Rad Onc Twitter

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elementaryschooleconomics said:
Everything about this is amazing:

View attachment 356038

Followed by:

View attachment 356039

Uh, yeah...yeah he is:

View attachment 356040

Direct response:

View attachment 356041


Dude, Drew...wtf
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And you call certain other people's graphs chaotic!

4vie3OF.jpg


Btw all this data is antecedent 2020. Rad onc twitter has changed a lot since then. This thing is already outdated most likely.
 
RO28 said:
Ok, you have to at least out the journal that accepted this? Is this real? Please tell me this is the Onion version of the Red Journal.
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When I went back to grab a screenshot of the journal...I realized the hilarity goes deeper:

1654728435632.png


I honestly think he forgot he was an author.

It was initially submitted in November 2021.

Published online March 23rd, and Fumiko Tweeted it on March 24th.

Drew grabbed a screenshot of one of the Figures, and Tweeted it with a ton of tags, also on March 24th.

Then...here we are today, June 7th.

I don't see anything that catalyzed him Tweeting about this today, so who knows how he came across his own paper again.

We go from him PUBLISHING A PAPER on this topic AND THEN TAGGING A BUNCH OF PEOPLE in the Figure with "Top 10 influencers" on March 24th to HIM TWEETING THE EXACT SAME FIGURE LESS THAN SIX MONTHS LATER, this time CONCERNED ABOUT THE FIGURE THAT HE HELPED AUTHOR.

1654728755753.png


10/10, would follow Drew on Twitter again.
 
elementaryschooleconomics said:
When I went back to grab a screenshot of the journal...I realized the hilarity goes deeper:

View attachment 356054

I honestly think he forgot he was an author.

It was initially submitted in November 2021.

Published online March 23rd, and Fumiko Tweeted it on March 24th.

Drew grabbed a screenshot of one of the Figures, and Tweeted it with a ton of tags, also on March 24th.

Then...here we are today, June 7th.

I don't see anything that catalyzed him Tweeting about this today, so who knows how he came across his own paper again.

We go from him PUBLISHING A PAPER on this topic AND THEN TAGGING A BUNCH OF PEOPLE in the Figure with "Top 10 influencers" on March 24th to HIM TWEETING THE EXACT SAME FIGURE LESS THAN SIX MONTHS LATER, this time CONCERNED ABOUT THE FIGURE THAT HE HELPED AUTHOR.

View attachment 356055

10/10, would follow Drew on Twitter again.
Click to expand...
A rad onc forgetting he's an author on a rad onc paper. So #radonc.
A rad onc forgetting he's an author on a rad onc paper, and then throwing some shade on said paper... so very #radonc.
 
elementaryschooleconomics said:
When I went back to grab a screenshot of the journal...I realized the hilarity goes deeper:

View attachment 356054

I honestly think he forgot he was an author.

It was initially submitted in November 2021.

Published online March 23rd, and Fumiko Tweeted it on March 24th.

Drew grabbed a screenshot of one of the Figures, and Tweeted it with a ton of tags, also on March 24th.

Then...here we are today, June 7th.

I don't see anything that catalyzed him Tweeting about this today, so who knows how he came across his own paper again.

We go from him PUBLISHING A PAPER on this topic AND THEN TAGGING A BUNCH OF PEOPLE in the Figure with "Top 10 influencers" on March 24th to HIM TWEETING THE EXACT SAME FIGURE LESS THAN SIX MONTHS LATER, this time CONCERNED ABOUT THE FIGURE THAT HE HELPED AUTHOR.

View attachment 356055

10/10, would follow Drew on Twitter again.
Click to expand...
Does the VA do an annual drug screen? They may have started recently if they weren't doing it before
 
jondunn said:
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Why are rad oncs so quick to fall on their sword? Also, why are so many specialists so against radiation?

For all my hypofx breast patients, I can’t even recall having any significant issues other then the mild erythema and fatigue we give them.

In regards to rectal cancer… the one modality we should look to ban is surgery. Which is better for the patient, omitting an APR or radiation, is this something people are doing no just for knowledge sake? I don’t order MMR status, why should I care?
 
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RadOncDoc21 said:
Why are rad oncs so quick to fall on their sword? Also, why are so many specialists so against radiation?

For all my hypofx breast patients, I can’t even recall having any significant issues other then the mild erythema and fatigue we give them.

In regards to rectal cancer… the one modality we should look to ban is surgery. Which is better for the patient, omitting an APR or radiation, is this something people are doing no just for knowledge sake? I don’t order MMR status, why should I care?
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Nothing wrong with ordering MMR, I absolutely would not offer these patients definitive IO based on that study. That's not to say it won't ultimately be the direction we head in, but I don't think there's enough out there to say this should be the definitive treatment unless RT is contraindicated.

Absolutely agree with reserving surgery for salvage.
 
RSAOaky said:
Nothing wrong with ordering MMR, I absolutely would not offer these patients definitive IO based on that study. That's not to say it won't ultimately be the direction we head in, but I don't think there's enough out there to say this should be the definitive treatment unless RT is contraindicated.

Absolutely agree with reserving surgery for salvage.
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I almost never say this but... if you had a (MMRd) cT3N1 rectal cancer, and knowing what you know, are you saying you'd go for chemoRT/chemo and surgery or get the IO. And what if the surgeon says this has def got to be an APR.

I would not hesitate a split second to get the IO. I love my specialty, and radiation; but I love my rectum more. And I'm a wuss.

I free-handed the IO outcomes on to OPRA:

rxKEpMM.png


EDIT: ignoring actuariality, IO vs consolidative OPRA is p<0.0001*
* yes this type of comparison is specious @communitydoc13
 
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jondunn said:
agree with needing more data, and we will get it. but as a rad onc we should care about this.

this is a BFD, a boon for patients (a small minority of patients).
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Sort of like HER2. Used to be, HER2 breast cancer was the cancer you didn't want. And MMRd rectal... responds not as well to chemoRT. Immunotherapies, when they "hit their target," change cancer natural histories.
 
RadOncDoc21 said:
Why are rad oncs so quick to fall on their sword? Also, why are so many specialists so against radiation?

For all my hypofx breast patients, I can’t even recall having any significant issues other then the mild erythema and fatigue we give them.

In regards to rectal cancer… the one modality we should look to ban is surgery. Which is better for the patient, omitting an APR or radiation, is this something people are doing no just for knowledge sake? I don’t order MMR status, why should I care?
Click to expand...

TheWallnerus said:
I almost never say this but... if you had a (MMRd) cT3N1 rectal cancer, and knowing what you know, are you saying you'd go for chemoRT/chemo and surgery or get the IO. And what if the surgeon says this has def got to be an APR.

I would not hesitate a split second to get the IO. I love my specialty, and radiation; but I love my rectum more. And I'm a wuss.

I free-handed the IO outcomes on to OPRA:

rxKEpMM.png
Click to expand...
I agree that it's very exciting. I would also expect a radonc to jump on a 5 fraction plus IO in this population type trial.

The stats are still bad enough though that this sort of graph is specious.
 
TheWallnerus said:
Sort of like HER2. Used to be, HER2 breast cancer was the cancer you didn't want. And MMRd rectal... responds not as well to chemoRT. Immunotherapies, when they "hit their target," change cancer natural histories.
Click to expand...
And then anti her2 is shown to be effective against cancers that are 1,2+ Triple negative. That was the biggest trial at asco. This is not abt a small subset of rectal cancers. It is abt the rate of progress.
 
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TheWallnerus said:
I almost never say this but... if you had a (MMRd) cT3N1 rectal cancer, and knowing what you know, are you saying you'd go for chemoRT/chemo and surgery or get the IO. And what if the surgeon says this has def got to be an APR.

I would not hesitate a split second to get the IO. I love my specialty, and radiation; but I love my rectum more. And I'm a wuss.
Click to expand...
I love your rectum too bb.

Alright I'm going to walk back my "absolute" statement. I'd probably get the upfront IO too. I think one challenge with this is do you believe this treatment is 100% curative and if not, what do you do at the time of recurrence?

1) More IO
2) Surgery
3) CRT + Chemo
4) CRT + Chemo + Surgery
5) Some combination of the above

Definitely the kind of thing that benefits from a bigger trial just for the purpose of standardizing/optimizing management.

To play devil's advocate, what if the upfront IO results in 100% CR at 2 years and 0% CR at 4 years? What if when these patients recur, we've selected out for the "bad" cancer and upon recurrence you have a more aggressive disease/worse long-term outcome than if you'd done SoC?

That's not to say that there's no role, or even that it's not what I'd want for my rectum, but I'd feel a lot more comfortable doing something like this on trial. It ensures that patients fully understand that we have no long-term data and thus treatment is experimental, and it standardizes salvage management.
 
RSAOaky said:
"Major issue, especially in radiation oncology" says radiation oncologist from top 10 metro area.
Click to expand...

<2% of patients have to travel >50 miles for RT.

It is ridiculous to think we need to increase LINACs for such a small subset of patients in the era of decreasing RT indications and shortened RT fxn

Gaslighting knows no bounds
 
RSAOaky said:
I love your rectum too bb.

Alright I'm going to walk back my "absolute" statement. I'd probably get the upfront IO too. I think one challenge with this is do you believe this treatment is 100% curative and if not, what do you do at the time of recurrence?

1) More IO
2) Surgery
3) CRT + Chemo
4) CRT + Chemo + Surgery
5) Some combination of the above

Definitely the kind of thing that benefits from a bigger trial just for the purpose of standardizing/optimizing management.

To play devil's advocate, what if the upfront IO results in 100% CR at 2 years and 0% CR at 4 years? What if when these patients recur, we've selected out for the "bad" cancer and upon recurrence you have a more aggressive disease/worse long-term outcome than if you'd done SoC?

That's not to say that there's no role, or even that it's not what I'd want for my rectum, but I'd feel a lot more comfortable doing something like this on trial. It ensures that patients fully understand that we have no long-term data and thus treatment is experimental, and it standardizes salvage management.
Click to expand...
 
grenz said:
It’s as if laypeople are making treatment recommendations based on breathless NYT articles
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I mean what could go wrong with omitting chemo, radiation, and surgery for locally advanced rectal cancer? We see single agent immunotherapy cure localized cancer all the time right?

I feel bad for the T3N1 patient getting this off trial...
 
We've always had MMR testing done on our colorectal patients. I'm surprised this wasn't standard of care at Cornell, Dr. Pashtoon Kasi's institution.

Suggesting that standard of care should change based on a small single-arm study with limited follow up is crazy.
 
ROforbetterorworse said:
<2% of patients have to travel >50 miles for RT.

It is ridiculous to think we need to increase LINACs for such a small subset of patients in the era of decreasing RT indications and shortened RT fxn

Gaslighting knows no bounds
Click to expand...
Absolutely agree. One of the choices you make in deciding to live far from civilization is reduced access to things that civilization has to offer. This is not exclusive to highly specialized healthcare. It includes basic necessities. It includes PRIMARY care, let alone TERTIARY care.

I don't know James Bates personally but I think we all know people like this. The people who are quick to point out a problem but have no viable solution or have no interest in being a part of those solutions.

"There is a serious lack of rural radiation oncologists!"
"Yea! It's terrible! So what do you propose?"
"We need to convince radiation oncologists about the joy of caring for patients in underserved communities!"
"Yea! I totally agree! So which community would you like to serve?"
"WHOA WHOA WHOA, we need to convince OTHER radiation oncologists."
 
TheWallnerus said:
Sort of like HER2. Used to be, HER2 breast cancer was the cancer you didn't want. And MMRd rectal... responds not as well to chemoRT. Immunotherapies, when they "hit their target," change cancer natural histories.
Click to expand...
I've seen way more h2n+ pts in the last year than MSH mutated ones... Honestly not sure I've seen a single mismatch+ pt in the last 3 years
 
RSAOaky said:
Absolutely agree. One of the choices you make in deciding to live far from civilization is reduced access to things that civilization has to offer. This is not exclusive to highly specialized healthcare. It includes basic necessities. It includes PRIMARY care, let alone TERTIARY care.

I don't know James Bates personally but I think we all know people like this. The people who are quick to point out a problem but have no viable solution or have no interest in being a part of those solutions.

"There is a serious lack of rural radiation oncologists!"
"Yea! It's terrible! So what do you propose?"
"We need to convince radiation oncologists about the joy of caring for patients in underserved communities!"
"Yea! I totally agree! So which community would you like to serve?"
"WHOA WHOA WHOA, we need to convince OTHER radiation oncologists."
Click to expand...

Rather than paying some consultant or spending gazillions on a govt solution to this, let me just propose this.

Apply 340B price "mark ups" to radiation codes too for centers that qualify for 340 B
Quit paying for prostate only proton radiation above IMRT rates.

There - you've got a solution to the rural care radiation problem.
 
RSAOaky said:
Absolutely agree. One of the choices you make in deciding to live far from civilization is reduced access to things that civilization has to offer. This is not exclusive to highly specialized healthcare. It includes basic necessities. It includes PRIMARY care, let alone TERTIARY care.

I don't know James Bates personally but I think we all know people like this. The people who are quick to point out a problem but have no viable solution or have no interest in being a part of those solutions.

"There is a serious lack of rural radiation oncologists!"
"Yea! It's terrible! So what do you propose?"
"We need to convince radiation oncologists about the joy of caring for patients in underserved communities!"
"Yea! I totally agree! So which community would you like to serve?"
"WHOA WHOA WHOA, we need to convince OTHER radiation oncologists."
Click to expand...
Rurality for thee, but none for me!
 
RSAOaky said:
Absolutely agree. One of the choices you make in deciding to live far from civilization is reduced access to things that civilization has to offer. This is not exclusive to highly specialized healthcare. It includes basic necessities. It includes PRIMARY care, let alone TERTIARY care.

I don't know James Bates personally but I think we all know people like this. The people who are quick to point out a problem but have no viable solution or have no interest in being a part of those solutions.

"There is a serious lack of rural radiation oncologists!"
"Yea! It's terrible! So what do you propose?"
"We need to convince radiation oncologists about the joy of caring for patients in underserved communities!"
"Yea! I totally agree! So which community would you like to serve?"
"WHOA WHOA WHOA, we need to convince OTHER radiation oncologists."
Click to expand...
what does this have to do with the docs?. The issues is building bunkers, paying for physics, linacs etc to serve populations 20-50K w/ 1 consult a week. For less than half the cost of a medonc locums, you could get a radonc to go out there 1/2-one day a week.
 
BobbyHeenan said:
Rather than paying some consultant or spending gazillions on a govt solution to this, let me just propose this.

Apply 340B price "mark ups" to radiation codes too for centers that qualify for 340 B
Quit paying for prostate only proton radiation above IMRT rates.

There - you've got a solution to the rural care radiation problem.
Click to expand...
How would the 340b thing work? 22.5% boost to radiation technical charges? Professional also?
 
RickyScott said:
what does this have to do with the docs?. The issues is building bunkers, paying for physics, linacs etc to serve populations 20-50K w/ 1 consult a week. For less than half the cost of a medonc locums, you could get a radonc to go out there 1/2-one day a week.
Click to expand...
I may be mixing up ASTROs at this point, but I remember back in 2012 there was a session on the job market. It may have been the same session where Zietman gave his canaries in the coal mine speech. The party line at that time was "RadOnc doesn't have a jobs problem, it has a geographic maldistribution problem." Some radonc came up to the mic during the Q&A portion of the session and said something along the lines of "I have a rural clinic in Iowa and I've been trying to hire someone for 5 years but I can't pay people enough to move and I'm sorry that I don't SBRT bone mets to make more money."

The issue is not just opening up clinics in the middle of nowhere. It's getting people to consistently staff the middle-of-nowhere-adjacent clinics that already exist. That's what it has to do with docs.
 
RSAOaky said:
I may be mixing up ASTROs at this point, but I remember back in 2012 there was a session on the job market. It may have been the same session where Zietman gave his canaries in the coal mine speech. The party line at that time was "RadOnc doesn't have a jobs problem, it has a geographic maldistribution problem." Some radonc came up to the mic during the Q&A portion of the session and said something along the lines of "I have a rural clinic in Iowa and I've been trying to hire someone for 5 years but I can't pay people enough to move and I'm sorry that I don't SBRT bone mets to make more money."

The issue is not just opening up clinics in the middle of nowhere. It's getting people to consistently staff the middle-of-nowhere-adjacent clinics that already exist. That's what it has to do with docs.
Click to expand...
Pay enough and people will staff them.
 
OTN said:
Pay enough and people will staff them.
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For sure. And if your clinic isn't profitable enough to pay the wages required to staff them, you either need to get creative or your clinic probably shouldn't exist. It's the case with every other business in this country. The only reason radiation oncologists continue to push this maldistribution agenda is to gaslight us into thinking the job market is good, but the problem is that we're too picky.
 
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RSAOaky said:
For sure. And if your clinic isn't profitable enough to pay the wages required to staff them, you either need to get creative or your clinic probably shouldn't exist. It's the case with every other business in this country. The only reason radiation oncologists continue to push this maldistribution agenda is to gaslight us into thinking the job market is good, but the problem is that we're too picky.
Click to expand...

I think the days of hungry new grads going to upper Midwest for amazing salaries are done. The salaries are not amazing anymore and even the new grads don't want to tolerate living in those places for a few years. Maybe in the near future when they're having trouble getting A job but the money won't be there.
 
I
RSAOaky said:
I may be mixing up ASTROs at this point, but I remember back in 2012 there was a session on the job market. It may have been the same session where Zietman gave his canaries in the coal mine speech. The party line at that time was "RadOnc doesn't have a jobs problem, it has a geographic maldistribution problem." Some radonc came up to the mic during the Q&A portion of the session and said something along the lines of "I have a rural clinic in Iowa and I've been trying to hire someone for 5 years but I can't pay people enough to move and I'm sorry that I don't SBRT bone mets to make more money."

The issue is not just opening up clinics in the middle of nowhere. It's getting people to consistently staff the middle-of-nowhere-adjacent clinics that already exist. That's what it has to do with docs.
Click to expand...
Times have changed and there is a lot of oversupply. if anyone has a one day week job at lets say 5k/week, I know a lot of docs who would staff that.
 
RickyScott said:
I

Times have changed and there is a lot of oversupply. if anyone has a one day week job at lets say 5k/week, I know a lot of docs who would staff that.
Click to expand...

right now this would be locums docs mostly though

There aren't enough people that want to be employed that aren't right now. we need to be accurate in our assessments.

5/k a week is 250k. FEW working rad oncs will take a pay cut, even if it frees up their life like that
 
jondunn said:
5/k a week is 250k. FEW working rad oncs will take a pay cut, even if it frees up their life like that
Click to expand...

This is an important point with the "hiring two docs to do the job of one" and "one day a week rural job" potential situations

Many people see that in their future but not now. Me included - I debate daily whether I'd take a significant pay cut for a 3 day/week job. Once you see the $$$ it's hard to turn back even for better lifestyle. If it's forced, could accept begrudgingly and enjoy more time off, but I would think most want to make that transition on their own terms.
 
jondunn said:
right now this would be locums docs mostly though

There aren't enough people that want to be employed that aren't right now. we need to be accurate in our assessments.

5/k a week is 250k. FEW working rad oncs will take a pay cut, even if it frees up their life like that
Click to expand...
Plenty of qasi retired/part timers who would take a one day a week job for 250k a year/easy to line up locums at this rate. If I could go 4 days a week (and certainly pt wise I could, if the hospital permitted), I would happily come out one day a week for an extra 250-300k a year.
 
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jondunn said:
right now this would be locums docs mostly though

There aren't enough people that want to be employed that aren't right now. we need to be accurate in our assessments.

5/k a week is 250k. FEW working rad oncs will take a pay cut, even if it frees up their life like that
Click to expand...
You clearly haven't worked in Cali or FL. At 190/graduates a year, someone will happily take that job this decade too if it means living where they want to live
 
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