Rad Onc-- following up with your patients?

[BraggPeak]

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I'm doing a med onc rotation right now. The medical oncologist told me that radiation oncologists are not trained in managing PSA recurrence after a patient fails RT. I told him that in my experience, Rad Oncs were managing patients with hormonal therapy on their own. He seemed really shocked and said that most Rad Oncs 1) don't follow up with patients and 2) refer patients to either a medical onc or urologist. He told me my experience is not an accurate one because I had rotated at a 'big name' radiation oncology clinic. Is this true?? He was even more shocked when I told him that Rad Oncs know to give patients HT with osteopenia Zometa.

 

[Adawaal]

Your Med Onc is an idiot. Most Rad Oncs (at least in academics) follow their patients closely. Many who treat prostate cancer will even manage long-term androgen ablation after biochemical failure following XRT.

 

[IndyXRT]

I agree with Adawaal. We follow our patients after treatment and manage ADT as needed.

 

[stephew]

agree. your med onc is a fool.

 

[neutron reaper]

I may be wrong, but I imagine that a rad onc gets way more experience during residency managing and treating prostate cancer pts than a med onc does during their fellowship program. I have also witnessed rad oncs managing prostate ca recurrences and doing a great job at it.

 

[deleted4401]

Not that this medonc isn't in idiot- he/she may well be. Their local radonc might be some shlub that relegated his role to technician and actually behaves like this. Most centers don't have huge departments of radoncs. There is a fair amount of old school radoncs that just do what people tell them to do and leave follow up to the medonc/surgeon. It isn't right, but it's certainly seen in the community.

Aside: so you guys prescribe/deliver the shot yourselves? Do the urologists get POd? I thought they billed a lot for that.

S

 

[qwert]

I am not aware of ANY RadOnc prescribing Lupron. Urology does it most of the time. In that regard your Med-Onc is correct.
Besides, there are multiple options available for biochemical recurrence after XRT (provided it is local relapse, no nodes/bone mets). Cryosurgery is gaining acceptance, and radical prostatectomy post-XRT is advocated by some centers as well.

I'm doing a med onc rotation right now. The medical oncologist told me that radiation oncologists are not trained in managing PSA recurrence after a patient fails RT. I told him that in my experience, Rad Oncs were managing patients with hormonal therapy on their own. He seemed really shocked and said that most Rad Oncs 1) don't follow up with patients and 2) refer patients to either a medical onc or urologist. He told me my experience is not an accurate one because I had rotated at a 'big name' radiation oncology clinic. Is this true?? He was even more shocked when I told him that Rad Oncs know to give patients HT with osteopenia Zometa.

 

[BraggPeak]

OK, maybe that is what he meant. So I guess RadOncs are following up with the patients, but we're not actually managing the hormonal therapy?

I am not aware of ANY RadOnc prescribing Lupron. Urology does it most of the time. In that regard your Med-Onc is correct.
Besides, there are multiple options available for biochemical recurrence after XRT (provided it is local relapse, no nodes/bone mets). Cryosurgery is gaining acceptance, and radical prostatectomy post-XRT is advocated by some centers as well.

 

[Adawaal]

I am not aware of ANY RadOnc prescribing Lupron. Urology does it most of the time. In that regard your Med-Onc is correct.
Besides, there are multiple options available for biochemical recurrence after XRT (provided it is local relapse, no nodes/bone mets). Cryosurgery is gaining acceptance, and radical prostatectomy post-XRT is advocated by some centers as well.

Hell, our department gave them all the time. It's not like it's rocket science to either prescribe or to inject Lupron. Any monkey can do it (and urologists do, so that proves it). Cryo is easy enough to do as well, much easier than quality permanent brachy for prostate.

 

[qwert]

I guess some RadOnc's give Lupron. It pays well I hear.

But cryo?? Have you ever personally seen a radiation oncologist performing cryoablation of the prostate?

Hell, our department gave them all the time. It's not like it's rocket science to either prescribe or to inject Lupron. Any monkey can do it (and urologists do, so that proves it). Cryo is easy enough to do as well, much easier than quality permanent brachy for prostate.

 

[Adawaal]

Yes, I have. I believe it was repayment for the Rad Onc teaching the urologist brachy techniques. But it's essentially very similar with the TRUS and the perineal template. You can see the iceball form under US nicely.

 

[medgator]

I haven't seen many rad oncs write for lupron --- generally it will fall under the domain of urology, or med onc. As for casodex, we refill scripts every so often when the pt. isn't seeing their urologist any time soon.

I've heard that hormone shots used to be quite lucrative to the point where many patients were getting them (even those in whom it might be questionable). The reimbursements have been cut a lot in the last few years from what i've heard.

We definitely refer out to med onc when it comes time for taxotere 😉 As for cryo --- hadn't heard about a situation where rad oncs did that, until now 😱

I don't think the situation that the OP described occurs in academics, but who knows in PP.

 

[Zap]

We order and our nurses give Lupron injections all the time. Usually it's in the setting of neoadjuvant/concurrent hormone tx for patients getting IMRT, but sometimes it's for post-recurrence management. And I agree that a monkey could pretty much do it. 😉

 

[dsh]

Hey this is a kind of dumb question, so I didn't want to make a new thread about it.

Is rad onc pronounced like the bug spray or radical?

 

[yeasterbunny]

Hey this is a kind of dumb question, so I didn't want to make a new thread about it.

Is rad onc pronounced like the bug spray or radical?

Lol. You will hear it both ways. Maybe it depends on where you train? I think it's totally random. I personally use the long a because that's how it sounds in "radiation" but that's just me.

I did have an attending on my heme-onc rotation that would call the radoncs ra-donkeys. I called him a he-monkey. Should've see it coming.

 

[IndyXRT]

I am not aware of ANY RadOnc prescribing Lupron.

You can add me to your rapidly growing list of RadOncs who prescribe Lupron for patients in both the neoadjuvant/concurrent/adjuvant setting and in the PSA failure after RT setting.

 

[IndyXRT]

Hey this is a kind of dumb question, so I didn't want to make a new thread about it.

Is rad onc pronounced like the bug spray or radical?

I've always pronounced it with the short a, as in radical. I have no great reason for doing it this way.

 

[Pewl]

"Radical Onc" definitely.

I mean, do you typically hear radiology referred to as "Rads" or "Raids?" 😀

 

[G'ville Nole]

I've heard that hormone shots used to be quite lucrative to the point where many patients were getting them (even those in whom it might be questionable). The reimbursements have been cut a lot in the last few years from what i've heard.

This has been my experience. During my first year, I would routinely call the referring urologists to ask if they wanted the patient to return for a hormone injection. Around the time reimbursement got slashed, they started saying "naah, you guys can give it".

 

[Palex80]

Your Med Onc is an idiot.

your med onc is a fool.

Not that this medonc isn't in idiot- he/she may well be.

So, I guess we all share the same opinion, with one small detail:


ALL MED ONCS ARE IDIOTS AND FOOLS.



Now, back to the subject:
We dont prescribe HTx here.
We usually call the urologist and say
"We would like 6 months of HTx, starting tomorrow, we will initiate RTx in 4 months from tomorrow. Any objections? Fine, thank you very much for performing the injection. You may decide for yourself which LHRH-Analogon you wanna give."

But frankly, its way too much work to take care of everything. We have so many patients, I am glad to be able to see all the new ones and bring them through treatment. So we leave much of the follow up for most patients to the colleagues.
We don't see breast cancer, endometrium, cervix patients later, the gynecologists take care of that.
We don't follow up all of our palliative patients, the med oncs send them back when they have problems with pain, etc in time.
We see all of our prostate patients and monitor PSA.
Our head and neck patients are followed-up in joint sessions with the head-neck-surgeons.
We don't see any of our neoadjuvant patients (rectum, etc).
We do follow up "special patients" like glioblastoma recurrencies, treated with stereotactic RTx or body-stereotaxy patiens.

 

[stephew]

Hold on there cowpoke. We always did the lupron in my training. And radical prostatectomy adjuvant to xrt? sounds malpractice worthy to me. What am i missing there.?

I am not aware of ANY RadOnc prescribing Lupron. Urology does it most of the time. In that regard your Med-Onc is correct.
Besides, there are multiple options available for biochemical recurrence after XRT (provided it is local relapse, no nodes/bone mets). Cryosurgery is gaining acceptance, and radical prostatectomy post-XRT is advocated by some centers as well.

 

[stephew]

no, i wont accept that either. This one medonc may be, but I wont take the same road as physicians who denigrate radiation oncologists out of ignorance.

So, I guess we all share the same opinion, with one small detail:


ALL MED ONCS ARE IDIOTS AND FOOLS.

I even follow many of my mets patients long term as I typically know best how to keep the brain mets under control and how interpret what's going on with MRI changes. I have several patients with mets Ive followed for nearly 4 years now.

 

[Palex80]

Hold on there cowpoke. We always did the lupron in my training. And radical prostatectomy adjuvant to xrt? sounds malpractice worthy to me. What am i missing there.?

There are some urologists who can perform such operations. There is only a very limited number of patients that actually benefit from such a procedure, but it can be theretically curative.
One would have to stage however very extensively to know that the PSA-rise is only coming from the prostate itself.

 

[qwert]

Talking about salvage prostatectomy for local relapse.

Hold on there cowpoke. We always did the lupron in my training. And radical prostatectomy adjuvant to xrt? sounds malpractice worthy to me. What am i missing there.?

 

[stephew]

ahhh. i see.
i thought you meant adjuvantly.

 

[BraggPeak]

For those of you who do administer lupon shots, do you guys also adminster zometa if your patients develop osteopenia or does someone else do that?

 

[stephew]

good question. We didnt do zometa.

 

[StreamTeam]

For those of you who do administer lupon shots, do you guys also adminster zometa if your patients develop osteopenia or does someone else do that?

Let the medonc give the Zometa. They get paid for it, and they get to take the blame for its side effects of mandibular osteonecrosis and nonhealing of bone. Ive seen a number of these complications lately.

 

[IndyXRT]

For those of you who do administer lupon shots, do you guys also adminster zometa if your patients develop osteopenia or does someone else do that?

We order the scans to check for osteopenia, but refer to medical oncology if it develops and Zometa is indicated.