Never knew the med onc hatred for us was this bad

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OTN said:
You'll be seeing that patient at some point, no doubt
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Yeah, dude is just straight up lying to the patient so he can be the one to give (lots and lots) of systemics.

Tale as old as time.
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OTN said:
You'll be seeing that patient at some point, no doubt
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This is likely, indeed.

But let's be honest: The WORST treatment we perform in terms of side effects is H&N radiochemotherapy, so this is likely the lowest hanging fruit.
 
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Palex80 said:
This is likely, indeed.

But let's be honest: The WORST treatment we perform in terms of side effects is H&N radiochemotherapy, so this is likely the lowest hanging fruit.
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Everything they've tried in H+N hasn't worked: induction chemo, concurrent chemoradiation + immunotherapy, dose de-escalation. None of those have done anything to improve upon the current standard of care.

This patient who is being mismanaged to the point of malpractice should be presented at a H+N tumor board. There is no justification - ZERO - to do "induction immunotherapy" for what may be a curable malignancy. Shameful.
 
OTN said:
Everything they've tried in H+N hasn't worked: induction chemo, concurrent chemoradiation + immunotherapy, dose de-escalation. None of those have done anything to improve upon the current standard of care.

This patient who is being mismanaged to the point of malpractice should be presented at a H+N tumor board. There is no justification - ZERO - to do "induction immunotherapy" for what may be a curable malignancy. Shameful.
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Well, he was presented in the tumor board. And didn't like the taste (pun intended!) of the recommendation, which was chemorads, obviously.
A patient will always find an oncologist that is willing to do something outside of the guideline or a tumor board's proposal.

Induction chemotherapy does not offer long term remission. There are however some patients out there (it's a minority) that can be probably cured from locally advanced H&N cancer with immunochemotherapy, followed by maintenance immunotherapy without any local treatment. The very same principle likely applies to locally advanced NSCLC and melanoma.

Do I endorse it? No.
Do I like it? No.
Do I have to live with it? Yes.
 
I love my Med Oncs and they love me. Despite shrinking indications for XRT, I still find that I'm able to have nuanced and meaningful discussions with them. Also, we have regular morning conferences and occasionally the Rad Oncs present didactics on new and expanding indications like SBRT of oligomets.

Outside Med Oncs are a different beast, but that has much to do with the intense regional competition as well as their individual views.
 
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Gfunk6 said:
I love my Med Oncs and they love me. Despite shrinking indications for XRT, I still find that I'm able to have nuanced and meaningful discussions with them. Also, we have regular morning conferences and occasionally the Rad Oncs present didactics on new and expanding indications like SBRT of oligomets.

Outside Med Oncs are a different beast, but that has much to do with the intense regional competition as well as their individual views.
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Must med oncs are not interested in nuance. They have 20-30 patients to see plus the hospital. Idk where you work but where I am they are being pulled in so many directions if you can’t make your point in under 5 seconds it won’t be heard.
 
Fpg1245 said:
Must med oncs are not interested in nuance. They have 20-30 patients to see plus the hospital.
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Radoncs should run the tumor boards. We are all pretty smart. We have a little more time to read than they do. It will make you more valuable and visible to admin or your physician co-owners.
 
Palex80 said:
Well, he was presented in the tumor board. And didn't like the taste (pun intended!) of the recommendation, which was chemorads, obviously.
A patient will always find an oncologist that is willing to do something outside of the guideline or a tumor board's proposal.

Induction chemotherapy does not offer long term remission. There are however some patients out there (it's a minority) that can be probably cured from locally advanced H&N cancer with immunochemotherapy, followed by maintenance immunotherapy without any local treatment. The very same principle likely applies to locally advanced NSCLC and melanoma.

Do I endorse it? No.
Do I like it? No.
Do I have to live with it? Yes.
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From some old French data multiagent chemo alone can provide long term LC in ~13%. The efficacy of IO in HN probably isn't going to move the needle that much. Won't stop them from trying for sure.

But med oncs aint got a patch on those TORS surgeons. Out there doing unnecessary QoL altering operations (these hands!). If TORS was a drug, pharma would have pulled the plug years ago.
 
I'm sorry that this has been your experience with med oncs. It's certainly not the attitude in our institution, in which tumor boards involve academic and PP docs from all oncologic subspecialties and give RO as much of a seat at the table as MO and SO. Regardless, you can probably expect more collegiality from the newer crops, as by now, docs from all specialties recognize that that it's universally the MDs who get hosed and the bean-counting admins who get paid. Their parasitism aside, there's unfortunately more than enough cancer to go around.
 
Ubba said:
I'm sorry that this has been your experience with med oncs. It's certainly not the attitude in our institution, in which tumor boards involve academic and PP docs from all oncologic subspecialties and give RO as much of a seat at the table as MO and SO. Regardless, you can probably expect more collegiality from the newer crops, as by now, docs from all specialties recognize that that it's universally the MDs who get hosed and the bean-counting admins who get paid. Their parasitism aside, there's unfortunately more than enough cancer to go around.
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I assume you’re med onc. These are nice words, thank you. Re: more than enough cancer to go around, rad oncs face falling RT utilization in cancer year after year. “Med onc utilization” is booming. Please keep us in your thoughts, in your prayers, and at the table.
 
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