Rad Onc Twitter

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Chartreuse Wombat said:
My thoughts are that QOL endpoints are difficult to study. SDN is not the place to provide a complete answer but the issue is how does one define a clinically meaningful difference in a QOL endpoint also considered as "minimally important difference (MID)".

There are (at least) two ways.

One relies on simple statistics and generally uses 0.5 of a standard deviation (0.5SD) as a MID (this is what GU003 used).

The other is "anchoring" which is more complicated and involves patient focus groups where patients have a distribution of scores and they are asked to rate themselves-is Joe worse off than Bob...more expensive and time consuming.

The paper attached describes some of the problems with studying QOL as endpoints
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so it was designed in order to show hypofrac is non-inferior? I wouldn't be bothered with this if it weren't for the fact that the hypofrac arm is numerically worse, regardless of how squishy the endpoint is. Sure, we can say not ss, but that's because the trial was designed to not allow for that.
 
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RickyScott said:
Btw Pollack doesn’t use a lot of hypofract off protocol. If a regimen can be used to capture distant pts (5 treatments etc) it will be roundly endorsed.
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This is it. Proton studies looking for justification of therapy based on acute toxicity profile, whereas common knowledge that acute toxicity is nearly uniformly worse with hypofractionated regimens (exceptions include moderately hypo breast, which we have all adopted, and 8x1 bone met).

I'm not giving 5 fraction whole breast and not giving hypo post-prostatectomy.

Just look at the peculiar strategic thinking that must be going on with regard to NRG GU trials. Adding apalutamide to abiraterone in clinical scenarios where we don't have data for adding abiraterone alone? Trying to establish a de-facto standard of care for Decipher in high risk patients? What do you think the added cost of care is for this type of BS.

But drop 13 fractions from salvage/adjuvant XRT using opaque endpoints and nearly ensuring non-inferiority? Sure

Hopefully my hospital will defer to my clinical judgement under APM and accept higher staffing and technical costs for more protracted courses that I think are justified in my older, retired population.

As a community physician, your reputation is much more sensitive to rare, adverse outcomes than enormous institutions.
 
Ray D. Ayshun said:
so it was designed in order to show hypofrac is non-inferior? I wouldn't be bothered with this if it weren't for the fact that the hypofrac arm is numerically worse, regardless of how squishy the endpoint is. Sure, we can say not ss, but that's because the trial was designed to not allow for that.
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I will wait for the publication before making any decision about whether to adopt. I did not see the presentation.
 
medgator said:


Be mindful of the drunk contouring... Easily rivals drunk dialing
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1635209566814.png
 
medgator said:


Be mindful of the drunk contouring... Easily rivals drunk dialing
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he's so drunk he only blurred the name in the QUICKLINKS line but not at the top of the window 😉

Surgeon: "I operate when I'm drunnkk *hiccup*" (busted)

Rad onc: "Hold my beer while I drink a beer and contour/HIPAA f**koff at the Waldorf Astoria"

.... aaaaand tweet deleted
 
TheWallnerus said:
he's so drunk he only blurred the name in the QUICKLINKS line but not at the top of the window 😉

Surgeon: "I operate when I'm drunnkk *hiccup*" (busted)

Rad onc: "Hold my beer while I drink a beer and contour/HIPAA f**koff at the Waldorf Astoria"

.... aaaaand tweet deleted
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Ignorance/arrogance meets recklessness at the same time.
 
TheWallnerus said:
he's so drunk he only blurred the name in the QUICKLINKS line but not at the top of the window 😉

Surgeon: "I operate when I'm drunnkk *hiccup*" (busted)

Rad onc: "Hold my beer while I drink a beer and contour/HIPAA f**koff at the Waldorf Astoria"

.... aaaaand tweet deleted
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What did the tweet say? I missed it.
 
TheWallnerus said:
he's so drunk he only blurred the name in the QUICKLINKS line but not at the top of the window 😉

Surgeon: "I operate when I'm drunnkk *hiccup*" (busted)

Rad onc: "Hold my beer while I drink a beer and contour/HIPAA f**koff at the Waldorf Astoria"

.... aaaaand tweet deleted
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Screenshot_20211026-052618_Twitter.jpg

Looks like the walrus is correct. I guess once you've seen a tweet it will still load it hence i was able to view it now. Crazy
 
medgator said:
View attachment 344953
Looks like the walrus is correct. I guess once you've seen a tweet it will still load it hence i was able to view it now. Crazy
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HOLY CRAP.

Imagine thinking is is a good idea to (a) contour in a public place like a bar where everyone can see your business, (b) not only admit to drinking while doing so but in full view of untold bottles of alcohol, (c) forget to properly blur out the patients PHI on the screen, (d) tag our damn professional society in the process and (e) try to shill shamelessly for the company who gives you money like some vapid Instagram model.

I can only imagine the reaction from the ASTRO 2021 Twitter curator when they saw this post.
 
Gfunk6 said:
HOLY CRAP.

Imagine thinking is is a good idea to (a) contour in a public place like a bar where everyone can see your business, (b) not only admit to drinking while doing so but in full view of untold bottles of alcohol, (c) forget to properly blur out the patients PHI on the screen, (d) tag our damn professional society in the process and (e) try to shill shamelessly for the company who gives you money like some vapid Instagram model.

I can only imagine the reaction from the ASTRO 2021 Twitter curator when they saw this post.
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At the same time, it's strange nobody here has questioned whether it's even reasonable to srs 30 mets.
 
Ray D. Ayshun said:
At the same time, it's strange nobody here has questioned whether it's even reasonable to srs 30 mets.
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Alcohol gives you confidence! I’ve seen people do >30, of course at work and definitely not while drinking. I think my threshold is around 10 before I start asking myself isn’t this whole brain anyway.
 
Being active on Twitter always seems like riding the lighting. It's this bizarre arena where you can accelerate becoming well known in your field, but you have to be personable/relatable in specific ways (and Evan did not choose one of the "correct" avenues with that Tweet). Twitter will either cement Spratt's career or destroy him...or both, I guess, like a well known American political figure.

Exciting times! I will continue to just lurk on Twitter.
 
medgator said:
View attachment 344953
Looks like the walrus is correct. I guess once you've seen a tweet it will still load it hence i was able to view it now. Crazy
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It’s hard to find words. Let’s act a fool and risk losing eligibility to sit for ABR boards/job security/etc as possible repercussions for this. Someone who cares for this guy needs to speak into his life ASAP.
 
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StIGMA said:
It’s hard to find words. Let’s act a fool and risk losing eligibility to sit or ABR boards. That’s a possible repercussion for this. Someone who cares for this guy needs to speak into his life ASAP.
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This can be the start of a new instagram thing. We take pics of ourselves contouring in beautiful and/or extreme conditions. In a tent on El Capitan. Next to a line of coke with Keith Richards. Underwater in Australia in a shark cage in chummed waters. Driving a Formula 1 racecar.
 
Ray D. Ayshun said:
This can be the start of a new instagram thing. We take pics of ourselves contouring in beautiful and/or extreme conditions. In a tent on El Capitan. Next to a line of coke with Keith Richards. Underwater in Australia in a shark cage in chummed waters. Driving a Formula 1 racecar.
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...or sitting in my home office, wearing pajama pants (it's all I got)
 
elementaryschooleconomics said:
Being active on Twitter always seems like riding the lighting. It's this bizarre arena where you can accelerate becoming well known in your field, but you have to be personable/relatable in specific ways (and Evan did not choose one of the "correct" avenues with that Tweet). Twitter will either cement Spratt's career or destroy him...or both, I guess, like a well known American political figure.

Exciting times! I will continue to just lurk on Twitter.
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At least he got 1 retweet and 11 likes before deleting it.

D6C2B5A5-43F8-4135-9209-7A2C3567418E.jpeg
 
Palex80 said:



It's weeks, not months!
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Yeah I noticed this immediately and I thought "Is this the first time where someone is Kaplan Meiering me in weeks over a 1 year period?" It was pretty... um... odd. Not really wrong, but kind of like dressing up and missing a belt loop in your pants with your belt and one of you shirt buttons is buttoned in the wrong hole. Not my cup of tea. Praising this study is like telling a guy dressed this way "You look so GQ."
 
jondunn said:
Anyone at ASTRO? The chatter is out, you hear it everywhere :

- job market is strong!
- residents HAPPY HAPPY
- rad onc is back, folks!


Many expecting SDN to Bend the knee. I have my doubts!
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So, the Establishment™ is basically saying what they've always said?

I'm unsurprised, the only number they have indicated would change their minds about things is significant unemployment of new grads. There is no amount of data or logic which will get them off that path if that number remains low.

Clearly the medical students can have a more nuanced understanding of economics, and are making career decisions accordingly.
 
thecarbonionangle said:
This has been most boring ASTRO in a while since that hellpit, San Antonio TX! Highlight has been SWRO happy hour with ma girls!
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I'll tell you what, this ASTRO has given us one of my least favorite things: more debate about how to treat prostate cancer.
 
elementaryschooleconomics said:
I'll tell you what, this ASTRO has given us one of my least favorite things: more debate about how to treat prostate cancer.
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Nothing that practice changing (shocker)

1) more hypofractionation, many many saying 25 fx regimen new SOC for post op prostate, sorry folks grift is over!

2) Orator 2 closed early. Will be quickly ignored by surgeons. Mayo rad onc guy even criticized it on stage shilling for the surgeons stating that the rate of complications in a RCT has simply not been the mayo experience where they boast a 3 pct rate of complications like a tonsillectomy

3) dont do ipi with concurrent chemoxrt for NSCLC with current techniques, or you might hurt almost half of people

4) the korean IMC trial. Another “daaaa worst worst” breast study to add to the debate. Underpowered. Meat for both sides

5) 0815 shows no OS benefit in IR but PFS and DM benefit. Newer decipher studies in works to try to further answer questions
 
Great. There are jobs. Great. Seven out of 200 residents “self chose” (whatever that means) a fellowship. Great. 160 out of 200 residents describe getting jobs and a lot of hard, scary work to do so. Half the chairs will offer a job in the next few years.

Doesn’t change the fact that 10% of US rad oncs/centers treat 50% of American RO patients and consolidation is only getting worse. That the pt number per RO keeps dropping due to oversupply and falling utilization. Doesn’t change fact that payment reform will happen. Doesn’t change the fact that supervision changes keep happening. Doesn’t change the fact that fractions per patient keep dropping. Doesn’t change fact the RO residents have the least number of job offers coming out of residency versus any other specialty in medicine.

If we could get leadership to see that flirting with disaster by ignoring math puts us AND them at risk it would be so nice.
 
RickyScott said:
Has Lou broken 2 million yet? His 1.8 million salary was for 2019, I believe
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You shouldn't be so hard on Dr. Potts. It would literally take 10 graduating residents to do his job and ensure they were still being paid competitive compensation.
 
TheWallnerus said:
If he doesn’t hire (new add… “entry level”) anybody in the next three years he’s a liar. When he hires he cuts into his own wallet so will be interesting to circle back.
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It's all part of the master plan. Inflate salary to 2 mil over a few years. Hire some new grads at 200k to say you're helping. Salary goes "down" to 1.4 mil and can boast a ~25% pay cut. #radoncrocks
 
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