakthroughs, new value created for the medical ecosystem, no difficult surgeon lifestyle, or managing dying patients on the wards.

The sad thing is you have no idea how wrong you are and no possible way of fixing that.

Sad!

 

[medgator]

Wow, really sorry to see all this happening to your field.

Academia doesn't respect RadOnc: No new research, new breakthroughs, new value created for the medical ecosystem, no difficult surgeon lifestyle, or managing dying patients on the wards. People working into their 80s without breaking a sweat? Where in medicine does that happen?

RadOnc had a sweet gig, attracted all the rent-seekers, and all the rent has been extracted. I can think of quite a few MD classmates who went into RadOnc because they thought it was Cush, easy $.

Derm is probably next.

Naive to assume primary care wants to know when to send someone to RadOnc. They want to dump that entire problem list to someone else. MedOnc is the cancer PCP. Despite your longest onc training, are you wiling to play that role?

nope. Rad Onc has the most oncology training out of any post graduate specialty, period

Your best bet is to be more active at Tumor Boards.

Advocate for yourself at Tumor Board!

Cardiology has completely outplayed CT surgery. If anyone is crying, it's the surgeons!

Yup

 

[Lamount]

It doesn't matter if your colleagues respect the "field of radiation oncology", it matters if they respect YOU... and if they don't, YOU are the only one who can do something about it.

 

[radoncgrad2019]

It doesn't matter if your colleagues respect the "field of radiation oncology", it matters if they respect YOU... and if they don't, YOU are the only one who can do something about it.

So true

 

[FrostyHammer]

If you read earlier in this thread, it’s well laid out. RT is and always has been very effective at tumor kill, there is always more dose to give- normal tissue is always the limiting factor. Thus all the breakthroughs have been modernizing treatment delivery- unfortunately not something that other doctors have any clue about and many don’t care to know and would rather go on believing radiation is radiation despite technique, dose or intent. Had a medonc once tell me we couldn’t treat a single non-regional metastatic node in a patient because we wouldn’t be able to fit it in a “box” with the primary disease.

There are plenty of PCPs who would rather avoid multiple consults for their patients satisfaction. Ask ENT and urology they see tons of PCP referrals. The idea that medonc are the gatekeepers is also not good for patients when clinics are so backed up- esp for straight forward things where chemo has no role.

As far as value to the health care ecosystem??! That’s because RT is cost/efficient meanwhile new targeted agents and immunotherapy are extremely costly. Sure it generates revenue but is it really good for the overall societal burden of healthcare cost?

Immunotherapy will bankrupt the nation many times over. The day insurance companies start tightly regulating it can't come soon enough...

 

[RTx]

Trump Administration Makes CAR T-Cell Cancer Therapy Available to Medicare Beneficiaries Nationwide | CMS

Decision ensures consistency in access to the innovative new cancer therapy, and CMS is working closely with sister agencies to monitor outcomes for patients receiving the therapy

www.cms.gov

Medicare Part B reimbursements for CAR T-cell therapies are at $400,000 for Yescarta and $500,000 for Kymriah. These are “per procedure” costs...