Proton Pricing/Protons for Breast Discussion

[jondunn]

This is my take!

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[Lamount]

Sometimes wealth is inversely proportional to ignorance.

I hope I retire a dumb man

 

[RSAOaky]

I hope I retire a dumb man

...sometimes

 

[Mandelin Rain]

Protons for breast cancer: quadrupling costs while also doubling toxicity.

But, by all means, do it if the insurance allows.

 

[thecarbonionangle]

Is urbanic as rude/unpleasant in person as he is on twitter?

 

[deleted1111261]

Is urbanic as rude/unpleasant in person as he is on twitter?

Uncertain.

 

[Mandelin Rain]

Breast radiation, described in brief.

Hypofractionated Photons:

Protons:

 

[iradi8r]

As another data point, MGH had really poor results when they tried protons for APBI. It was an abstract at ASTRO but i am not sure if the paper was ever written up.

 

[deleted941485]

Do we have any data on non PFS exempt centers with protons?

 

[Palex80]

(Reasonably fractionated and prescribed) APBI with photons is the most well tolerated of all breast treatments.
Why should protons show a benefit in this special cohort?

 

[thecarbonionangle]

(Reasonably fractionated and prescribed) APBI with photons is the most well tolerated of all breast treatments.
Why should protons show a benefit in this special cohort?

Comes down to DVH idolatry, what a “pretty” plan!

 

[RickyScott]

pretty sure one of my patients saw Ben smith for a second opinion and ended up with partial breast protons.

 

[RadRadRad]

These people are the same people that would crucify pp for right breast Imrt

And yes, apbi proton abstract at Astro several years ago showed worse skin toxicity

 

[RadRadRad]

…I’m not advocating for right breast Imrt

 

[thecarbonionangle]

pretty sure one of my patients saw Ben smith for a second opinion and ended up with partial breast protons.

Of course! Not a grift guy did not like.

 

[RickyScott]

These people are the same people that would crucify pp for right breast Imrt

And yes, apbi proton abstract at Astro several years ago showed worse skin toxicity

if you point that out, they will just bring up that keytruda costs more than all of xrt.

 

[deleted1111261]

 

[SubserviantToABR]

View attachment 352650

I have an idea who this is but won't dox them. But the duality is amazing. On the one hand, you're exploiting medical students and DEI to trap them into radiation oncology to exploit them as you climb the academic ladder, and on the other hand, you're sticking patients with a huge bill for a 3 decade old modality with no proven benefits. If that ain't a grifter, I don't know what is.

 

[communitydoc13]

View attachment 352650

Yeah, pretty easy to figure this one out. I believe this institution was a relatively late adopter of protons, with reasonable concerns for going all in and with a self-righteous approach to how they would implement them when they did (to differentiate themselves from multiple other proton centers in the immediate region).

Now soliciting prostate proton referrals, when they probably know better.

Very hard to have the moral high ground in this game.

 

[RickyScott]

Yeah, pretty easy to figure this one out. I believe this institution was a relatively late adopter of protons, with reasonable concerns for going all in and with a self-righteous approach to how they would implement them when they did (to differentiate themselves from multiple other proton centers in the immediate region).

Now soliciting prostate proton referrals, when they probably know better.

Very hard to have the moral high ground in this game.

Osler wouldn’t approve. Pimping protons and this specialty to URM?

 

[jondunn]

Why are people beating around the bush - things are ROTTEN, and I’m not talking about the crab cakes

 

[deleted1111261]

I woke up expecting at least one Poe reference. You guys disappointed me 😞

 

[radoncftw]

Name and shame.

 

[SubserviantToABR]

I woke up expecting at least one Poe reference. You guys disappointed me 😞

I was thinking more Ray Lewis (I'm sorry proton people, please don't stab me).

 

[RickyScott]

Name and shame.

I got the letter off doximity. Doc publically invites radoncs to contact him via phone and email to discuss protons for prostate, so can I post? Would love to have group q and a with him on who we should send for protons.

 

[jondunn]

Yes Ricky

 

[thecarbonionangle]

I got the letter off doximity. Doc publically invites radoncs to contact him via phone and email to discuss protons for prostate, so can I post? Would love to have group q and a with him on who we should send for protons.

Go ahead brotha!

 

[RickyScott]

Go ahead brotha!

Ok, the author publically hopes to connect with us and says he can be reached at [email protected] or 202-537-4787. I genuinely would like to connect and learn about the benefits of protons for prostate cancer especially as it relates to the rectum. He is targeting this info/message to radoncs not primary care.

 

[medgator]

Ok, the author publically hopes to connect with us and says he can be reached at [email protected] or 202-537-4787. I genuinely would like to connect and learn about the benefits of protons for prostate cancer especially as it relates to the rectum. He is targeting this info/message to radoncs not primary care.

He is welcome to create an account here, present his data and field a Q&A. This isn't truth social or ASTRO ROhub, no cancel culture here

 

[SubserviantToABR]

He is welcome to create an account here, present his data and field a Q&A. This isn't truth social or ASTRO ROhub, no cancel culture here

I would definitely welcome that. Perhaps @Dan Spratt should also chime in on the discussion, especially since he has protons now.

 

[communitydoc13]

I agree it would be great to have an open forum with prostate proton advocates. The name brand docs should trust the strength of their arguments. I have never bought the argument that "this is not the forum for detailed technical conversation". It is the perfect forum.

 

[elementaryschooleconomics]

Oh really? I don't know how other people are reading this statement, but this implies "no side effects" to me.

I guess if I go to Google Scholar and search "proton radiotherapy normal tissue injury" there will be zero results?

(editor's note: this is for a lung trial, not prostate, but you get the idea)

 

[evilbooyaa]

Ok, the author publically hopes to connect with us and says he can be reached at [email protected] or 202-537-4787. I genuinely would like to connect and learn about the benefits of protons for prostate cancer especially as it relates to the rectum. He is targeting this info/message to radoncs not primary care.

Is this serious? That DEI guy from Johnny Hops is the person publicly peddling protons for prostate like a snake oil salesman?

 

[OTN]

Is this serious? That DEI guy from Johnny Hops is the person publicly peddling protons for prostate like a snake oil salesman?

Why do only one grift when two grifts better

 

[radoncftw]

Seems suspect that the ivory towers which are so keen on practicing evidence based medicine also very overtly push protons for prostate...where there is not great data.

 

[radoncftw]

Id be curious to see if lemmiwinks can circulate on twitter to engage the twitterati, especially academic crew, on their opinion on this.

 

[CaesarRO]

This is different because it's the doctor pushing it on doximity directly, but I wonder how often it's the marketing department for the hospital pushing a campaign that's totally divorced from physician input.

I'm reminded of the Silicon Valley marketing team