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OncCOVID calculator here to save day, save lives, do heady calcs

scarbrtj

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Could actually be helpful and all kidding aside actually save somebody's day.

App Calculates Risk of Delayed Cancer Treatment During COVID-19

The OncCOVID model estimates an individual's integrated risk of mortality (survival) from immediate (routine care) versus delayed cancer treatment. Delays in cancer treatment variably impact cancer-specific survival, while delays in cancer treatment reduce immediate exposure to the healthcare system and cancer therapies which variably impacts COVID-19-specific survival. This model is intended to estimate outcomes in individuals not yet infected by COVID-19. This model should not be used to estimate survival outcomes in individuals previously infected or recovered, or actively infected with COVID-19.

Developed by:
Holly Hartman, MS
Matthew Schipper, PhD
Daniel Spratt, MD
 
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Dan Spratt

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Hi everyone! I have not been on these forums for 15 years, but I came across this thread when googling the OncCOVID app to find an article. It has changed a lot!

I appreciate the kind words about the app. Credit really goes to my whole team (especially Holly Hartman who is a brilliant PhD biostats student who works on my team), and we hope to continue to improve the model with more and more data. I think everyone wishes we had better and more robust Covid data in cancer patients (many ongoing national and international registries will help). I hope to get paper out showing the power of the app to answer bigger questions, but we wanted to make it public for people to use and provide feedback so we can make version 2, 3, 4, etc. Hopefully it will help patients/providers. This is about the 20th iteration of it thanks to many people's feedback, but still more we want to refine with stochastic SIR modeling and better R(t) estimates.

I am not sure which twitter post you are referring to FrostyHammer, but Cliff is awesome. Very smart guy. I am sure he can school me on many things and welcome his feedback and criticism. As those who know me, I put myself out there as transparently as I can but also am happy to take a beating. This is why I collaborate with 40+ centers, as teamwork is key and they teach me so much. Collaboration, humility, and mentorship I find are some of the best keys to success. I 100% understand ppl can view my opinions as strong, and when they dont know me they view it as arrogance. Totally makes sense. However, my job is to make a difference for patients, and I advocate strongly for them largely through my clinic and research and whatever voice I have. As often our leaders at times are silent on issues that I believe may really be negatively impacting patients, so I push on what I believe based on the way I interpret the evidence (which dynamically can change overtime with new data). As Nancy Lee told me as a resident (someone who ppl think from a far may be arrogant, but is actually very humble and inquisitive) is you must stay "empty". If you are "full" you will have no room to grow. We continue to do what I hope is great work is because we take the criticism and grow and adapt.

Although I am sure you all know, try not to over interpret twitter...it is something many of us use to create entertaining debates for people to see both sides of the coin (my name after all is DrSpratticus on twitter!). One of the recurring positive things I have heard >1000 times from people around the world about the twitter debates is how they learn new points about a topic (I personally learn a lot from them too). Some debates are highly political that touch on financial issues (protons, HIFU, combo-brachy, etc). These types of topics there is a lot behind the scenes that occurs, sometimes all the way up in national leadership of our organizations. You can imagine that when you are talking about topics that have billions $$ backing them, or people's research focus and grant support, or pharma's backing, or peoples long held beliefs, it can push some buttons.

Anyways, happy to answer any questions about the app.

Back to virtual clinic world. Hope everyone is safe and thanks for promoting and representing our field on this platform. Really awesome to see.

Best,
Dan
 
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RadOncMegatron

Blasting Away Cancer!
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Hi everyone! I have not been on these forums for 15 years, but I came across this thread when googling the OncCOVID app to find an article. It has changed a lot!

I appreciate the kind words about the app. Credit really goes to my whole team (especially Holly Hartman who is a brilliant PhD biostats student who works on my team), and we hope to continue to improve the model with more and more data. I think everyone wishes we had better and more robust Covid data in cancer patients (many ongoing national and international registries will help). I hope to get paper out showing the power of the app to answer bigger questions, but we wanted to make it public for people to use and provide feedback so we can make version 2, 3, 4, etc. Hopefully it will help patients/providers. This is about the 20th iteration of it thanks to many people's feedback, but still more we want to refine with stochastic SIR modeling and better R(t) estimates.

I am not sure which twitter post you are referring to FrostyHammer, but Cliff is awesome. Very smart guy. I am sure he can school me on many things and welcome his feedback and criticism. As those who know me, I put myself out there as transparently as I can but also am happy to take a beating. This is why I collaborate with 40+ centers, as teamwork is key and they teach me so much. Collaboration, humility, and mentorship I find are some of the best keys to success. I 100% understand ppl can view my opinions as strong, and when they dont know me they view it as arrogance. Totally makes sense. However, my job is to make a difference for patients, and I advocate strongly for them largely through my clinic and research and whatever voice I have. As often our leaders at times are silent on issues that I believe may really be negatively impacting patients, so I push on what I believe based on the way I interpret the evidence (which dynamically can change overtime with new data). As Nancy Lee told me as a resident (someone who ppl think from a far may be arrogant, but is actually very humble and inquisitive) is you must stay "empty". If you are "full" you will have no room to grow. We continue to do what I hope is great work is because we take the criticism and grow and adapt.

Although I am sure you all know, try not to over interpret twitter...it is something many of us use to create entertaining debates for people to see both sides of the coin (my name after all is DrSpratticus on twitter!). One of the recurring positive things I have heard >1000 times from people around the world about the twitter debates is how they learn new points about a topic (I personally learn a lot from them too). Some debates are highly political that touch on financial issues (protons, HIFU, combo-brachy, etc). These types of topics there is a lot behind the scenes that occurs, sometimes all the way up in national leadership of our organizations. You can imagine that when you are talking about topics that have billions $$ backing them, or people's research focus and grant support, or pharma's backing, or peoples long held beliefs, it can push some buttons.

Anyways, happy to answer any questions about the app.

Back to virtual clinic world. Hope everyone is safe and thanks for promoting and representing our field on this platform. Really awesome to see.

Best,
Dan

Nice to see @Dan Spratt on SDN! Does this man ever sleep? I have some quibbles about the app, but overall a great resource. And I will say it, it's nice to see that it is from a rad onc and not med or surg onc. :thumbup:
 
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scarbrtj

I Don't Like To Bragg
5+ Year Member
Dec 18, 2015
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  1. Attending Physician
Hi everyone! I have not been on these forums for 15 years, but I came across this thread when googling the OncCOVID app to find an article. It has changed a lot!

I appreciate the kind words about the app. Credit really goes to my whole team (especially Holly Hartman who is a brilliant PhD biostats student who works on my team), and we hope to continue to improve the model with more and more data. I think everyone wishes we had better and more robust Covid data in cancer patients (many ongoing national and international registries will help). I hope to get paper out showing the power of the app to answer bigger questions, but we wanted to make it public for people to use and provide feedback so we can make version 2, 3, 4, etc. Hopefully it will help patients/providers. This is about the 20th iteration of it thanks to many people's feedback, but still more we want to refine with stochastic SIR modeling and better R(t) estimates.

I am not sure which twitter post you are referring to FrostyHammer, but Cliff is awesome. Very smart guy. I am sure he can school me on many things and welcome his feedback and criticism. As those who know me, I put myself out there as transparently as I can but also am happy to take a beating. This is why I collaborate with 40+ centers, as teamwork is key and they teach me so much. Collaboration, humility, and mentorship I find are some of the best keys to success. I 100% understand ppl can view my opinions as strong, and when they dont know me they view it as arrogance. Totally makes sense. However, my job is to make a difference for patients, and I advocate strongly for them largely through my clinic and research and whatever voice I have. As often our leaders at times are silent on issues that I believe may really be negatively impacting patients, so I push on what I believe based on the way I interpret the evidence (which dynamically can change overtime with new data). As Nancy Lee told me as a resident (someone who ppl think from a far may be arrogant, but is actually very humble and inquisitive) is you must stay "empty". If you are "full" you will have no room to grow. We continue to do what I hope is great work is because we take the criticism and grow and adapt.

Although I am sure you all know, try not to over interpret twitter...it is something many of us use to create entertaining debates for people to see both sides of the coin (my name after all is DrSpratticus on twitter!). One of the recurring positive things I have heard >1000 times from people around the world about the twitter debates is how they learn new points about a topic (I personally learn a lot from them too). Some debates are highly political that touch on financial issues (protons, HIFU, combo-brachy, etc). These types of topics there is a lot behind the scenes that occurs, sometimes all the way up in national leadership of our organizations. You can imagine that when you are talking about topics that have billions $$ backing them, or people's research focus and grant support, or pharma's backing, or peoples long held beliefs, it can push some buttons.

Anyways, happy to answer any questions about the app.

Back to virtual clinic world. Hope everyone is safe and thanks for promoting and representing our field on this platform. Really awesome to see.

Best,
Dan
I think the best thing about work like this is it reminds one that sometimes the conventional wisdom is neither wisdom nor conventional.
 

Brim

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@Dan Spratt , very interesting and timely app. Kudos to you and your team.
It looks like it's a web browser-based app at present, and I'm wondering is there a stand-alone smartphone app currently being worked on or planned for development in the near future?
Thanks.
 
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thecarbonionangle

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Hi everyone! I have not been on these forums for 15 years, but I came across this thread when googling the OncCOVID app to find an article. It has changed a lot!

I appreciate the kind words about the app. Credit really goes to my whole team (especially Holly Hartman who is a brilliant PhD biostats student who works on my team), and we hope to continue to improve the model with more and more data. I think everyone wishes we had better and more robust Covid data in cancer patients (many ongoing national and international registries will help). I hope to get paper out showing the power of the app to answer bigger questions, but we wanted to make it public for people to use and provide feedback so we can make version 2, 3, 4, etc. Hopefully it will help patients/providers. This is about the 20th iteration of it thanks to many people's feedback, but still more we want to refine with stochastic SIR modeling and better R(t) estimates.

I am not sure which twitter post you are referring to FrostyHammer, but Cliff is awesome. Very smart guy. I am sure he can school me on many things and welcome his feedback and criticism. As those who know me, I put myself out there as transparently as I can but also am happy to take a beating. This is why I collaborate with 40+ centers, as teamwork is key and they teach me so much. Collaboration, humility, and mentorship I find are some of the best keys to success. I 100% understand ppl can view my opinions as strong, and when they dont know me they view it as arrogance. Totally makes sense. However, my job is to make a difference for patients, and I advocate strongly for them largely through my clinic and research and whatever voice I have. As often our leaders at times are silent on issues that I believe may really be negatively impacting patients, so I push on what I believe based on the way I interpret the evidence (which dynamically can change overtime with new data). As Nancy Lee told me as a resident (someone who ppl think from a far may be arrogant, but is actually very humble and inquisitive) is you must stay "empty". If you are "full" you will have no room to grow. We continue to do what I hope is great work is because we take the criticism and grow and adapt.

Although I am sure you all know, try not to over interpret twitter...it is something many of us use to create entertaining debates for people to see both sides of the coin (my name after all is DrSpratticus on twitter!). One of the recurring positive things I have heard >1000 times from people around the world about the twitter debates is how they learn new points about a topic (I personally learn a lot from them too). Some debates are highly political that touch on financial issues (protons, HIFU, combo-brachy, etc). These types of topics there is a lot behind the scenes that occurs, sometimes all the way up in national leadership of our organizations. You can imagine that when you are talking about topics that have billions $$ backing them, or people's research focus and grant support, or pharma's backing, or peoples long held beliefs, it can push some buttons.

Anyways, happy to answer any questions about the app.

Back to virtual clinic world. Hope everyone is safe and thanks for promoting and representing our field on this platform. Really awesome to see.

Best,
Dan

superman has landed, welcome hope you stick around!
 
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Dan Spratt

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@Dan Spratt , very interesting and timely app. Kudos to you and your team.
It looks like it's a web browser-based app at present, and I'm wondering is there a stand-alone smartphone app currently being worked on or planned for development in the near future?
Thanks.

Brim- That is great feedback. Will try to get to a true smartphone app. It has a lot of info in it and it will take some time to make it smartphone ready, but great idea. Top priority for the team is to try to further refine estimates and add more cancer types.
 

Dan Spratt

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RIP FrostyHammer. Killed by kindness

I welcome feedback from FrostyHammer. Some of my biggest critics teach me the most. I learned a long time ago that you will never please everyone, which is why the goal is to always help patients. Our own ego only gets in the way, and honestly is not about us in anyway. It is about the patients. We are a team after all, even if we dont know each other, as we all have a common goal.
 
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D

deleted774703

I welcome feedback from FrostyHammer. Some of my biggest critics teach me the most. I learned a long time ago that you will never please everyone, which is why the goal is to always help patients. Our own ego only gets in the way, and honestly is not about us in anyway. It is about the patients. We are a team after all, even if we dont know each other, as we all have a common goal.

@Dan Spratt welcome to SDN!

Thank you for your App as well as your very informative post. Much appreciated and have certainly learned a lot from you.

Keep on doing big things!
 
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evilbooyaa

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Damn, Daniel back at it again ..... with the killing with kindness.

I don't know that I have seen a better first post in this forum. Welcome to SDN.

I have criticized your strong opinions previously and at times feel you do come off arrogant but you're more than welcome to continue having them.

Hope you stick around. This does make it so people can't target you specifically as has happened in the past, as SDN members get protections not afforded to those not involved with SDN.
 
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OTN

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Dan, major props for coming in here, addressing the issues head on, welcoming criticism, understanding the issues are complex, and thanking SDN for advocating for our specialty.

Badass post, has me hopeful that younger leadership in academia is going to be able to step up and affect real change.
 
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ProtonElectronNeutron

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Hi everyone! I have not been on these forums for 15 years, but I came across this thread when googling the OncCOVID app to find an article. It has changed a lot!

I appreciate the kind words about the app. Credit really goes to my whole team (especially Holly Hartman who is a brilliant PhD biostats student who works on my team), and we hope to continue to improve the model with more and more data. I think everyone wishes we had better and more robust Covid data in cancer patients (many ongoing national and international registries will help). I hope to get paper out showing the power of the app to answer bigger questions, but we wanted to make it public for people to use and provide feedback so we can make version 2, 3, 4, etc. Hopefully it will help patients/providers. This is about the 20th iteration of it thanks to many people's feedback, but still more we want to refine with stochastic SIR modeling and better R(t) estimates.

I am not sure which twitter post you are referring to FrostyHammer, but Cliff is awesome. Very smart guy. I am sure he can school me on many things and welcome his feedback and criticism. As those who know me, I put myself out there as transparently as I can but also am happy to take a beating. This is why I collaborate with 40+ centers, as teamwork is key and they teach me so much. Collaboration, humility, and mentorship I find are some of the best keys to success. I 100% understand ppl can view my opinions as strong, and when they dont know me they view it as arrogance. Totally makes sense. However, my job is to make a difference for patients, and I advocate strongly for them largely through my clinic and research and whatever voice I have. As often our leaders at times are silent on issues that I believe may really be negatively impacting patients, so I push on what I believe based on the way I interpret the evidence (which dynamically can change overtime with new data). As Nancy Lee told me as a resident (someone who ppl think from a far may be arrogant, but is actually very humble and inquisitive) is you must stay "empty". If you are "full" you will have no room to grow. We continue to do what I hope is great work is because we take the criticism and grow and adapt.

Although I am sure you all know, try not to over interpret twitter...it is something many of us use to create entertaining debates for people to see both sides of the coin (my name after all is DrSpratticus on twitter!). One of the recurring positive things I have heard >1000 times from people around the world about the twitter debates is how they learn new points about a topic (I personally learn a lot from them too). Some debates are highly political that touch on financial issues (protons, HIFU, combo-brachy, etc). These types of topics there is a lot behind the scenes that occurs, sometimes all the way up in national leadership of our organizations. You can imagine that when you are talking about topics that have billions $$ backing them, or people's research focus and grant support, or pharma's backing, or peoples long held beliefs, it can push some buttons.

Anyways, happy to answer any questions about the app.

Back to virtual clinic world. Hope everyone is safe and thanks for promoting and representing our field on this platform. Really awesome to see.

Best,
Dan
Great first post, Dan Spratt!! Welcome to SDN. Just like Twitter, there are good discussions in SDN. Visit often!!
 
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scarbrtj

I Don't Like To Bragg
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Dec 18, 2015
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  1. Attending Physician
Hi everyone! I have not been on these forums for 15 years, but I came across this thread when googling the OncCOVID app to find an article. It has changed a lot!

I appreciate the kind words about the app. Credit really goes to my whole team (especially Holly Hartman who is a brilliant PhD biostats student who works on my team), and we hope to continue to improve the model with more and more data. I think everyone wishes we had better and more robust Covid data in cancer patients (many ongoing national and international registries will help). I hope to get paper out showing the power of the app to answer bigger questions, but we wanted to make it public for people to use and provide feedback so we can make version 2, 3, 4, etc. Hopefully it will help patients/providers. This is about the 20th iteration of it thanks to many people's feedback, but still more we want to refine with stochastic SIR modeling and better R(t) estimates.

I am not sure which twitter post you are referring to FrostyHammer, but Cliff is awesome. Very smart guy. I am sure he can school me on many things and welcome his feedback and criticism. As those who know me, I put myself out there as transparently as I can but also am happy to take a beating. This is why I collaborate with 40+ centers, as teamwork is key and they teach me so much. Collaboration, humility, and mentorship I find are some of the best keys to success. I 100% understand ppl can view my opinions as strong, and when they dont know me they view it as arrogance. Totally makes sense. However, my job is to make a difference for patients, and I advocate strongly for them largely through my clinic and research and whatever voice I have. As often our leaders at times are silent on issues that I believe may really be negatively impacting patients, so I push on what I believe based on the way I interpret the evidence (which dynamically can change overtime with new data). As Nancy Lee told me as a resident (someone who ppl think from a far may be arrogant, but is actually very humble and inquisitive) is you must stay "empty". If you are "full" you will have no room to grow. We continue to do what I hope is great work is because we take the criticism and grow and adapt.

Although I am sure you all know, try not to over interpret twitter...it is something many of us use to create entertaining debates for people to see both sides of the coin (my name after all is DrSpratticus on twitter!). One of the recurring positive things I have heard >1000 times from people around the world about the twitter debates is how they learn new points about a topic (I personally learn a lot from them too). Some debates are highly political that touch on financial issues (protons, HIFU, combo-brachy, etc). These types of topics there is a lot behind the scenes that occurs, sometimes all the way up in national leadership of our organizations. You can imagine that when you are talking about topics that have billions $$ backing them, or people's research focus and grant support, or pharma's backing, or peoples long held beliefs, it can push some buttons.

Anyways, happy to answer any questions about the app.

Back to virtual clinic world. Hope everyone is safe and thanks for promoting and representing our field on this platform. Really awesome to see.

Best,
Dan
Dan

You said questions OK so here goes...
I wanted to look at the "benefit" or lack thereof in an older (60+ yo) breast Stage I br Ca patient receiving adj XRT. My hunch was the app would not show a survival benefit to giving XRT in a healthy (or maybe even not that healthy) older female. Right now I'm seeing a 5y death rate reduction benefit from 5% to 2.4% for a 60yo and 6.9% to 2.5% for a 70yo, for immediate vs delayed XRT. (Relatively, these are pretty significant jumps.) In a fashion much more eloquently than I can express, here's (here!) a discussion of why I think your calc app is "off" for Stage I breast for older patients. See what you think. As always, could be my user error. But if not, perhaps a calc adjustment necessary. Just in general, and this is a minority opinion evidently (again, see the article), we over-irradiate older Stage I br CA patients anyways. And COVID was perhaps a good time to espouse that viewpoint more thoroughly. At first glance don't see any other hiccups in other disease sites so to speak. (Intentionally leaving the mono-XRT vs mono-anti-Estrogen adjuvant debate in older females for another day...)
 
Last edited:

Dan Spratt

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May 27, 2020
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Dan

You said questions OK so here goes...
I wanted to look at the "benefit" or lack thereof in an older (60+ yo) breast Stage I br Ca patient receiving adj XRT. My hunch was the app would not show a survival benefit to giving XRT in a healthy (or maybe even not that healthy) older female. Right now I'm seeing a 5y death rate reduction benefit from 5% to 2.4% for a 60yo and 6.9% to 2.5% for a 70yo, for immediate vs delayed XRT. (Relatively, these are pretty significant jumps.) In a fashion much more eloquently than I can express, here's (here!) a discussion of why I think your calc app is "off" for Stage I breast for older patients. See what you think. As always, could be my user error. But if not, perhaps a calc adjustment necessary. Just in general, and this is a minority opinion evidently (again, see the article), we over-irradiate older Stage I br CA patients anyways. And COVID was perhaps a good time to espouse that viewpoint more thoroughly. At first glance don't see any other hiccups in other disease sites so to speak. (Intentionally leaving the mono-XRT vs mono-anti-Estrogen adjuvant debate in older females for another day...)

Great question. The app is about delay of all cancer therapy from the date of diagnosis. So in your example they would likely have already received surgery, and the question is what does the delay in XRT do for OS. I am not a breast cancer expert, but my understanding of the data is that it is fairly clear that delays in adjuvant RT in breast cancer, at least in the spectrum of ~3 months, have not been shown to impact OS. Thus, in the app you should slide the treatment delay slider bar to a HR of 1. Then use as normal. What it likely will show you is that for older patients with comorbidities, especially if they have not had chemo yet, that Covid mortality is non-trivial. However, if younger/healthier and doesnt need chemo (or already had it), then there is no benefit in delaying their treatment, and no harm in delaying treatment. This can be used to either help reassure your patient it is safe to come in for RT if your hospital has capacity, or that it is safe to wait if needed.

Hope that helps.
best,
Dan
 

scarbrtj

I Don't Like To Bragg
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Dec 18, 2015
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Great question. The app is about delay of all cancer therapy from the date of diagnosis. So in your example they would likely have already received surgery, and the question is what does the delay in XRT do for OS. I am not a breast cancer expert, but my understanding of the data is that it is fairly clear that delays in adjuvant RT in breast cancer, at least in the spectrum of ~3 months, have not been shown to impact OS. Thus, in the app you should slide the treatment delay slider bar to a HR of 1. Then use as normal. What it likely will show you is that for older patients with comorbidities, especially if they have not had chemo yet, that Covid mortality is non-trivial. However, if younger/healthier and doesnt need chemo (or already had it), then there is no benefit in delaying their treatment, and no harm in delaying treatment. This can be used to either help reassure your patient it is safe to come in for RT if your hospital has capacity, or that it is safe to wait if needed.

Hope that helps.
best,
Dan
Maybe you're going to have to do an explainer video lol. I am trying to look at a healthy 70yo with stage I br CA. I tried shifting the HR to 1 both before and after inputting the data, and when pressing UPDATE it doesn't seem to change anything. And before you slide the HR slider, the app says "The estimated overall survival HR for delaying treatment by 3 month(s) for a patient with stage I Breast cancer is 1.309." And I tried sliding to some outrageous delay, like 12 months, and then the app for HR says "We do not have an estimated overall survival HR for delaying treatment by 12 month(s) for a patient with stage I Breast cancer." So again the calculator seems to be trying to tell me that even a 3 month delay for a Stage I older breast patient is harmful, oncologically. (I am not factoring in chemo for any Stage I older br CA patients on the app.) And the app also seems to be telling me that the mortality from COVID for a healthy 70yo is so trivial and that the mortality risk from a three month delay is so high that I am getting outputs like this...

hwBp6wA.png
 

Dan Spratt

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May 27, 2020
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Maybe you're going to have to do an explainer video lol. I am trying to look at a healthy 70yo with stage I br CA. I tried shifting the HR to 1 both before and after inputting the data, and when pressing UPDATE it doesn't seem to change anything. And before you slide the HR slider, the app says "The estimated overall survival HR for delaying treatment by 3 month(s) for a patient with stage I Breast cancer is 1.309." And I tried sliding to some outrageous delay, like 12 months, and then the app for HR says "We do not have an estimated overall survival HR for delaying treatment by 12 month(s) for a patient with stage I Breast cancer." So again the calculator seems to be trying to tell me that even a 3 month delay for a Stage I older breast patient is harmful, oncologically. (I am not factoring in chemo for any Stage I older br CA patients on the app.) And the app also seems to be telling me that the mortality from COVID for a healthy 70yo is so trivial and that the mortality risk from a three month delay is so high that I am getting outputs like this...

hwBp6wA.png
Looks like I do need to make a tutorial! Let me work on it and I will even use your example in the video. May need a few days to make it. Will try to get one up by next week.
Great feedback. You need to set the HR slide bar to 1. It snaps to the estimated delay HR whenever you change the cancer type and or stage (if we have an estimate).
 
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FrostyHammer

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I welcome feedback from FrostyHammer. Some of my biggest critics teach me the most. I learned a long time ago that you will never please everyone, which is why the goal is to always help patients. Our own ego only gets in the way, and honestly is not about us in anyway. It is about the patients. We are a team after all, even if we dont know each other, as we all have a common goal.
Dan,

Firstly I appreciate your post. Before going further, know that I am not a "critic" of yours. What I am critical of, however, is the manner in which you conduct and portray yourself when it comes to your work. Allow me to explain, because many in the SDN group have been similarly critical, yet after you posted your first comment above they all began giving you sycophantic replies. To that end, I give high respect to @evilbooyaa for at least mentioning that he was critical of your opinions and how you came off to others. I always strive to be genuine and real, even if the opinion isn't a popular one, so I won't sugarcoat anything.

I have never met you, nor probably will I ever, because people like me who work in small facilities in places of the country where no one cares to go are always seen as inferior by your circles of the academic Twitterati. This issue has been discussed at length on multiple SDN threads. I don't care if you perceive me as inferior, or anyone else on SDN. So with that being said, let me discuss a few things.

Being a recognized "thought leader" in rad onc, your work is admirable and has influenced patient care for millions of patients across the globe. However, you need to understand that with this power comes great responsibility. Your bravado and "guns ablaze" attitude in presenting your data is unacceptable. Is it great to get enthused about your research? Of course. And you have every right to that because you worked immensely hard to earn it all. But there is a fine line between enthusiasm and the feeling of imposing your opinions on others. You have not found that fine line yet. As a "thought leader" in rad onc, you need to understand that just as important as what you publish is how you come across to deliver that message. One can deliver that message with humility and thus come across that 1) there are many ways to address x clinical question, and/or 2) there are limitations in your approach. What I, and others on SDN who are too scared to say it to your face, am concerned about is that the way you present your work gives off a strong impression that your way is the only way and is practice changing. It almost feels like your goal in a plenary session is to "convert" others to your ideas and way of thinking. To offer a parallel analogy, converting others in the context of religion is insulting because it assumes that the converter thinks his religion is superior to the convertee's religion. Dan, there is nothing wrong in the least about having strong opinions. It's awesome that you're pushing to advocate for your patients. But keep those opinions between you and your patients, instead of coming across as imposing them on others. It's OK to have a wide variety of opinions, even if they aren't the same as yours! For instance, I agree with you 100% about your opinions on protons for prostate...but it's OK for others to be pro-proton for prostate. Everyone is entitled to their opinions. Politics these days have become so divisive because both parties think they're the only right ones and can't tolerate the others' opinions. Although SDN folk may be able to glean my political leanings from prior posts, I fully respect others' views on this forum (e.g. @KHE88) and have never once criticized them for their opinions. If one actually respects others' opinions, they will automatically not seek to impose their own on others. Just remember that. Words matter, along with the way you present those words. You need to learn this, plain and simple. The way something is delivered is just as important as its content.

Perhaps if you have an open mind, you will see what I mean if you rewatch any of your conference presentations. Case in point your 9601 secondary analysis. I'm an n=1, so take my opinion with a grain of salt, but your talk was perceived as a guns ablaze imposition of your opinion from your end, trying to make everyone "see the light" that you saw. Whereas Paul Nguyen, in a mild mannered way, nicely reminded the audience to look at the big picture in light of the nonrandomized nature and some other major limitations of your analysis, which have been discussed ad libitum on this forum. Thus, the way you vs Paul were perceived by the audience was very different. Hopefully this is an example of how, while no one is belittling your research, your words and delivery thereof matter a lot. Imposing your opinion on others is really no different than Fox News/MSNBC/CNN imposing their opinions on their audience, when in reality their job is to just report the news. So I am sure many people will appreciate it if you just present your great data and leave it at that, without editorializing, without coming across as imposing any opinion on others, without any of that extraneous material. The words you choose matter, as does how you deliver your message. But feel free to ignore anything and everything I wrote above. After all, I don't have my own research team, fancy job titles, or any of that... I'm just a small-time rad onc who treats patients in forgotten regions of the country. But I have core morals such as respect for all others, a strong belief in God, and helping those who are less fortunate. And I'll take the lasting satisfaction from each of those over the transient satisfaction of publishing a paper any day of the week.
 
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scarbrtj

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Allow me to explain, because many in the SDN group have been similarly critical, yet after you posted your first comment above they all began giving you sycophantic replies.
Now even Elton John said "Daniel, you're a star." But dang. Dan's livin' rent-free in some heads. Makes him even more impressive! I kid, I kid. But Frosty my dude, to paraphrase 'ol Ben Franklin: you can catch more flies with sycophancy than with vinegar. And a further point: Dan doesn't know who you are and about that one time you did that one thing that was super embarrassing.* Or those 1001 things you did that were regrettable. But we all know him. Unfair asymmetrical warfare on the Internet is when one person is anonymous and the other's not.

* I don't know you... purely hypothetical!
 
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Dan,

Firstly I appreciate your post. Before going further, know that I am not a "critic" of yours. What I am critical of, however, is the manner in which you conduct and portray yourself when it comes to your work. Allow me to explain, because many in the SDN group have been similarly critical, yet after you posted your first comment above they all began giving you sycophantic replies. To that end, I give high respect to @evilbooyaa for at least mentioning that he was critical of your opinions and how you came off to others. I always strive to be genuine and real, even if the opinion isn't a popular one, so I won't sugarcoat anything.

I have never met you, nor probably will I ever, because people like me who work in small facilities in places of the country where no one cares to go are always seen as inferior by your circles of the academic Twitterati. This issue has been discussed at length on multiple SDN threads. I don't care if you perceive me as inferior, or anyone else on SDN. So with that being said, let me discuss a few things.

Being a recognized "thought leader" in rad onc, your work is admirable and has influenced patient care for millions of patients across the globe. However, you need to understand that with this power comes great responsibility. Your bravado and "guns ablaze" attitude in presenting your data is unacceptable. Is it great to get enthused about your research? Of course. And you have every right to that because you worked immensely hard to earn it all. But there is a fine line between enthusiasm and the feeling of imposing your opinions on others. You have not found that fine line yet. As a "thought leader" in rad onc, you need to understand that just as important as what you publish is how you come across to deliver that message. One can deliver that message with humility and thus come across that 1) there are many ways to address x clinical question, and/or 2) there are limitations in your approach. What I, and others on SDN who are too scared to say it to your face, am concerned about is that the way you present your work gives off a strong impression that your way is the only way and is practice changing. It almost feels like your goal in a plenary session is to "convert" others to your ideas and way of thinking. To offer a parallel analogy, converting others in the context of religion is insulting because it assumes that the converter thinks his religion is superior to the convertee's religion. Dan, there is nothing wrong in the least about having strong opinions. It's awesome that you're pushing to advocate for your patients. But keep those opinions between you and your patients, instead of coming across as imposing them on others. It's OK to have a wide variety of opinions, even if they aren't the same as yours! For instance, I agree with you 100% about your opinions on protons for prostate...but it's OK for others to be pro-proton for prostate. Everyone is entitled to their opinions. Politics these days have become so divisive because both parties think they're the only right ones and can't tolerate the others' opinions. Although SDN folk may be able to glean my political leanings from prior posts, I fully respect others' views on this forum (e.g. @KHE88) and have never once criticized them for their opinions. If one actually respects others' opinions, they will automatically not seek to impose their own on others. Just remember that. Words matter, along with the way you present those words. You need to learn this, plain and simple. The way something is delivered is just as important as its content.

Perhaps if you have an open mind, you will see what I mean if you rewatch any of your conference presentations. Case in point your 9601 secondary analysis. I'm an n=1, so take my opinion with a grain of salt, but your talk was perceived as a guns ablaze imposition of your opinion from your end, trying to make everyone "see the light" that you saw. Whereas Paul Nguyen, in a mild mannered way, nicely reminded the audience to look at the big picture in light of the nonrandomized nature and some other major limitations of your analysis, which have been discussed ad libitum on this forum. Thus, the way you vs Paul were perceived by the audience was very different. Hopefully this is an example of how, while no one is belittling your research, your words and delivery thereof matter a lot. Imposing your opinion on others is really no different than Fox News/MSNBC/CNN imposing their opinions on their audience, when in reality their job is to just report the news. So I am sure many people will appreciate it if you just present your great data and leave it at that, without editorializing, without coming across as imposing any opinion on others, without any of that extraneous material. The words you choose matter, as does how you deliver your message. But feel free to ignore anything and everything I wrote above. After all, I don't have my own research team, fancy job titles, or any of that... I'm just a small-time rad onc who treats patients in forgotten regions of the country. But I have core morals such as respect for all others, a strong belief in God, and helping those who are less fortunate. And I'll take the lasting satisfaction from each of those over the transient satisfaction of publishing a paper any day of the week.

Sycophantic is far too harsh. Some of us are happy to see academic radoncs finally take bold stances- it's what we've been asking for on this board for a long time.
 
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Sycophantic is far too harsh. Some of us are happy to see academic radoncs finally take bold stances- it's what we've been asking for on this board for a long time.

Agreed. I’ve thought Spratt comes off harsh on Twitter as well

But the guy came on here with real name to state his intent and positions. Let’s give some credit

Btw @Dan Spratt if you have energy left would certainly appreciate your support against residency expansion as it’s ruining the field :)
 
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evilbooyaa

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There will always be people who make conclusions that, to them, are correct based on their interpretation of the data. Others may not necessarily agree with the strength of a conclusion in that regard. Both opinions are valid @FrostyHammer

I'd personally have avoided sycophantic as I don't think anyone here is going to gain any advantage from sucking up to Dan, but you're entitled to your opinion.

Regardless, I'm happy to see a Rad Onc with (metaphorical) balls, willing to bat for his opinions, and willing to challenge other people's perceptions. Something we need more of in our field, IMO.
 
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Dan Spratt

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Frosty- That is a heavy "welcome to SDN" that seems like it has been waiting to be released! I appreciate the directness, and that means a lot that you believe I have helped millions of people around the world. That truly makes my day, and thank you for saying that.

You should have more confidence to speak up, and you may be surprised if you put yourself out there (with your real name) that you can make as big of an impact as you want (ASCO for example is looking for a community practice doc for their board). There are many very influential people in radonc that work in community practices (Chris Jones, first author on RTOG 9408; Frank Vicini is a world expert in breast cancer...very long list). I am a firm believer data is data, and there are many community docs that have a better synthesis of the data than some in the ivory towers who dont have to deal with the complete implications of various recommendations.

I think we all can agree that everyone has a voice, just as all of you have a very important voice here that I imagine many undergraduates, med students, residents and attendings read that help shape the perception of radonc. You also have an important voice in that you can use it to promote radonc, spread knowledge, etc, or use it to make assumptions and talk about people who you may or may not know personally. The fact that this thread started off with people sharing the OncCOVID app, it seems at first glance that people here are trying to disseminate knowledge to help our field and patients. This is awesome. As a quote that I have realized is spot on year after year...great minds discuss ideas. Average minds discuss events. Small minds discuss people. For you to be a radonc you all must have great minds :)

Humility is very important, and try to not over-interpret people (good or bad) based on limited data. To give you one example Frosty that you brought up, please dont think what happens on stage is not scripted or unrehearsed. Paul is a good friend of mine, a brilliant clinician, and is and will be a great leader in our field (will be an incredible Chair). I helped make Paul's slides with him and we went over what each of us would say. Although I delivered the talk, do you think my co-authors didnt edit/approve my slides (19 other experts in GU)? Do you think ASTRO leadership doesnt edit the final plenary slides? Paul did a perfect job in providing balance and that is the job of a discussant. My job is to present new data and draw conclusions. I am always happy to discuss limitations/problems with research, especially my own.

People on this forum, in practice, myself included, should be humble enough to know what they are and are not an expert in (hence why I have built a huge team with diverse expertise). Often quantifying the credibility of research and complex biostatistics is not something most people in medicine can say they are well-versed in. Thus, it is easy to dismiss something because of simple rules they read or heard about. Even biostatisticians are often not experts in balancing clinical and statistical significance and credibility; it is a retrospective study so its bad (that is how Gleason grade groups were created and the D'amico risk groups, which are practice changing), post-hoc from randomized data so it is not credible (why we dont give ADT to low risk men despite them being included in RTOG 9408), or people who even dismiss randomized data because of their own anecdotes or how they were trained (multiple trials showing no benefit in treating low risk PCa, but 20-50% of practices still do it) or those who believe all randomized data (PLCO PSA screening trial- US Task Force believed it). I can promise you that the more I read, the more collaborators I have, the more I learn in general....the more I realize how much I dont know and how insanely complex doing good research is. So many variables are out there that 99% of clinicians and academicians dont know are creating confounding, but want to draw conclusions anyways. There are so many complexities to even a published paper that never are shown given word limits.

Bottom line, I hope everyone keeps promoting our field, helping our patients, and trying to always learn more. Challenge dogma with data. The power of social media, journals, ASTRO, etc is that data is data. It doesnt matter if you are the president of ASTRO, a Chair, Professor, a thought leader, clinician, resident, or med student, data can prove any of these people wrong, but more importantly, can and should be used to help our patients.

I hope to pop in and out if there are questions. I sadly likely cant stay 100% on top of SDN, but that is why all of you are here to represent! Feel free to email with questions and I will do my best to keep up.

Best,
Dan


So on that note.
 
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Dan Spratt

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Agreed. I’ve thought Spratt comes off harsh on Twitter as well

But the guy came on here with real name to state his intent and positions. Let’s give some credit

Btw @Dan Spratt if you have energy left would certainly appreciate your support against residency expansion as it’s ruining the field :)

I think Covid-19 may help with that in various parts of the country. I know some centers are actually mandating residency contractions, and many more restricting any expansions (at least for the next year).

It is always unfortunate when many of us could see this coming from miles away that we were once almost the most competitive specialty, to now we are one of the easiest to match into. This goes far beyond expansion of resident slots (a component for sure).
Best,
Dan
 
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RadOncDoc21

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Frosty- That is a heavy "welcome to SDN" that seems like it has been waiting to be released! I appreciate the directness, and that means a lot that you believe I have helped millions of people around the world. That truly makes my day, and thank you for saying that.

You should have more confidence to speak up, and you may be surprised if you put yourself out there (with your real name) that you can make as big of an impact as you want (ASCO for example is looking for a community practice doc for their board). There are many very influential people in radonc that work in community practices (Chris Jones, first author on RTOG 9408; Frank Vicini is a world expert in breast cancer...very long list). I am a firm believer data is data, and there are many community docs that have a better synthesis of the data than some in the ivory towers who dont have to deal with the complete implications of various recommendations.

I think we all can agree that everyone has a voice, just as all of you have a very important voice here that I imagine many undergraduates, med students, residents and attendings read that help shape the perception of radonc. You also have an important voice in that you can use it to promote radonc, spread knowledge, etc, or use it to make assumptions and talk about people who you may or may not know personally. The fact that this thread started off with people sharing the OncCOVID app, it seems at first glance that people here are trying to disseminate knowledge to help our field and patients. This is awesome. As a quote that I have realized is spot on year after year...great minds discuss ideas. Average minds discuss events. Small minds discuss people. For you to be a radonc you all must have great minds :)

Humility is very important, and try to not over-interpret people (good or bad) based on limited data. To give you one example Frosty that you brought up, please dont think what happens on stage is not scripted or unrehearsed. Paul is a good friend of mine, a brilliant clinician, and is and will be a great leader in our field (will be an incredible Chair). I helped make Paul's slides with him and we went over what each of us would say. Although I delivered the talk, do you think my co-authors didnt edit/approve my slides (19 other experts in GU)? Do you think ASTRO leadership doesnt edit the final plenary slides? Paul did a perfect job in providing balance and that is the job of a discussant. My job is to present new data and draw conclusions. I am always happy to discuss limitations/problems with research, especially my own.

People on this forum, in practice, myself included, should be humble enough to know what they are and are not an expert in (hence why I have built a huge team with diverse expertise). Often quantifying the credibility of research and complex biostatistics is not something most people in medicine can say they are well-versed in. Thus, it is easy to dismiss something because of simple rules they read or heard about. Even biostatisticians are often not experts in balancing clinical and statistical significance and credibility; it is a retrospective study so its bad (that is how Gleason grade groups were created and the D'amico risk groups, which are practice changing), post-hoc from randomized data so it is not credible (why we dont give ADT to low risk men despite them being included in RTOG 9408), or people who even dismiss randomized data because of their own anecdotes or how they were trained (multiple trials showing no benefit in treating low risk PCa, but 20-50% of practices still do it) or those who believe all randomized data (PLCO PSA screening trial- US Task Force believed it). I can promise you that the more I read, the more collaborators I have, the more I learn in general....the more I realize how much I dont know and how insanely complex doing good research is. So many variables are out there that 99% of clinicians and academicians dont know are creating confounding, but want to draw conclusions anyways. There are so many complexities to even a published paper that never are shown given word limits.

Bottom line, I hope everyone keeps promoting our field, helping our patients, and trying to always learn more. Challenge dogma with data. The power of social media, journals, ASTRO, etc is that data is data. It doesnt matter if you are the president of ASTRO, a Chair, Professor, a thought leader, clinician, resident, or med student, data can prove any of these people wrong, but more importantly, can and should be used to help our patients.

I hope to pop in and out if there are questions. I sadly likely cant stay 100% on top of SDN, but that is why all of you are here to represent! Feel free to email with questions and I will do my best to keep up.

Best,
Dan


So on that note.

Damn man, not going to lie... you are a hard person to hate! I feel like I owe you an apology even though I never said anything to or about you!
 
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scarbrtj

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I still can't get the app to tell me delaying RT indefinitely in older person w/ Stage I breast doesn't affect survival

 

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I still can't get the app to tell me delaying RT indefinitely in older person w/ Stage I breast doesn't affect survival


Scarbrtj-
Remember the app is for delay of all treatment not just adjuvant RT. For adjuvant RT just set the HR to 1.0 and have at it. Every variable is adjustable and meant to be changed based on your specific case. Hope that helps!
Best
Dan
 

scarbrtj

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Scarbrtj-
Remember the app is for delay of all treatment not just adjuvant RT. For adjuvant RT just set the HR to 1.0 and have at it. Every variable is adjustable and meant to be changed based on your specific case. Hope that helps!
Best
Dan
Dan, are you saying, a priori, one should know that the HR is 1.0 for delaying RT for Stage I br CA?
I mean, yeah, one should "know" that but I would've hoped the calculator would have spit out the HRs for delaying RT at me, versus me having to spit HRs at it. If you get what I'm saying.
And I also say again, this is the initial view in the UI when one first logs in; and if you set HR to 1.0, and hit RESET TO DEAFULT, it bounces to 1.309 as the HR for delaying RT in Stage I breast. (Yes, manually setting the HR to 1.0 pretty much equalizes the Overall Mortality at 5y to ~9.0% in the left-side-of-page table.) No matter if we say it's 1.0 or not, your calc is saying it's >>1.0, for the "default."

The "default" setting in a nomogram/calculator means something IMHO. As the dunderheaded user, who am I to fiddle with the afflatus of the default? In the immortal paraphrasing of Forrest Gump: I may not be entitled to think I am a smart man.

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ramsesthenice

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Dan, welcome! Serious question that I am curious about: how will your App deal with uncertainties in the trajectory of infections? My concern from the very beginning was that we are delaying people’s cancer care based on the assumption that it would be safer to address their cancer in a couple months when COVID subsides. Sadly, we have very clear proof now that not only is the pandemic not gone, it’s getting worse in some highly populated areas. I don’t live in a hot spot but our numbers are stable to increasing and based on all the @ssholes I see in public acting like everything is fine and refusing to do simple control measures like wearing a mask, I have no reason to believe that community spread in our state is going anywhere anytime soon. There is real reason to believe we are going to be stuck with this for many months to years. For patients who don’t live in an active hot spot with genuine capacity concerns, is it still appropriate to delay therapy into an unknown endpoint from a COVID standpoint? I would imagine that a lot of oncologists in Texas are not feeling great about having put off treatments in April that could have been done by now ☹️
 
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OTN

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Dan, welcome! Serious question that I am curious about: how will your App deal with uncertainties in the trajectory of infections? My concern from the very beginning was that we are delaying people’s cancer care based on the assumption that it would be safer to address their cancer in a couple months when COVID subsides. Sadly, we have very clear proof now that not only is the pandemic not gone, it’s getting worse in some highly populated areas. I don’t live in a hot spot but our numbers are stable to increasing and based on all the @ssholes I see in public acting like everything is fine and refusing to do simple control measures like wearing a mask, I have no reason to believe that community spread in our state is going anywhere anytime soon. There is real reason to believe we are going to be stuck with this for many months to years. For patients who don’t live in an active hot spot with genuine capacity concerns, is it still appropriate to delay therapy into an unknown endpoint from a COVID standpoint? I would imagine that a lot of oncologists in Texas are not feeling great about having put off treatments in April that could have been done by now ☹

I’m in Texas as most know. I didn’t delay treatments in March and April, as it was plainly obvious the virus wasn’t here. It wasn’t easy to go against the national grain, but it made sense and I’m glad I didn’t delay. Now, however, we do have a problem. Just heard on a call this am that one of our main hospitals’ ICU is 88% full and admissions are doubling every day.

They locked things down here for far too long at first when the virus wasn’t even here and burned away most of the goodwill people had to obey. It was obvious this was going to happen, unfortunately.
 
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I’m in Texas as most know. I didn’t delay treatments in March and April, as it was plainly obvious the virus wasn’t here. It wasn’t easy to go against the national grain, but it made sense and I’m glad I didn’t delay. Now, however, we do have a problem. Just heard on a call this am that one of our main hospitals’ ICU is 88% full and admissions are doubling every day.

They locked things down here for far too long at first when the virus wasn’t even here and burned away most of the goodwill people had to obey. It was obvious this was going to happen, unfortunately.
The idea was to flatten the curve.... lockdowns wouldn't be needed as much if people were smart and a national mask mandate was instituted.
 

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just wanted to throw out counterfactual about delays in diagnosis when it comes to cancer. only cancers that delays in diagnosis proven to matter is when disease caught in pre cancerous form- cervical, colon. once cancer is a billion cells 1cm3, most of the time the dice is cast.


"Years ago, researchers observed this phenomenon in Norway. Women, ages 50-64, who underwent three mammograms over six years had more invasive breast cancers found compared to similar women who had a single mammogram at the end of six years. Delayed mammography led to less breast cancer diagnoses and the deficit never caught up -- despite a mammogram at the end of six years. These findings suggest that some small cancers regress on their own. Might this be happening right now during the Covid-19 pandemic? "
 
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People are tired of lockdowns whether it is Florida, Cali, Texas, North Dakota, you name it. All good will is burned. It is inhumane to keep people locked down for months. Solitary confinement makes people crazy. Joblessness, drugs, alcoholism. They were sold out of my favorite french liqueur the other day!!! People are drinking more and using drugs more. In states with legal weed, they can barely keep up, tough to find rolling paper i hear.

The cure is worst than the disease. This is only going to get worst. Most people will live, but many will die. Mother nature at play. Buckle up folks!
 

medgator

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People are tired of lockdowns whether it is Florida, Cali, Texas, North Dakota, you name it. All good will is burned. It is inhumane to keep people locked down for months. Solitary confinement makes people crazy. Joblessness, drugs, alcoholism. They were sold out of my favorite french liqueur the other day!!! People are drinking more and using drugs more. In states with legal weed, they can barely keep up, tough to find rolling paper i hear.

The cure is worst than the disease. This is only going to get worst. Most people will live, but many will die. Mother nature at play. Buckle up folks!
If only they'd listen and mask up! Even pence and Moscow Mitch are on board at this point

 
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ramsesthenice

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"If people were smart" - I think I found the issue

Quoting the great George Carlin:

"Think about how dumb the average person is. Now realize that half of all people are dumber than that." It use to be funny. But the reality of this is becoming very painful.

Im staying away from politics here. Just going to say that it is an outright embarrassment that we as an educated country with near limitless (relative) resources are failing where most succeeded. At its heart, unrepentant idealism pushed to the point of stupidity is a major cause of our woes. That and distrust. Its very sad.
 
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Dan Spratt

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Dan, are you saying, a priori, one should know that the HR is 1.0 for delaying RT for Stage I br CA?
I mean, yeah, one should "know" that but I would've hoped the calculator would have spit out the HRs for delaying RT at me, versus me having to spit HRs at it. If you get what I'm saying.
And I also say again, this is the initial view in the UI when one first logs in; and if you set HR to 1.0, and hit RESET TO DEAFULT, it bounces to 1.309 as the HR for delaying RT in Stage I breast. (Yes, manually setting the HR to 1.0 pretty much equalizes the Overall Mortality at 5y to ~9.0% in the left-side-of-page table.) No matter if we say it's 1.0 or not, your calc is saying it's >>1.0, for the "default."

The "default" setting in a nomogram/calculator means something IMHO. As the dunderheaded user, who am I to fiddle with the afflatus of the default? In the immortal paraphrasing of Forrest Gump: I may not be entitled to think I am a smart man.

zP4NXJU.png
Great feedback. I think I need to make it more clear in the app.

The model is based on data for delaying first cancer treatment from diagnosis. So in breast cancer that is usually surgery. The app is not designed specifically for radoncs for XRT, but rather delay in treatment after diagnosis. Also, when checking boxes like use of surgery or chemo that is assuming they haven’t had them if you check them and will receive them in the future.

I will look over the language in the app and make sure this point is more clear.

However, if you do want to show your patient the impact on treatment delay for adjuvant breast RT and you feel there is data to support a HR of 1.0, then everything was made to be adjusted, and for ppl savvy with the data they can adjust things in advanced settings based on their local data.

We have v3 update soon to go up with improved estimates and modeling. Will see if we can get a side project for just XRT delay, but will take a back seat to our growing list of changes. If anyone on here wants to compile the data on XRT treatment delay with references we would happily add it to the app and give you credit!
Best,
Dan
 

Dan Spratt

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May 27, 2020
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Dan, welcome! Serious question that I am curious about: how will your App deal with uncertainties in the trajectory of infections? My concern from the very beginning was that we are delaying people’s cancer care based on the assumption that it would be safer to address their cancer in a couple months when COVID subsides. Sadly, we have very clear proof now that not only is the pandemic not gone, it’s getting worse in some highly populated areas. I don’t live in a hot spot but our numbers are stable to increasing and based on all the @ssholes I see in public acting like everything is fine and refusing to do simple control measures like wearing a mask, I have no reason to believe that community spread in our state is going anywhere anytime soon. There is real reason to believe we are going to be stuck with this for many months to years. For patients who don’t live in an active hot spot with genuine capacity concerns, is it still appropriate to delay therapy into an unknown endpoint from a COVID standpoint? I would imagine that a lot of oncologists in Texas are not feeling great about having put off treatments in April that could have been done by now ☹
I am the first to say our model is far from perfect!

I can tell you that our model to predict the shape and trajectory of the curve is based on real time update from the Hopkins country level COVID data and are about to launch v3 which includes local replication time estimates by location. Thus it is a fairly personalized estimate.
However, the model has lots of assumptions and no model I am aware of can predict the rapid changes in behaviors from strict lock downs to mass gatherings without masks.

Despite this, it is probable that qualitative ranking of which types of patients benefit most from early vs delayed treatment will stay somewhat in rank order, so can still help prioritize which patients you bring in and which ones you reassure them it is safe to delay treatment.
I am sadly not able to accurately predict the future! However the app in my very biased opinion is more accurate and quantitative than most hospitals 3 or 5 tier system of telling people who and when to treat based on subjective criteria. It’s a start and feedback and suggestions always welcome! End of the day it’s to help people and is being made 100% for free on the side.

Hope this answers the question.

best
Dan
 

scarbrtj

I Don't Like To Bragg
5+ Year Member
Dec 18, 2015
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  1. Attending Physician
Great feedback. I think I need to make it more clear in the app.

The model is based on data for delaying first cancer treatment from diagnosis. So in breast cancer that is usually surgery. The app is not designed specifically for radoncs for XRT, but rather delay in treatment after diagnosis. Also, when checking boxes like use of surgery or chemo that is assuming they haven’t had them if you check them and will receive them in the future.

I will look over the language in the app and make sure this point is more clear.

However, if you do want to show your patient the impact on treatment delay for adjuvant breast RT and you feel there is data to support a HR of 1.0, then everything was made to be adjusted, and for ppl savvy with the data they can adjust things in advanced settings based on their local data.

We have v3 update soon to go up with improved estimates and modeling. Will see if we can get a side project for just XRT delay, but will take a back seat to our growing list of changes. If anyone on here wants to compile the data on XRT treatment delay with references we would happily add it to the app and give you credit!
Best,
Dan
Aha! Delay of ALL (any) treatment after diagnosis. Got it...
 
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