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medgator said:
That's why evilcore will approve IO and deny sabr-comet in oligometastatic disease until the cows come home
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guys let us be real. this is silly.

Immunotherapy has OS benefits in multiple disease sites in multiple settings and is the most important cancer progress in decades.

to compare this to SABR-COMET, a phase II trial with lots of data issues, is sort of silly.
 
jondunn said:
guys let us be real. this is silly.

Immunotherapy has OS benefits in multiple disease sites in multiple settings and is the most important cancer progress in decades.

to compare this to SABR-COMET, a phase II trial with lots of data issues, is sort of silly.
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So you don't srs isolated brain mets in your lung patients? You don't believe it will change os? Maybe you should just have the med onc stick them on IO instead.

Just another example of those in this field being our own worst enemy
 
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medgator said:
So you don't srs isolated brain mets in your lung patients? You don't believe it will change os? Maybe you should just have the med onc stick them on IO instead.

Just another example of those in this field being our own worst enemy
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hmmm. no that is not what I said, in any way, at all.


what I did say is rad oncs putting down immunotherapy and any other massively important transofrmative advancements that may be coming in cancer as a whole makes us look like dinosaurs, and frankly just flat out wrong.
 
also we should all be happy that radiation therapy does not face the same regulatory requirements that a drug does.

although when it comes to proton therapy, maybe it should.
 
jondunn said:
hmmm. no that is not what I said, in any way, at all.


what I did say is rad oncs putting down immunotherapy and any other massively important transofrmative advancements that may be coming in cancer as a whole makes us look like dinosaurs, and frankly just flat out wrong.
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jondunn said:
also we should all be happy that radiation therapy does not face the same regulatory requirements that a drug does.

although when it comes to proton therapy, maybe it should.
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If we put RO and IO side by side, being purely objective, I get nervous. Sure, I SRS brain mets (when the med onc sends them), but 99.9% of RO centers in the US have breast cancer as the most common sort of patient they treat. And what is the biggest additive (hypofractionation would be subtractive using my logic) RO advance in breast cancer in the last 20 years? Elective nodal irradiation for N1 and high risk N0 breast patients? It's helping certain survival metrics, but it's not helping OS. I can't think of an OS-improving advance in RO for breast cancer recently. Meanwhile, immunotherapy in breast cancer is saving THOUSANDS and thousands of women each year and adding billions of dollars of value to healthcare. There's profligate waste and spending and specious immunotherapy use, but IO is dramatically changing the overall cancer landscape. RO is not. Protons sure as hell are not.

Short of getting some major new RT indication, the only path to increasing value in RO is to make it cheaper. Our benefit-to-cost ratio is very high, but we may be rather maxed on the benefit side in the common disease sites. That said if you follow Ralph W on twitter, having people like him whine over cardiac radioablation ("Are we cardiologists or oncologists" he asked), which could be a major new indication for us, is stupid and harmful.
 
jondunn said:
hmmm. no that is not what I said, in any way, at all.


what I did say is rad oncs putting down immunotherapy and any other massively important transofrmative advancements that may be coming in cancer as a whole makes us look like dinosaurs, and frankly just flat out wrong.
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From a cost standpoint? Do you realize many patients are able to defer/delay changing systemic tx thanks to cost effective SABR of oligometastatic disease. Trying to compare them without considering the relative costs to society is ridiculous, yet here you are parroting the Evilcore mantra regarding the two
 
I agree with Wallnernus mostly but with a slight modification - yes we can show value by being cheaper and more practical to patients, with shorter courses where appropriate.

But to me what that is part of is a general framework of this - new systemic therapies are incredible, and what RO should be thinking about is how best we work WITH these agents. There is a lot to figure out.

this is where we can show value too.

it shouldn’t be a competition, as some will frame it, as that is a competition we can’t win. We should learn from thoracic surgeons and head and neck surgeons, who have welcomed the immunotherapy forefront. Like surgeons, we are local guys and gals. Systemic is not our enemy. In many cases they make local therapy more important.
 
jondunn said:
guys let us be real. this is silly.

Immunotherapy has OS benefits in multiple disease sites in multiple settings and is the most important cancer progress in decades.

to compare this to SABR-COMET, a phase II trial with lots of data issues, is sort of silly.
Click to expand...

Which is why it’s time to throw in the towel and at least try to join Med onc.

The only thing RO is focused on now is getting the service as cheap as possible which to me represents the end stage of any product or service. At this point any research talent that’s been recruited in the last 15 years has been be a criminal waste.
 
jondunn said:
I agree with Wallnernus mostly but with a slight modification - yes we can show value by being cheaper and more practical to patients, with shorter courses where appropriate.

But to me what that is part of is a general framework of this - new systemic therapies are incredible, and what RO should be thinking about is how best we work WITH these agents. There is a lot to figure out.

this is where we can show value too.

it shouldn’t be a competition, as some will frame it, as that is a competition we can’t win. We should learn from thoracic surgeons and head and neck surgeons, who have welcomed the immunotherapy forefront. Like surgeons, we are local guys and gals. Systemic is not our enemy. In many cases they make local therapy more important.
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Do you have any ideas regarding RT IO? Working with it how?
 
RadsWFA1900 said:
Which is why it’s time to throw in the towel and at least try to join Med onc.

The only thing RO is focused on now is getting the service as cheap as possible which to me represents the end stage of any product or service. At this point any research talent that’s been recruited in the last 15 years has been be a criminal waste.
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Incoming Doximity article:

Is Radiation Oncology the K-Mart of Medicine?
 
elementaryschooleconomics said:
Incoming Doximity article:

Is Radiation Oncology the K-Mart of Medicine?
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Hell, I’ll write it. It will be straight and to the point. I wouldn’t want to waste a good headline.

The thing about kmarts and Walmart is that nobody really wants to work for them. Nobody is looking to them for innovation. They are where careers die.
 
jondunn said:
But to me what that is part of is a general framework of this - new systemic therapies are incredible, and what RO should be thinking about is how best we work WITH these agents. There is a lot to figure out.
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This is the part where it gets hazy. Our megavoltage beams pretty much interact with all matter the same way. MV beams are rather matter indiscriminate. When they hit human matter, the only interaction that... matters... is at the DNA level. And that interaction is purely random, but model-able in terms of its proportionality. We hypothesized we could work with chemo (chemo and radiation at the same time used to be thought of as impossible) because chemo damaged DNA too. That we can work with any other chemical agent that won't be interacting at the DNA damage level... I don't know how we do that. And if we do find that RT and IO are synergistic, it will be a purely fortuitous finding as no IO agent (that I know of) is being expressly designed to work with RT. If we find ourselves favorably interacting with immunotherapy a decade plus from now it will be because we ass-backed into a happy circumstance... and that's what we are pinning our hopes and dreams on? And will that increase RT indications?

We can't even get the surgeons to send us patients...



And since they control the patients it's likely they'll get into IO on their own...

 
I think if there was unlimited money, there would be no radiation vs IO competition. But IO indications are expanding like crazy, oncology care cost is going up, and now CMS is going after rad onc's kneecaps. I think Wallernus has already shown that rad onc has been good at self-regulating our Medicare costs over past decade, but CMS still feels the need to cut more? I'm blaming this, at least partially, on soaring IO costs.
 
Complain about costs all you want. Just like Med oncs who used to complain about radiation costs. Frankly doesn’t matter. It’s not going to change the fact that patients get these better drugs. Costs will come down.
 
Keep in mind that both Nivolumab and Pembrolizumab will both go off patent/generic sometime around 2028 so the high cost of these only has a very limited horizon.
 
Sometimes somebody, “clinician” or not, says something so imbecile that they cancel themselves. Saying head and neck masks are “expensive” over tape is absolute dumbarsery . We are all dumber for paying any attention. May god have mercy on your souls!
 
jondunn said:
Complain about costs all you want. Just like Med oncs who used to complain about radiation costs. Frankly doesn’t matter. It’s not going to change the fact that patients get these better drugs. Costs will come down.
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It's a question about framing the issue to he public, and we are TERRIBLE at this.

We should have a public add campaign that argues the following.

Radiation is utilized in the treatment of about 33%-50% of cancer patients. When a solid tumor cannot be removed surgically, radiation is the only chance you will have at a cure. In many cases when it can be removed surgically, radiation offers an equally effective, non-invasive alternative to a major operation. Lastly, many people who have advanced tumors removed surgically will also require radiation to make sure that they remain cancer-free. No one wants to need radiation, but when you do, you want it to be delivered by a highly trained physician who is utilizing the best available technology. Don't cut funding for cancer care because you may be hurting someone you love.
 
GapCalc said:
just FYI, it’s Dr. Chino.
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Of course she's a Dr. Lot's of people are doctors (not only of medicine).
We generally don't use that title in the part of Europe I live when talking about others, unless it's something official or professional (like a news article or introducing them to patients or a conference or whatever).

edition.cnn.com

Angela Merkel sworn in for fourth term as German Chancellor | CNN

Angela Merkel was sworn in as Chancellor of Germany after lawmakers voted to re-elect her as leader in a close vote on Wednesday morning.
edition.cnn.com edition.cnn.com
Mrs. Merkel is also a doctor (of physics). This CNN-article, for instance, does not refer to her as Dr. 🙂

Sorry, if you felt "Mrs. Chino" sounded not appropriate. No intention to devalue Dr. Chino's track.
 
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TheWallnerus said:
Ralph W on twitter, having people like him whine over cardiac radioablation ("Are we cardiologists or oncologists" he asked), which could be a major new indication for us, is stupid and harmful.
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I agree with this entire quote.

You could also delete everything between the bolded portions of the above and I would still agree with it.


Separately: The whataboutism is annoying in the above discussions about RO vs MO, on both sides of the aisle, to me.
 
Palex80 said:
There are arguments for and against this.

It's obvious that "age" can be seen as discriminatory, however age is fluid in contrast to many other "classic" discriminatory criteria like ethnicity, sex (well nowadays, that's fluid too, but that's another discussion...), etc...

The point Mrs. Chino is trying to make is that people who get into academics at a later age will be excluded by these criteria, but on the other hand have a look at the other criteria the grant is requesting. It's obvious they are targetting those that are excelling in academic career at a very young age (the shooting stars). That is their target group. Is that bad? I think not.

I mean, adults only hotels also exist. Do you view them as discriminatory? 🙂
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Did you really call her "Mrs." Chino instead of Dr. Chino?
 
Lamount said:
It's a question about framing the issue to he public, and we are TERRIBLE at this.

We should have a public add campaign that argues the following.

Radiation is utilized in the treatment of about 33%-50% of cancer patients. When a solid tumor cannot be removed surgically, radiation is the only chance you will have at a cure. In many cases when it can be removed surgically, radiation offers an equally effective, non-invasive alternative to a major operation. Lastly, many people who have advanced tumors removed surgically will also require radiation to make sure that they remain cancer-free. No one wants to need radiation, but when you do, you want it to be delivered by a highly trained physician who is utilizing the best available technology. Don't cut funding for cancer care because you may be hurting someone you love.
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Exactly. This should be the message. Even this board which I love messes it up though.

Is our job that hard? Do we need to supervise things? We don't do anything etc etc. probably not best to whine about publicly
 
MegaVoltagePhoton said:
Exactly. This should be the message. Even this board which I love messes it up though.

Is our job that hard? Do we need to supervise things? We don't do anything etc etc. probably not best to whine about publicly
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yep
 
MegaVoltagePhoton said:
Did you really call her "Mrs." Chino instead of Dr. Chino?
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A prominent surgeon is driving a sports car down a twisty road. The surgeon's son is in the passenger seat. In a flash someone jumps out in front of the car. The surgeon swerves, and they crash down a ravine.

The son wakes up in the hospital, badly injured but conscious. He hears the nurse say "Young man, I am so sorry... but you were the only survivor. But I have some good news. The doctor is here. And wants to see you..." and she points to the door of the hospital room. And just then the son's father, the chief of surgery at the hospital... without a scratch... walks into the room.
 
TheWallnerus said:
A prominent surgeon is driving a sports car down a twisty road. The surgeon's son is in the passenger seat. In a flash someone jumps out in front of the car. The surgeon swerves, and they crash down a ravine.

The son wakes up in the hospital, badly injured but conscious. He hears the nurse say "Young man, I am so sorry... but you were the only survivor. But I have some good news. The doctor is here. And wants to see you..." and she points to the door of the hospital room. And just then the son's father, the chief of surgery at the hospital... without a scratch... walks into the room.
Click to expand...
I can't lie. When I first heard this riddle, when I was a wee child many decades ago, I definitely couldn't figure it out.

Now, it seems so obvious, and I think the current generation finds this much less tricky than I once did.
 
TheWallnerus said:
A prominent surgeon is driving a sports car down a twisty road. The surgeon's son is in the passenger seat. In a flash someone jumps out in front of the car. The surgeon swerves, and they crash down a ravine.

The son wakes up in the hospital, badly injured but conscious. He hears the nurse say "Young man, I am so sorry... but you were the only survivor. But I have some good news. The doctor is here. And wants to see you..." and she points to the door of the hospital room. And just then the son's father, the chief of surgery at the hospital... without a scratch... walks into the room.
Click to expand...
There were at least 2 old white men in the car!

In the news, ASTRO is relevant again:

www.cnbc.com

Here's everything Amazon just announced: A home robot named Astro, a fitness band and more

Amazon announced a home robot named Astro, a new Echo Show 15 smart screen, a thermostat, a new fitness tracker and more.
www.cnbc.com www.cnbc.com
 
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elementaryschooleconomics said:
I can't lie. When I first heard this riddle, when I was a wee child many decades ago, I definitely couldn't figure it out.

Now, it seems so obvious, and I think the current generation finds this much less tricky than I once did.
Click to expand...

RadOncDoc21 said:
There were at least 2 old white men in the car!

In the news, ASTRO is relevant again:

www.cnbc.com

Here's everything Amazon just announced: A home robot named Astro, a fitness band and more

Amazon announced a home robot named Astro, a new Echo Show 15 smart screen, a thermostat, a new fitness tracker and more.
www.cnbc.com www.cnbc.com
Click to expand...
Definitely had a sharper edge before gay marriage was legalized. I botched it a little. Forgot to emphasize the son IS the biological son of the surgeon driving the car, and the doctor that walked into the room.
 
TheWallnerus said:
A prominent surgeon is driving a sports car down a twisty road. The surgeon's son is in the passenger seat. In a flash someone jumps out in front of the car. The surgeon swerves, and they crash down a ravine.

The son wakes up in the hospital, badly injured but conscious. He hears the nurse say "Young man, I am so sorry... but you were the only survivor. But I have some good news. The doctor is here. And wants to see you..." and she points to the door of the hospital room. And just then the son's father, the chief of surgery at the hospital... without a scratch... walks into the room.
Click to expand...
Is this a joke about women‘s driving skills? I find this inappropriate!
 
medgator said:
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1632929897843.png
 
elementaryschooleconomics said:
View attachment 343946
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Breast is everything right and everything wrong in radiation oncology. It's the number one diagnosis in almost every rad onc dept and provides 25-50% of every center's compensation. So, one would think, we have a lot riding on breast. And that "messing around" with our... let's face it... gravy train... would be unwise.

In science often times a good block against dramatic change is that the vast majority of hypotheses turn out to be wrong. Not in breast hypofractionation! In a miracle hitherto unseen in science: every single hypofractionation hypothesis has turned out to be unfalse. Sixteen fraction? Works. Fifteen fraction? Works. Thirteen fraction? Not unlucky at all. 5 fraction? Works. Single fraction?? Works! Boost or no boost in hypofx? Works, or doesn't (no data). TARGIT-A??? Works the best because it's the breast RT trial in the modern era with the most striking survival advantage. And don't get me started on elective nodal irradiation. It works. Of course not doing ENI seems to work just as well if we're honest. And whole breast versus IMPORT-LOW? No difference!

To face facts, if the external beam is your treatment tool, you can not wield it any conceivably different way than you do now except to lower survival. And again, fortunately, all the different external beam perturbations haven't really shown us decreasing survival (except according to the TARGITists). Thank God.

Again. I don't know why we haven't tested a single drop of Tc-99m on the nipple after lumpectomy. It will be non-inferior to every fractionation scheme we have tried... and may even lead to improved survival.
 
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RickyScott said:
Didn’t sound like mskcc grads had much luck w/jobs this year. Next year going to be even worse for big radonc, especially if you are an Indian, Asian, white male.
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The Sloan residents will continue to serve their purpose: helping the faculty generate RVUs to make a tremendous amount of money for the Sloan Corporation while getting paid a (relatively) meager salary.

I would love it if there were some way we could quantify the profit margin on a RadOnc resident, really at any institution, but especially at Sloan, Anderson, etc. It would be even more interesting to see the profit margins on the folks at those institutions who have authorship on any sort of financial toxicity publications.
 
Saw this on Twitter:
1632937561695.png


I remember when I applied, I was also thinking of dual applying to medicine as a back up. I applied to the majority of the programs. After submitting my application, I was anxiously waiting for the interviews to come in. After each invite, a slight sigh of relief. The stat I remembered was 95% chance of getting into rad onc if you get at 9 interviews, so a slightly bigger sigh of relief at that point. I went on 10 interviews and was still a nervous wreck on Match Day, thinking about what I would have to do in my gap year if I didn't match.

Now this person, I know nothing about - could have amazing stats or crap stats, but either way - they are confident they will become a rad onc before getting even one interview. Not saying this person is cocky, but more a reflection of how the times have changed!
 
w00tz said:
Saw this on Twitter:
View attachment 343953

I remember when I applied, I was also thinking of dual applying to medicine as a back up. I applied to the majority of the programs. After submitting my application, I was anxiously waiting for the interviews to come in. After each invite, a slight sigh of relief. The stat I remembered was 95% chance of getting into rad onc if you get at 9 interviews, so a slightly bigger sigh of relief at that point. I went on 10 interviews and was still a nervous wreck on Match Day, thinking about what I would have to do in my gap year if I didn't match.

Now this person, I know nothing about - could have amazing stats or crap stats, but either way - they are confident they will become a rad onc before getting even one interview. Not saying this person is cocky, but more a reflection of how the times have changed!
Click to expand...

I would bet $100000 the median number of interviews per applicant has or will increase

Programs panic interviewing everybody in 2021
 
With all the money they could put towards RT research and this is the question they want to ask. Using that PPS exemption wisely I suppose,
 
w00tz said:
Saw this on Twitter:
View attachment 343953

I remember when I applied, I was also thinking of dual applying to medicine as a back up. I applied to the majority of the programs. After submitting my application, I was anxiously waiting for the interviews to come in. After each invite, a slight sigh of relief. The stat I remembered was 95% chance of getting into rad onc if you get at 9 interviews, so a slightly bigger sigh of relief at that point. I went on 10 interviews and was still a nervous wreck on Match Day, thinking about what I would have to do in my gap year if I didn't match.

Now this person, I know nothing about - could have amazing stats or crap stats, but either way - they are confident they will become a rad onc before getting even
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She will at least be a radiation oncology resident.

She will be a radiation oncologist as well, but whether she is a RO with a job that she feels happy and fulfilled in... that's the new gamble. The risk of not matching of my (and w00tz's) generation has now been kicked down the line to the risk of not finding a fulfilling job, at least right now. Perhaps (some feel likely on this board) by the time this student graduates residency, it will be the risk of finding A job, ANY job.

May the odds ever be in her favor.
 
SubserviantToABR said:
Signed,
3rd year attending with <25ile MGMA salary
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so the market is for sure scary for current and future residents

BUT I gotta ask.

did you have some weird super specific location requirement? why are you making so low?

maybe one of my PP brothas can throw you a bone. we just hired a new start this past july.
 
SubserviantToABR said:


Interview season can be a scary and uncertain time.

If you think residency interviews are scary, just wait until you have to find a job after residency!

Signed,
3rd year attending with <25ile MGMA salary
Click to expand...

Join the club brother (or sister); I'm there at <25ile with you
 
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