Rad Onc Twitter

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OTN said:
From a hospital administrator standpoint, the "correct" profit margin is the most that can be extracted, and paying the radonc as little as market forces will allow is the correct way to accomplish this.

Now, one could argue (and I would) that this is short-sighted, and paying a little more (in the current market, given the intentional oversaturation of radonc supply by academia, that's all you would need) to get a good radonc will increase profit margin long-term. I would not expect to win that argument with administration, however, as their bonus structures are set to much tighter timelines than this kind of planning would allow.
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I have seen that hospitals have little interest in incentivizing rad oncs in a mutually beneficial way instead favoring minimizing physician salary expense above all else. The easiest and most effective way to incentivize is let them buy into a portion of the machine, indebting them to the success of the practice (and tying them down for the long haul) and motivating them to produce. What I found was actually the opposite. Accessing TC is off the table, and they instead dangle an RVU bonus in front of you and do everything possible to make sure you can never realize any bonus, thereby motivating you to produce as little as possible once you realize your base salary is your ceiling. Physician gets frustrated after a few years and rather than work with them, they show them the door and bring on locums (who will not produce to the level of a good rad onc as you point out) for as long as needed to repeat the cycle again.
 
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jondunn said:
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Those aren't even proper sentences. We need people fluent in English. In all seriousness, why can't tweeted sentences have subject nouns? Also, in the context of people who opt to use "they" as their pronoun, why aren't the verbs conjugated as if it's a singular subject? "They is going to the store," for instance. Using a verb as if "they" refers to multiple people implies a pathology in the subject, like multiple personality disorder. These are important questions. Also, is the radonc Twitter thread finally dying?
 
Ray D. Ayshun said:
. Also, is the radonc Twitter thread finally dying?
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In a sense, yes. We have a certain poster who just spam posts the thread with random tweets and provides no commentary, which would be helpful as some of them in the past have had questionable relevance to RO?
 
medgator said:
In a sense, yes. We have a certain poster who just spam posts the thread with random tweets and provides no commentary, which would be helpful as some of them in the past have had questionable relevance to RO?
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I'm more interested in knowing how people think we should conjugate verbs when "they" is used to refer to a single person.
 
Ray D. Ayshun said:
I'm more interested in knowing how people think we should conjugate verbs when "they" is used to refer to a single person.
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In my native language, the third person pronoun is not gendered.

So I vote we take the ambiguity all the way. They can be both singular and plural. The conjugation determines if the antecedent is one or many.
 
Ray D. Ayshun said:
I'm more interested in knowing how people think we should conjugate verbs when "they" is used to refer to a single person.
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This is like nails on a chalkboard for me.

I don't really have any interest in engaging in the pronoun stuff, but I will say that using "they" as a singular triggers me to no end as a former student of linguistics. I instructed on this in college and would mercilessly markup and deduct for subject verb disagreement. Call yourself zot or blee or whatever, just don't repurpose a word to imply the opposite of what it has meant for literally all of the history of the English language (singular vs. plural). Or maybe I'm just the out of touch principal skinner in the Simpsons meme.

Ok, I'll make one political comment. Ask anybody who grew up under communism, particularly in the USSR, about this zeitgeist of redefining words/PC/having to publicly tout party lines that make no sense/etc, and they will say, yep, seen all this before...
 
maxxor said:
In my native language, the third person pronoun is not gendered.

So I vote we take the ambiguity all the way. They can be both singular and plural. The conjugation determines if the antecedent is one or many.
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Exactly. I get confused when "they are" refers to one person. "They is" would clear that up. They is taking their parents to the mall so they can buy them new shoes.
 
Moonbeams said:
I'm talking about a hospital making a >50% profit margin on the TC and using it to make up for shortfalls elsewhere (or something like chemo with 340b). That guy's argument was flooding the market and taking a hefty chunk of the pro too without anyone being the wiser. Academic centers generally don't discuss their billing and collections, they say here is your base salary, RVU target, and scheme for dividing up RVUs over target. We can change it at any time with no notice as required to support the financial health of the institution. Attempts to negotiate are unprofessional and will be met with withdrawal of the offer.
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Most hospital admins I think just believe that rad onc TC is magic, “it just happens” like some benevolent force majeure
 
The stage 3 lung and pancreas calls are interesting and i know they've been echoed elsewhere on this forum but I'm just not seeing it IRL.

When you are in a rural setting/suburbia, you just aren't going to have the same level of access to good CT and Whipple surgeons. The stage 3 lung thing doesn't make sense either in that IO was specifically looked at in unresectable pts
 
jondunn said:
Like clockwork lol. Dude all the Med onc fellow was saying was ‘hey you rad oncs are cool’

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So… Lemmiwinks (wherever you are)

If you keep telling everyone our field is dying, they will believe you.

We are not on the way out in stage III lung. Thoracic surgeons are secretly nervous about neoadj IO because they think the whole field will move toward non-operative management. There are like 7 cooperative group trials combing RT with new move immunotherapy drug combos for stage III… it’s an area in which there is some real research.

Nobody wants that bitter guy at the party who always complains about how great things used to be and how much they suck now… and it’s not as though you are helping us with this comment. “I am just trying to protect med students from making a mistake”, right? Sounds more like someone trying to make kicking the dirt sound noble.
 
SDN usually great, although the periodic pronoun diatribes are effing preposterous. Linguistics?

Many languages have no gender specific personal pronouns.

Ebonics? A semi-creole language in my estimation. Like some southern white dialect. Y'all get your panties in a bunch over y'all?

Where is Turaco? They are in the closet.
 
Getting deluded self-important chairs to shrink our residency contingent is a worthwhile endeavor… this would actually help our field.

…but wallowing for the sake of wallowing is pointless —and doing it on social media, as if you speak for all of us, is destructive.
 
Lamount said:
Getting deluded self-important chairs to shrink our residency contingent is a worthwhile endeavor… this would actually help our field.

…but wallowing for the sake of wallowing is pointless —and doing it on social media, as if you speak for all of us, is destructive.
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There's enough ra ra from the pro RO crowd happening on Twitter too, we even have chairs at good programs kissing up to rotating MS's etc. No one gave a **** about me when i rotated through a dept, let alone having a chair trying to grovel me.

It is a bit ridiculous to watch fractions go down, indications fall by the wayside etc while those in charge don't seem to acknowledge the obvious until literally our specialty gets embarrassed in the match a few years in a row.

If we are playing less of a role in some gi cancers, post op lung, etc, could argue we should be well below residency numbers from a decade ago and yet nothing is really happening on that front minus the residency requirements being tightened up a bit which will take several years to trickle through
 
medgator said:
There's enough ra ra from the pro RO crowd happening on Twitter too. It is a bit ridiculous to watch fractions go down, indications fall by the wayside etc while those in charge don't seem to acknowledge the obvious until literally our specialty gets embarrassed in the match a few years in a row.

If we are playing less of a role in some gi cancers, post op lung, etc, could argue we should be well below residency numbers from a decade ago
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You know what surgeons said when PACIFIC came out “well, just wait until you see our trials. Surgery will always have a role”. They weren’t running around screaming about the sky falling. They got to work accruing patients to Checkmate and IMpower

We’ve got encouraging data… now they do too. Ball’s in our court.

Sounds like we should be getting to work -accruing to ANY NUMBER of phase III trials in the space- rather than wallowing about their data.
 
Lamount said:
We are not on the way out in stage III lung.
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Stage III lung, itself, is on the way out, a lot, and we are on the way out in Stage III lung quite a bit (not as much as "a lot," granted)... *ART* cough

It's like compound interest, or geologic processes, or frogs jumping halfway to a wall, or "lim," etc etc. Use your imagination. It won't take much imagination.
Lamount said:
You know what surgeons said when PACIFIC came out “well, just wait until you see our trials. Surgery will always have a role”.
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If I would have heard this I would have felt... confused. "Surgery will always have a role in patients for which surgeons did not want to operate?"
 
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TheWallnerus said:
Stage III lung, itself, is on the way out, a lot, and we are on the way out in Stage III lung quite a bit (not as much as "a lot," granted)... *ART* cough

It's like compound interest, or geologic processes, or frogs jumping halfway to a wall, or "lim," etc etc. Use your imagination. It won't take much imagination.
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Or… alternatively… someone asks the question: what about those folks who get neoadj IO and have little or no response in their N2 disease? I bet those folks cancer has some bad biology and have a high risk of local recurrence. If only there was something we could try…

As much fun as it is to look at past trends and imagine how they will asymptotically approach zero…
 
Lamount said:
Sounds like we should be getting to work -accruing to ANY NUMBER of phase III trials in the space- rather than wallowing about their data
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I like your enthusiasm, but this is the thinking of an academic doc. (This is a good thing.)

I agree wallowing is not helpful.

But in a community tumor board, it goes like this: 82 y/o active smoker with moderate COPD and stage III disease is presented. Thoracic surgeon brings up option of neoadjuvant chemoimmunotherapy plus lobectomy. (Never would have happened 2 years ago)

Now if you've established your personality, you bring up age disparity. They are probably close to the oldest patient on Checkmate 816 (but also very old for Pacific) and the outstanding long term outcomes for chemorads plus immuno. But, you are the third person in a room of three.

Am I going to be eager to enroll this patient on a randomized trial? Would I recommend this for my own mother if in the same condition? Probably not.

If I could pick one lung trial to enroll patients on, it would be a trial looking at observation vs radical treatment (SBRT or segmental+ resection) for patients 75 and up with low grade lung adenocarcinomas. Is anyone doing a trial like this? Also, definitely not a good trial for radonc numbers.
 
Lamount said:
So… Lemmiwinks (wherever you are)

If you keep telling everyone our field is dying, they will believe you.

We are not on the way out in stage III lung. Thoracic surgeons are secretly nervous about neoadj IO because they think the whole field will move toward non-operative management. There are like 7 cooperative group trials combing RT with new move immunotherapy drug combos for stage III… it’s an area in which there is some real research.

Nobody wants that bitter guy at the party who always complains about how great things used to be and how much they suck now… and it’s not as though you are helping us with this comment. “I am just trying to protect med students from making a mistake”, right? Sounds more like someone trying to make kicking the dirt sound noble.
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Neoadjuvant chemo/io trials with path response endpoint can be run many times faster than non surgical trials and this approach will evolve/ optimize much faster than definitive drug/xrt trials relying on dfs/os endpt. (Path cr to drugs/io is reflective of systemic path cr, while path cr to drug/xrt is not).
 
communitydoc13 said:
I like your enthusiasm, but this is the thinking of an academic doc. (This is a good thing.)

I agree wallowing is not helpful.

But in a community tumor board, it goes like this: 82 y/o active smoker with moderate COPD and stage III disease is presented. Thoracic surgeon brings up option of neoadjuvant chemoimmunotherapy plus lobectomy. (Never would have happened 2 years ago)

Now if you've established your personality, you bring up age disparity. They are probably close to the oldest patient on Checkmate 816 (but also very old for Pacific) and the outstanding long term outcomes for chemorads plus immuno. But, you are the third person in a room of three.

Am I going to be eager to enroll this patient on a randomized trial? Would I recommend this for my own mother if in the same condition? Probably not.

If I could pick one lung trial to enroll patients on, it would be a trial looking at observation vs radical treatment (SBRT or segmental+ resection) for patients 75 and up with low grade lung adenocarcinomas. Is anyone doing a trial like this? Also, definitely not a good trial for radonc numbers.
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Granted, I don’t know how your tumor boards work… but I would say something like “It sounds like we have a number of treatments to offer this patient. let’s each meet with him and talk through the options” this usually works with my group.

Then I simply talk about how my approach won’t involve them “going under”, I mention there won’t be any “knives”… chronic chest wall pain. You know all the greatest hits.

The surgeon talks to them about how they won’t cause RP

…the patient makes an informed choice.

We have a dynamic where we all trust each other… so when there are two legit approaches, the patient hears about it all.
 
RickyScott said:
Neoadjuvant chemo/io trials with path response endpoint can be run many times faster than non surgical trials and this approach will evolve/ optimize much faster than definitive drug/xrt trials relying on dfs/os endpt. (Path cr to drugs/io is reflective of systemic path cr, while path cr to drug/xrt is not).
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That is a fair point…

Conversely, non-operative management looms large in this sickly population, and anything with a good pCR is likely to translate to the RT setting rather quickly.
 
medgator said:
The stage 3 lung and pancreas calls are interesting and i know they've been echoed elsewhere on this forum but I'm just not seeing it IRL.

When you are in a rural setting/suburbia, you just aren't going to have the same level of access to good CT and Whipple surgeons. The stage 3 lung thing doesn't make sense either in that IO was specifically looked at in unresectable pts
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I understand for lung.

For pancreas - even if not getting a whipple - straight to chemoRT isn’t really considered the SOC in my area
 
Sheesh, I read these posts and I just cannot relate. In my neck of the woods payors have kicked all the risk over to the med oncs and surgeons, basically making me the coolest kid in town. IO followed by surgery? That would get a good laugh in our tumor board. The only things our med oncs care about are tests that can tell them to avoid chemo, and every patient is medically inoperable as far as the surgeons are concerned.
 
medgator said:
Nor in mine, but eventually they do see RT after a few cycles of chemo if no progression
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Which is not backed up by data. We even have a negative French Phase III trial that tested this concept and failed to show benefit.


pubmed.ncbi.nlm.nih.gov

Effect of Chemoradiotherapy vs Chemotherapy on Survival in Patients With Locally Advanced Pancreatic Cancer Controlled After 4 Months of Gemcitabine With or Without Erlotinib: The LAP07 Randomized Clinical Trial - PubMed

clinicaltrials.gov Identifier: NCT00634725.
pubmed.ncbi.nlm.nih.gov pubmed.ncbi.nlm.nih.gov
 
Palex80 said:
Which is not backed up by data. We even have a negative French Phase III trial that tested this concept and failed to show benefit.


pubmed.ncbi.nlm.nih.gov

Effect of Chemoradiotherapy vs Chemotherapy on Survival in Patients With Locally Advanced Pancreatic Cancer Controlled After 4 Months of Gemcitabine With or Without Erlotinib: The LAP07 Randomized Clinical Trial - PubMed

clinicaltrials.gov Identifier: NCT00634725.
pubmed.ncbi.nlm.nih.gov pubmed.ncbi.nlm.nih.gov
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Local control was better as was delay to reinitiation of therapy. We sometimes will do it to improve resectability also at the request of the surgical oncologist.

More importantly, It's still endorsed by the national guidelines in the US. I don't think anyone believes chemotherapy alone is curative in a localized solid GI tumor
 
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medgator said:
Local control was better as was delay to reinitiation of therapy. We sometimes will do it to improve resectability also at the request of the surgical oncologist.
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All valid endpoints, but not "hard enpoints". No differences in PFS and OS. Patients with irresectable tumors have a bad prognosis, we know that.
medgator said:
More importantly, It's still endorsed by the national guidelines in the US. I don't think anyone believes chemotherapy alone is curative in a localized solid GI tumor
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Of course it's not. But an unresectable tumor is not a curative scenario in my humble opinion.

Radiochemotherapy in pancreatic cancer is not atoxic therapy. You may be improving local control and delay to reinitiation of therapy, but you are producing a lot of toxicity with RCT.
 
Palex80 said:
, but you are producing a lot of toxicity with RCT.
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Really? Has that been your experience with vmat (3DCRT was used in that trial and at least they had the sense not to chase the lymphatics) and xeloda? It certainly has not been mine. I would say esophagus and rectal are more toxic in my experience
 
OTN said:
Why Jordan Johnson thinks he is even remotely qualified to be talking about clinical radiation oncology is waaaaaaay beyond me.
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Jordan Johnson's behavior on Twitter perfectly mirrors the majority of Radiation Therapists I know.
 
OTN said:
Why Jordan Johnson thinks he is even remotely qualified to be talking about clinical radiation oncology is waaaaaaay beyond me.
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Don't get him started on Temodar. Completely expert. He'll pull rank on you. Chemotherapeutics definitely a HUGE part of the RTT curriculum.
 
medgator said:
Really? Has that been your experience with vmat (3DCRT was used in that trial and at least they had the sense not to chase the lymphatics) and xeloda? It certainly has not been mine. I would say esophagus and rectal are more toxic in my experience
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I agree. It's not really all too toxic, which makes it all the more frustrating. Referrals have just dried up (Appropriately; based on the data, IMO).
 
OTN said:
Why Jordan Johnson thinks he is even remotely qualified to be talking about clinical radiation oncology is waaaaaaay beyond me.
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He's no worse than ~90% of rad onc department managers out there.

Also, do you not know how twitter works? It's simple:
1. Pretend to be an expert on everything
2. Post outrageous nonsense for likes from crazy people who will vociferously attack anybody who posts anything remotely sane.

I read from someone who sounded smart that the "like" button will end up being one of the most destructive inventions in all of history. I liked and subscribed.
 
Moonbeams said:
He's no worse than ~90% of rad onc department managers out there.

Also, do you not know how twitter works? It's simple:
1. Pretend to be an expert on everything
2. Post outrageous nonsense for likes from crazy people who will vociferously attack anybody who posts anything remotely sane.

I read from someone who sounded smart that the "like" button will end up being one of the most destructive inventions in all of history. I liked and subscribed.
Click to expand...

Oh, I know how Twitter works. Why do you think I'm here?
 
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