Rad Onc Twitter

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Lot of buzz in Uro Twitter about TAR-200. A sustained release intravesical gemcitabine tube placed into the bladder. Phase 1 trial in the neoadjuvant setting with promising pCR rates in low volume disease prior to cystectomy. Currently accruing phase 2 and 3trials looking at that, bcg unresponsive T1 disease, and most interestingly as an RCT of TAR-200 plus cetrelimab vs chemorads.

TAR-200/Cetrelimab Under Investigation in Muscle-Invasive Bladder Cancer look

Crazy the type/volume of trials you get with pharma money involved. Don’t see that in surgery or radiation.
 
DoctwoB said:
Lot of buzz in Uro Twitter about TAR-200. A sustained release intravesical gemcitabine tube placed into the bladder. Phase 1 trial in the neoadjuvant setting with promising pCR rates in low volume disease prior to cystectomy. Currently accruing phase 2 and 3trials looking at that, bcg unresponsive T1 disease, and most interestingly as an RCT of TAR-200 plus cetrelimab vs chemorads.

TAR-200/Cetrelimab Under Investigation in Muscle-Invasive Bladder Cancer look

Crazy the type/volume of trials you get with pharma money involved. Don’t see that in surgery or radiation.
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If only Johnson & Johnson could put a patent on the use of electrons in medicine, then they could charge for the current in the Bovie, the screen on the Da Vinci, or per the MU for breast boosts.
 
thecarbonionangle said:
I forsee more of these “retirements”. These hellpit places are getting 60 applications if that. Many of them are facing a terrible match prospect for the forseable future. UK already cut the match to 401ks using the pandemic as an excuse. Why would you want to preside over departments who cannot match and employees have decreasing salaries and benefits. Retirement with a sweet pension new grads no longer have access to and continue grift elsewhere opening up clinics in Scotland all of a sudden sounds great. Sneak out the backdoor with tons of cheese before the ship sinks is what our “leaders” do.
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60 applications may even be a stretch. based on that twitter account, it looks like every pgy2 at ukentucky was a general surgery resident at some point. couldn't even match the people who wanted rad onc in the first place. but hey, as long as their faculty don't have to go uncovered, am i right?
 


This is the type of research I’d like to see more of. Risky trials that have the potential to expand indications. Unfortunately it might only be possible at very high volume centers like mdacc
 
radOresident said:
60 applications may even be a stretch. based on that twitter account, it looks like every pgy2 at ukentucky was a general surgery resident at some point. couldn't even match the people who wanted rad onc in the first place. but hey, as long as their faculty don't have to go uncovered, am i right?
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Additionally, at least one of their senior residents transferred programs to finish training elsewhere last year.
 
elementaryschooleconomics said:
Additionally, at least one of their senior residents transferred programs to finish training elsewhere last year.
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This is not going to end well.

A recruiter recently told me an internist at their hospital went back to residency to "do what I did". She said it like it's something you just sign up for if you want to. I couldn't believe it, but I googled this person and it was true. How did this hospitalist have time to do the multiple away rotations and publish the research needed to match into rad onc? Remember how important that used to be? Some more googling out of curiosity finds people who did internship years ago, never did a residency, and are now training in rad onc.

What can be done to get the message out to people like this poor hospitalist that retraining in rad onc is likely going to leave them in a much worse spot than they were to begin with? Imagine the opportunity cost of losing 4 years of a $400k income + retirement match in a field where you can literally work anywhere to retrain in something only to fail boards, have no reasonable employment prospects and end up struggling to claw your way back into a hospitalist gig in your 40s. Why would someone like this not just complete a far more lucrative and geographically flexible med onc fellowship?

It's like rad onc suddenly became the Caribbean medical school of residency. The applications are all rubber stamped and everyone thinks they are going to be the 1% exception like that guy who went to some island and got an ortho residency and not the 50% who graduated and couldn't get a residency at all.
 
Moonbeams said:
This is not going to end well.

A recruiter recently told me an internist at their hospital went back to residency to "do what I did". She said it like it's something you just sign up for if you want to. I couldn't believe it, but I googled this person and it was true. How did this hospitalist have time to do the multiple away rotations and publish the research needed to match into rad onc? Remember how important that used to be? Some more googling out of curiosity finds people who did internship years ago, never did a residency, and are now training in rad onc.

What can be done to get the message out to people like this poor hospitalist that retraining in rad onc is likely going to leave them in a much worse spot than they were to begin with? Imagine the opportunity cost of losing 4 years of a $400k income + retirement match in a field where you can literally work anywhere to retrain in something only to fail boards, have no reasonable employment prospects and end up struggling to claw your way back into a hospitalist gig in your 40s. Why would someone like this not just complete a far more lucrative and geographically flexible med onc fellowship?

It's like rad onc suddenly became the Caribbean medical school of residency. The applications are all rubber stamped and everyone thinks they are going to be the 1% exception like that guy who went to some island and got an ortho residency and not the 50% who graduated and couldn't get a residency at all.
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What is even more disheartening is that for the hospital admin doing the hiring for rad onc in Elizabethtown KY sees two CVs come in across his desk... one from a 40yo female who is board certified in internal medicine and rad onc, and trained at UK, and a 31yo guy who did a rad onc residency in Manhattan... which CV do you think he will keep and which one will he trash? Spoiler alert: the hospital admin played football at UK and both his kids are in college there.

"But nobody who does a rad onc residency in Manhattan applies for a job in rural Kentucky."

Right.
 
Moonbeams said:
This is not going to end well.

A recruiter recently told me an internist at their hospital went back to residency to "do what I did". She said it like it's something you just sign up for if you want to. I couldn't believe it, but I googled this person and it was true. How did this hospitalist have time to do the multiple away rotations and publish the research needed to match into rad onc? Remember how important that used to be? Some more googling out of curiosity finds people who did internship years ago, never did a residency, and are now training in rad onc.

What can be done to get the message out to people like this poor hospitalist that retraining in rad onc is likely going to leave them in a much worse spot than they were to begin with? Imagine the opportunity cost of losing 4 years of a $400k income + retirement match in a field where you can literally work anywhere to retrain in something only to fail boards, have no reasonable employment prospects and end up struggling to claw your way back into a hospitalist gig in your 40s. Why would someone like this not just complete a far more lucrative and geographically flexible med onc fellowship?

It's like rad onc suddenly became the Caribbean medical school of residency. The applications are all rubber stamped and everyone thinks they are going to be the 1% exception like that guy who went to some island and got an ortho residency and not the 50% who graduated and couldn't get a residency at all.
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If that poor hospitalist made his decision in the last 5 years, the message was indeed out there, and that hospitalist has no one to blame but her or himself for making what I do agree would be a poor decision.

We've done all we can in that time. The consequences of that decision are on the hospitalist, not on us anymore.
 
radOresident said:
60 applications may even be a stretch. based on that twitter account, it looks like every pgy2 at ukentucky was a general surgery resident at some point. couldn't even match the people who wanted rad onc in the first place. but hey, as long as their faculty don't have to go uncovered, am i right?
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Not necessarily - in recent history, due to the decrease in quality of applicants, a Rad Onc applicant (especially at a non-top program) may match Rad onc with ease but fail to match into a prelim IM or TY program, and thus have to do prelim surg. I remember incoming rad onc residents who were posting on Twitter about how they were unable to secure ANY prelim year (including prelim surg).
 
elementaryschooleconomics said:
Additionally, at least one of their senior residents transferred programs to finish training elsewhere last year.
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UK had two residents transfer out last year. In the last several years they have matched FMGs who couldn't get PGY-1 spots. They have picked up multiple prelim surgery interns who did not secure advanced training spots in surgery to fill any open positions. No idea if this had anything to do with their chair leaving. It used to be you needed to be a med student in the top 10% with a great personality and research or a MD Phd to even get a spot at programs of UK's caliber. Now it's just who is willing and able to sign up! I wonder if UK is considering going from 6 to 4 residents, lol.

This is probably representative of what's been going on in many lower tier programs over the past several years.
 
evilbooyaa said:
Not necessarily - in recent history, due to the decrease in quality of applicants, a Rad Onc applicant (especially at a non-top program) may match Rad onc with ease but fail to match into a prelim IM or TY program, and thus have to do prelim surg. I remember incoming rad onc residents who were posting on Twitter about how they were unable to secure ANY prelim year (including prelim surg).
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I did a surgery intern year intentionally. But this was back in a time when interns actually got to go to the O.R. a little and do a lot of minor procedures too (at least at the VA!). A month of neurosurgery, urology, CT surgery, ENT, gyn, etc., in your intern year is helpful. But who knows a month in cardiology in your intern year in the future may be VERY helpful.
 
TheWallnerus said:
OH MY GOD RESIDENCY PROGRAM AND CLERKSHIP DIRECTORS AND DEANS CONSIDERING RESIDENCY CAPS IN OB GYN

Has the FBI been called???

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OB which is not exactly known for a nurturing culture allows for a pgy2 to put their name on such a piece without putting their career at risk. Meanwhile in the rad onc snake pit, a young faculty at Washu is ostracized and unfriended after a hit job by Hallahan and Lee et al for simply sounding the alarm, only to now find himself on top of workforce commission, one of the most visible people in our field. The morale of the story is to stop being a turtle and stick your neck out every once in a while for what you know is right. You might actually amount to something in our putrid swamp of inaction!
 
TheWallnerus said:
OH MY GOD RESIDENCY PROGRAM AND CLERKSHIP DIRECTORS AND DEANS CONSIDERING RESIDENCY CAPS IN OB GYN

Has the FBI been called???

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I think it's "just" a cap on the number of residency applications and interviews medical students can send/accept, not on the number of residency spots.

However, the point stands - a coordinated effort on the part of physicians (or soon-to-be physicians) to place some kind of limit/restriction on an aspect of the residency system. ASTRO would indeed have labeled this anti-trust a mere 5 years ago.

Is the FBI even enough? I think we should call the FBI, DEA, Homeland Security, the Navy Seals, appoint a special prosecutor, and hold trials on an abandoned cargo ship 26 miles off the coast of Maine.
 
elementaryschooleconomics said:
I think it's "just" a cap on the number of residency applications and interviews medical students can send/accept, not on the number of residency spots.

However, the point stands - a coordinated effort on the part of physicians (or soon-to-be physicians) to place some kind of limit/restriction on an aspect of the residency system. ASTRO would indeed have labeled this anti-trust a mere 5 years ago.

Is the FBI even enough? I think we should call the FBI, DEA, Homeland Security, the Navy Seals, appoint a special prosecutor, and hold trials on an abandoned cargo ship 26 miles off the coast of Maine.
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I think the main reason for the cap is in the era of online interviews, there are too many people in every specialty accepting every interview invitation because there is no airfare barrier. Even rad onc is talking about this

The Game Continues: Seeking Clarity in the Radiation Oncology Match

Though the previous Gaming the Match agreement offered guidance to programs on how best to approach the Match process, guidance for applicants remains inconsistent. Here we review and propose guidelines by which the spirit of the Match may better be achieved for both program directors and...
www.advancesradonc.org


1638936229029.png
 
radiation said:
I think the main reason for the cap is in the era of online interviews, there are too many people in every specialty accepting every interview invitation because there is no airfare barrier. Even rad onc is talking about this

The Game Continues: Seeking Clarity in the Radiation Oncology Match

Though the previous Gaming the Match agreement offered guidance to programs on how best to approach the Match process, guidance for applicants remains inconsistent. Here we review and propose guidelines by which the spirit of the Match may better be achieved for both program directors and...
www.advancesradonc.org


View attachment 346581
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What on Earth are they trying to say?
 


Seems like this is the party line this year. Will be intersting to see what happens

Anecdotally I have heard from a friend in academics that apps look better this year than 2020
 
jondunn said:


Seems like this is the party line this year. Will be intersting to see what happens

Anecdotally I have heard from a friend in academics that apps look better this year than 2020
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Quality, what about quantity? Going to guess the high quality US MD applicants have not gone up, may have gone down with all the APM nonsense happening.

Unc isn't looking like a lock for matching someone anywhere close to where they were matching people a decade ago i wager
 
Very interesting to see people who liked that tweet, mostly residents and faculty at certain departments. Columbia PD one of them of course. A great calamari game is coming. If you cannot fill your program you should shut down without any SOAP or taking anybody with a pulse. I don’t care about your feelings and your cheerleading. A great SOAP is coming for many of these folks!
 
Going back to the theme of a fundamental divide in this field. This reminds me of when a douchebag economist says something like “the fundamentals of the economy are strong” or “economy is great look at the stock market” while the average “real america” cannot afford milk meat and gasoline and clearly dont give a F about your ETFs and kathy wood. If you do not understand this, you will simply be slaughtered as a field. There might be some great applicants but clearly mathematically not everyone can have them. There are over double the residency spots for the amount of applications some places are getting with 60 and less. Just because someone speaks to you in a zoom doesnt mean they are going to match with you.
 
jondunn said:


Seems like this is the party line this year. Will be intersting to see what happens

Anecdotally I have heard from a friend in academics that apps look better this year than 2020
Click to expand...

My (total anecdote) sense is that, all else being equal, 2020 was where we bottomed out in terms of both quality and quantity. With everything being virtual, it was very hard for the #RaRaRadOnc faculty at residency institutions to sway students in-person with their soothsaying about the health of clinical RadOnc as a physician career. As in-person experiences claw their way back, impressionable students will listen to some of the charismatic folks in the field.

I'll predict that (again, ceteris paribus) total application numbers will hover at this level, and applicant quality will mild-to-moderately increase in the coming years (which will be difficult to judge against historical controls, given Step 1 being Pass/Fail).

I'll also predict that, when the dust settles in time for ASTRO 2022, the job market "reports" (if surveys can be called that) for 2021-2022 will be skewed positive. There seems to be A LOT of upheaval regarding people changing jobs or dialing back clinical presence compared to 5 years ago, at least in my personal circles. I think pandemic burnout and the same forces behind the "Great Resignation" in all sectors of the economy have crept into Radiation Oncology as well.

2022 is shaping up to be just as interesting as 2021, and 2020!
 
elementaryschooleconomics said:
My (total anecdote) sense is that, all else being equal, 2020 was where we bottomed out in terms of both quality and quantity. With everything being virtual, it was very hard for the #RaRaRadOnc faculty at residency institutions to sway students in-person with their soothsaying about the health of clinical RadOnc as a physician career. As in-person experiences claw their way back, impressionable students will listen to some of the charismatic folks in the field.

I'll predict that (again, ceteris paribus) total application numbers will hover at this level, and applicant quality will mild-to-moderately increase in the coming years (which will be difficult to judge against historical controls, given Step 1 being Pass/Fail).

I'll also predict that, when the dust settles in time for ASTRO 2022, the job market "reports" (if surveys can be called that) for 2021-2022 will be skewed positive. There seems to be A LOT of upheaval regarding people changing jobs or dialing back clinical presence compared to 5 years ago, at least in my personal circles. I think pandemic burnout and the same forces behind the "Great Resignation" in all sectors of the economy have crept into Radiation Oncology as well.

2022 is shaping up to be just as interesting as 2021, and 2020!
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You don’t get a numerical score for step 1 anymore??? I know it was always “pass/fail” but we all know that the number mattered immensely
 
Lamount said:
You don’t get a numerical score for step 1 anymore??? I know it was always “pass/fail” but we all know that the number mattered immensely
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Nope. In a little more than a month (Jan 26th, last I heard), USMLE Step 1 will only be reported as pass/fail with no numerical score. Also, Step 2 CS has been abolished for the past year or so.

It's crazy how much has changed so quickly.
 
elementaryschooleconomics said:
Nope. In a little more than a month (Jan 26th, last I heard), USMLE Step 1 will only be reported as pass/fail with no numerical score. Also, Step 2 CS has been abolished for the past year or so.

It's crazy how much has changed so quickly.
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CS is gone? Hopefully those folks can find work.
29130303194d5841f_w.jpg
 
elementaryschooleconomics said:
My (total anecdote) sense is that, all else being equal, 2020 was where we bottomed out in terms of both quality and quantity. With everything being virtual, it was very hard for the #RaRaRadOnc faculty at residency institutions to sway students in-person with their soothsaying about the health of clinical RadOnc as a physician career. As in-person experiences claw their way back, impressionable students will listen to some of the charismatic folks in the field.

I'll predict that (again, ceteris paribus) total application numbers will hover at this level, and applicant quality will mild-to-moderately increase in the coming years (which will be difficult to judge against historical controls, given Step 1 being Pass/Fail).

I'll also predict that, when the dust settles in time for ASTRO 2022, the job market "reports" (if surveys can be called that) for 2021-2022 will be skewed positive. There seems to be A LOT of upheaval regarding people changing jobs or dialing back clinical presence compared to 5 years ago, at least in my personal circles. I think pandemic burnout and the same forces behind the "Great Resignation" in all sectors of the economy have crept into Radiation Oncology as well.

2022 is shaping up to be just as interesting as 2021, and 2020!
Click to expand...

agree on every point
 
elementaryschooleconomics said:
Nope. In a little more than a month (Jan 26th, last I heard), USMLE Step 1 will only be reported as pass/fail with no numerical score. Also, Step 2 CS has been abolished for the past year or so.

It's crazy how much has changed so quickly.
Click to expand...

CS was an abortion of exam and complete money grab - good riddance
 
deleted969641 said:
The reality is that we have a phase 3 randomized trial of 222 patients that showed a statistically significant improvement in graded toxicity and quality of life metrics (large difference in the latter) without any reported serious adverse events. Which leads me to believe the rare adverse events that are happening via anecdote may have other factors involved other than spaceOAR just sucking in general. And the response is that we don't have good data that it works and it is safe, but we have a lot of "data" apparently that patients are embolizing and dropping dead. Hmm.. I don't think so!
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Do we?

Have I been misled that the primary endpoint of GI toxicity at six months was not met - and given that the primary endpoint was not met does that not mean that secondary endpoints are no longer evaluable?

I know how I approach those issues - we do not have statistically significant improvement in graded toxicity and quality of life metrics when the primary endpoint of the trial was not met.

And the primary endpoint was not met.

There is a lot of spin around this study.

My apologies if this point has previously been discussed already.
 
If the primary endpoint is not met than nothing else in the study matters ??
 
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I could be wrong (as I am no expert) but I thought that the study is designed, with respect to sample size (based on projected differences), for the primary endpoint. The secondary endpoints are of interest, but not what the sample size is contingent upon. But statistical significance is based solely upon probabilities, and therefore secondary endpoints can statistically significantly different regardless of the the primary endpoints' differences.
 
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Many rad onc trials are designed to have no chance at detecting a difference in the primary endpoint while having a chance at detecting a difference in 1 of the 20 secondary toxicity endpoints.
 
radiaterMike said:
I could be wrong (as I am no expert) but I thought that the study is designed, with respect to sample size (based on projected differences), for the primary endpoint. The secondary endpoints are of interest, but not what the sample size is contingent upon. But statistical significance is based solely upon probabilities, and therefore secondary endpoints can statistically significantly different regardless of the the primary endpoints' differences.
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1638965336665-jpeg.346585



1638965737269-jpeg.346586
 
OK ... makes sense. It seems as though it is still just probabilities, but maybe with 20 unpowered analyses, the p value for significance should be adjusted. But I see the point. Unfortunately most of the spin in radiation oncology is not centered on trial outcomes.
 
jondunn said:


Seems like this is the party line this year. Will be intersting to see what happens

Anecdotally I have heard from a friend in academics that apps look better this year than 2020
Click to expand...


I am on board with calling out residency expansion… but Lemmiwinks post on twitter made me cringe. 🤮 If you are in a debate and you are the one calling scores of nameless med students “deplorables”, you LOST, regardless of the point you are trying to make.
 
Lamount said:
I am on board with calling out residency expansion… but Lemmiwinks post on twitter made me cringe. 🤮 If you are in a debate and you are the one calling scores of nameless med students “deplorables”, you LOST, regardless of the point you are trying to make.
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Even Michael Jordan missed a foul shot now and then
 
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