Rad Onc Twitter

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medgator said:
Russia has already used them in Ukraine... No reason to doubt China in that regard.

My point is that for all the commentary regarding healthcare expenditures and cost effectiveness/QALY etc, no such accountability is applied to the defense budget (or the aerospace one for that matter for years. Look at how much we spent on NASA and the space shuttle over the years vs what SpaceX is charging now).

Considering we spend more on our military than the next several countries combined, why weren't we the first with a hypersonic missile? Why is China taking the lead on things like railguns etc
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Because Freedom isn’t free, now pay your damn taxes!
 
RadOncDoc21 said:
Math was never my best subject. I have no concept in regards to value. To me, 1,000 is the same as 100 billion.
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I hope you don't face these issues when prescribing treatment doses... 🤣🤣🤣

medgator said:
I'm fine with increasing the defense budget if Lockheed and Raytheon can show me they aren't dumping more down a rabbit hole.
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Buying stock now...
 
medgator said:
Russia has already used them in Ukraine... No reason to doubt China in that regard.

My point is that for all the commentary regarding healthcare expenditures and cost effectiveness/QALY etc, no such accountability is applied to the defense budget (or the aerospace one for that matter for years. Look at how much we spent on NASA and the space shuttle over the years vs what SpaceX is charging now).

Considering we spend more on our military than the next several countries combined, why weren't we the first with a hypersonic missile? Why is China taking the lead on things like railguns etc
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I agree our military funding/funding in general could be more efficient.

However, we don't really know all the moving parts in Ukraine. It does seem promising that we are offering indirect support to Ukraine and they are holding off Russia. I don't think we will get the full story until years after this war is done in terms of what actually transpired
 
metallica81788 said:
Nodes for breast!
Contouring in public at a hotel bar!
Ralph!
Breadlines!
Below MGMA median salary!

Maybe if you want to talk healthcare and government/politics it should be its own thread. Let the misanthropes resume feasting here.
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We haven’t had a good Ralph discussion in awhile. He’s like the Elon Musk of rad onc.
 
*Users are ONCE AGAIN reminded to avoid treating this cesspool of a thread as a ****bucket for all **** discussions including those of things that would be considered political and are unrelated to Radiation Oncology, or at least healthcare, on a 1st degree basis - Users that post about clearly political issues after this general warning will have posts deleted and warned for their actions. Rampant continuation that does not respond to warnings will lead to the closing of this thread.


*I do not have the patience to go through 2 pages of political garbage and delete/warn everyone who is going too far and discerning those who are going just far enough to toe the line without jumping over.
 
RealSimulD said:
“Nothing pairs better with albacore tuna than Lucky Strikes!”
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1649960377658.png
 
Not a tweet but man we are getting hit hard from everywhere and everyone:

pubmed.ncbi.nlm.nih.gov

Lobectomy Provides the Best Survival for Stage I Lung Cancer Patients Despite Advanced Age - PubMed

In octogenarians with pathologic stage I lung cancer, lobectomy provided better 5-year survival compared with sublobar resection regardless of the age at surgical procedure. Hence, all patients with stage I cancer should be considered for a lobectomy if they are medically able to tolerate such a...
pubmed.ncbi.nlm.nih.gov pubmed.ncbi.nlm.nih.gov

However, rad oncs are finding more ways to getting out of treating cancer.
 
I mean articles like that aren’t even worth discussion, everyone knows the clear bias at play with comparing groups retrospectively. Doesn’t move any needle with anyone.
 
jondunn said:
I mean articles like that aren’t even worth discussion, everyone knows the clear bias at play with comparing groups retrospectively. Doesn’t move any needle with anyone.
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Anecdotally I’ve seen the younger thoracic surgeons be more aggressive. I’ve also seen more early stage cancers being pushed to immunotherapy following surgery or neoadjivantly to skip radiation altogether. Maybe it’s just my world, but this is how it happens.
 
RadOncDoc21 said:
Not a tweet but man we are getting hit hard from everywhere and everyone:

pubmed.ncbi.nlm.nih.gov

Lobectomy Provides the Best Survival for Stage I Lung Cancer Patients Despite Advanced Age - PubMed

In octogenarians with pathologic stage I lung cancer, lobectomy provided better 5-year survival compared with sublobar resection regardless of the age at surgical procedure. Hence, all patients with stage I cancer should be considered for a lobectomy if they are medically able to tolerate such a...
pubmed.ncbi.nlm.nih.gov pubmed.ncbi.nlm.nih.gov

However, rad oncs are finding more ways to getting out of treating cancer.
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This compared lobar to sublobar resection...no mention of RT. Am I missing something?

From the methods section: "We excluded patients who received chemotherapy or radiation therapy as part of their therapy."

Also, even if this did include RT, NCDB isn't the right dataset to capture things like why an octogenarian might undergo a lobar vs sublobar. Consider a relatively healthy 80 year old with well controlled cardiovascular disease vs one with bad COPD - they may have similar comorbidity scores in the NCDB dataset but clearly different expected outcomes with each type of surgery.

When I get a chance to speak with a patient in the preoperative setting who has stage I disease, I always try to do my best to describe the surgery they'll have to recover from, because it's not nothing...
 
GapCalc said:
This compared lobar to sublobar resection...no mention of RT. Am I missing something?

From the methods section: "We excluded patients who received chemotherapy or radiation therapy as part of their therapy."

Also, even if this did include RT, NCDB isn't the right dataset to capture things like why an octogenarian might undergo a lobar vs sublobar. Consider a relatively healthy 80 year old with well controlled cardiovascular disease vs one with bad COPD - they may have similar comorbidity scores in the NCDB dataset but clearly different expected outcomes with each type of surgery.

When I get a chance to speak with a patient in the preoperative setting who has stage I disease, I always try to do my best to describe the surgery they'll have to recover from, because it's not nothing...
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I agree, but at least you do get the chance to speak to them.
 
RadOncDoc21 said:
Anecdotally I’ve seen the younger thoracic surgeons be more aggressive. I’ve also seen more early stage cancers being pushed to immunotherapy following surgery or neoadjivantly to skip radiation altogether. Maybe it’s just my world, but this is how it happens.
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I'm on the other end... Getting dlco <50% pts with an fev1 of 0.6 L everyone is scared to even biopsy....
 
GapCalc said:
This may be true, but I think this article has zilch to do with RT.

While it might not be a Twitter post, certainly it feels like one -- read the headline, not the article (nor the abstract).
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To be fair, we are the ones marginalizing them. Surgery has been the SOC for ES-NSCLC long before SBRT came along. In stage I disease, they have a lot more to lose than we do.
 
RealSimulD said:
They move fast to marginalize us, that’s for sure
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Its insane! Ive seen it first hand. Stage III Endometrial? Hell the med onc just read the abstract and referrals were gone overnight. Even cancelled the patients I had simmed!

All the BS I heard as a resident about knowing the data and "we are the true oncologist" makes no difference. At tumor board nobody cares. We lost the plot as ROs all the data dumping doesn't matter.
 
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RadsWFA1900 said:
Its insane! Ive seen it first hand. Stage III Endometrial? Hell the med onc just read the abstract and referrals were gone overnight. Even cancelled the patients I had simmed!
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I’m living in it. I feel like I’m sounding an alarm that we should all be aware of because this is real life and happening faster then I imagined.

It kind of feels similar to when the first group of people started to notice an increase in resident numbers in which the majority of folks where all saying “no way, that’s not what I’m seeing.”

Is it really too far fetch to believe that there are rad oncs in some communities being squeezed out by surgeons, med oncs and rad oncs pushing for less/no RT?

Most of the docs in my community could care less about data and the volume of patients drives everything they do. Do you think the small town general surgeon (breast cancers, GI, sarcomas), urologist (can’t spare nerves, all high risk gets surgery), ENT (can’t do TORS), cardiothoracic surgeon (think pneumonectomies, doesn’t want to treat cancer), pulmonologist (can’t do EBUS) who send all of their patients to the 65 yr old med onc (making a million a year) truly care about “data” or simply just pick and choose to keep doing what keeps them all fat and happy?

Around here, the term “immunotherapy” simply means every patient gets it and radiation can be omitted.
 
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RadsWFA1900 said:
Its insane! Ive seen it first hand. Stage III Endometrial? Hell the med onc just read the abstract and referrals were gone overnight. Even cancelled the patients I had simmed!

All the BS I heard as a resident about knowing the data and "we are the true oncologist" makes no difference. At tumor board nobody cares. We lost the plot as ROs all the data dumping doesn't matter.
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Human nature man. People respond to swagger, confidence, and bravado rather than some nerd reciting numbers.

Look at the countless crises this world is facing. They're not caused by scientists pushing the most accurate data. They're mainly caused by one man or a small group of men who say, "**** it. I want something and I'm taking it," and the rest of the people being like , "Hmm.. I guess that makes sense."
 
Mandelin Rain said:
The main issue is that... if 50% of centers close due to terrible financials, have we REALLY helped the patient-at-large because we spared the other 50% 2 weeks of treatment?
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I mean they have to travel to some centralized place to have it done

This sort of fake deference to the patient and shaming of practitioners is probably a big cause of burnout and discontent. Can expect these discussions to get more and more toxic as time goes on as the so called virtuous continue to put everyone else out of business.
 
RadsWFA1900 said:
I mean they have to travel to some centralized place to have it done

This sort of fake deference to the patient and shaming of practitioners is probably a big cause of burnout.
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Right, which entails travel, sometimes onerous and costly, and significant inconvenience.

Keeping your lights on so the patients in your area have access to care is certainly advocating for those patients.
 
to play devil's advocate - TheWallnernus has nicely shown we have way too many empty linacs. Makes the argument for centralization of some type, though I hope that happens after I retire, if it was to ever happen.
 
Hospitals can't afford to run rad onc departments as a loss center. They are very used to using it as the converse to cover losses in areas such as ICU.


If you were a profitable clinic in 2010 treating 20 mainly breast and prostate patients over 6-9 weeks. You could very easily be a highly unprofitable clinic in 2025 treating 5 patients a day in 1 week.

There are ripple effects from this that aren't immediately clear to the academics conducting non-inferiority trials that serve primarily to reduce our profession's role in cancer care.
 
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Mudit's point is fair. Why should a practicing clinician in the community worry about their fractionation scheme and it's effects on the specialty? The residency programs expanded - does that mean I should stay with maximal fractionation so I can hire a partner down the road and absorb the oversupply?

I don't see that as smug. It's reality.
 
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