Rad Onc Twitter

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Mandelin Rain said:
Don't get him started on Temodar. Completely expert. He'll pull rank on you. Chemotherapeutics definitely a HUGE part of the RTT curriculum.
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I had to physically go to the machine the other week to tell the therapists I was OK with treating a GBM patient who hadn't taken Temodar before treatment that day, because he was in the ED.

I had so many questions. Mostly - how do they think this all works? Evidently, not getting that day's fraction is preferable to taking the Temodar out of order?

I missed that RTOG trial I guess.
 
elementaryschooleconomics said:
I had to physically go to the machine the other week to tell the therapists I was OK with treating a GBM patient who hadn't taken Temodar before treatment that day, because he was in the ED.

I had so many questions. Mostly - how do they think this all works? Evidently, not getting that day's fraction is preferable to taking the Temodar out of order?

I missed that RTOG trial I guess.
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The simplest answer I fear is that somehow along the way some of our people have been taught to have more respect for the radiosensitizers (the doctors doing the radiosensitizing as well as the drugs doing the radiosensitizing) than the radiation.
 


Definitely a stronger market now than Year or two ago... Still not sustainable for the number of grads leaving training going forward, and much like the stock market, it feels like a bear market rally
 
medgator said:


Definitely a stronger market now than Year or two ago... Still not sustainable for the number of grads leaving training going forward, and much like the stock market, it feels like a bear market rally
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If anything, it's scarier to me because it feels like musical chairs and you don't want to be on a bad chair (or without one) when the music stops
 
My group isn’t hiring anytime soon.

My oldest partner is practically unsafe at this point but refuses to let go.
 
TheWallnerus said:
The simplest answer I fear is that somehow along the way some of our people have been taught to have more respect for the radiosensitizers (the doctors doing the radiosensitizing as well as the drugs doing the radiosensitizing) than the radiation.
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The dogmatic practice of many Radiation Oncologists (or other members of the team) is truly staggering. It feels like watching a baseball player step up to the plate and do some bizarre 14-step ritual.

medgator said:


Definitely a stronger market now than Year or two ago... Still not sustainable for the number of grads leaving training going forward, and much like the stock market, it feels like a bear market rally
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Neuronix said:
Anyone else getting "bombarded by recruiters" ?

That's an odd post.

Only targeted recruiting email I've gotten in the past year is University of Nebraska.

I guess that does beat out zero the prior year.

I hardly feel bombarded.
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I wouldn't say "bombarded", but there's definitely an uptick in recruiters and jobs in general.

My personal theory, going around and talking with institutions myself as well as hearing from my friends:

Not only is "COVID burnout" causing retirements and people stepping back from clinical roles, there seems to be a huge crop of boomers naturally hitting retirement age in all specialties. This is representative of the population as a whole (and why many of us have seen the raw % of consults increase, it's not more cancer, it's just more old people).

I think it's concerning, because we finally have traction regarding people paying attention to the supply issue. I see the current mini-bubble lasting at least 1-2 more years, but once all these 65+ docs have finished retiring, there will be a HUGE number of 30-something docs with 30 year careers left to go.

It feels like I'm at a global warming rally and it just started snowing.
 
Neuronix said:
Anyone else getting "bombarded by recruiters" ?

That's an odd post.

Only targeted recruiting email I've gotten in the past year is University of Nebraska.

I guess that does beat out zero the prior year.

I hardly feel bombarded.
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You gotta be the Koneru

I remember he used to post on LinkedIn about being able to do 40 pushups in under a minute

Bro!
 
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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Frankly, I rarely treat pancreas in the primary setting.
I also believe it's more of an issue concerning dose and volumes and not necessarily technique.
I do not believe for instance that you should do ENI in primary RT of pancreatic cancer and feel that ENI has resulted into a lot of toxicities in the past.

A trial which showed how bad toxicity can be, if RT is not delivered carefully, was the ECOG trial.
pubmed.ncbi.nlm.nih.gov

Gemcitabine alone versus gemcitabine plus radiotherapy in patients with locally advanced pancreatic cancer: an Eastern Cooperative Oncology Group trial - PubMed

This trial demonstrates improved overall survival with the addition of radiation therapy to GEM in patients with localized unresectable pancreatic cancer, with acceptable toxicity.
pubmed.ncbi.nlm.nih.gov pubmed.ncbi.nlm.nih.gov
41% grade IV and V (yes, deaths!) with RCT vs. 9% with CT alone.


Perhaps one more point concerning "improved resectability" in unresectable pancreatic cancer.
I believe that many trials have mixed up truly unresectable with borderline-resectable patients. If you look at SCALOP, which included only unresectable patients and delivered radiochemotherapy to all, less than 5% of the patients were convered to a resectable status. 95% remained unresectable or simply progressed.
 
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Palex80 said:
Frankly, I rarely treat pancreas in the primary setting.
I also believe it's more of an issue concerning dose and volumes and not necessarily technique.
I do not believe for instance that you should do ENI in primary RT of pancreatic cancer and feel that ENI has resulted into a lot of toxicities in the past.

A trial which showed how bad toxicity can be, if RT is not delivered carefully, was the ECOG trial.
pubmed.ncbi.nlm.nih.gov

Gemcitabine alone versus gemcitabine plus radiotherapy in patients with locally advanced pancreatic cancer: an Eastern Cooperative Oncology Group trial - PubMed

This trial demonstrates improved overall survival with the addition of radiation therapy to GEM in patients with localized unresectable pancreatic cancer, with acceptable toxicity.
pubmed.ncbi.nlm.nih.gov pubmed.ncbi.nlm.nih.gov
41% grade IV and V (yes, deaths!) with RCT vs. 9% with CT alone.


Perhaps one more point concerning "improved resectability" in unresectable pancreatic cancer.
I believe that many trials have mixed up truly unresectable with borderline-resectable patients. If you look at SCALOP, which included only unresectable patients and delivered radiochemotherapy to all, less than 5% of the patients were convered to a resectable status. 95% remained unresectable or simply progressed.
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Hey don't hate on one of the only positive radiation trials for pancreatic cancer. Improved overall survival yet this almost never cited to support radiation instead of chemotherapy alone.

Can I humbly suggest that our self-flaggellation has hurt our field relative to others? Some examples of our peers 'placing research into proper context' come to mind:

Vascular neurosurgeons continue to treat AVM despite ARUBA
German radiation oncologists continue to treat osteoarthritis despite negative Dutch trials
Urologic oncologists continue to perform prostatectomy despite ProtecT
Medical oncologists continue to order surveillance CEA and CA-125 (often in their own in house labs) despite lack of evidence of benefit
 
Gonna hafta protect German arthritis treatment here and say the RCT used doses and fractionation schedules which were different than the Germans use, and in my experience going more slowly makes a big difference.

Bottom line re: pancreas is that the data simply does not show that we make a huge impact in the disease. I still treat borderline-resectable and unresectable patients from time to time, but the reality is that, at least based on the data we have now, chemotherapy and surgery need to be the mainstays of treatment.
 
theradiator said:
Hey don't hate on one of the only positive radiation trials for pancreatic cancer. Improved overall survival yet this almost never cited to support radiation instead of chemotherapy alone.
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Indeed, but look at the toxicity data! When I showed our med oncs that article years ago, they were like „You are nuts, we are not going to use that regime!“
theradiator said:
Can I humbly suggest that our self-flaggellation has hurt our field relative to others? Some examples of our peers 'placing research into proper context' come to mind:
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theradiator said:
Vascular neurosurgeons continue to treat AVM despite ARUBA
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Many issues with that trial…
theradiator said:
German radiation oncologists continue to treat osteoarthritis despite negative Dutch trials
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That is however the definition of atoxic therapy.
theradiator said:
Urologic oncologists continue to perform prostatectomy despite ProtecT
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The same argument could be made for RT.
theradiator said:
Medical oncologists continue to order surveillance CEA and CA-125 (often in their own in house labs) despite lack of evidence of benefit
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True, but little harm.
 
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jondunn said:
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So after one year of internship, sounds like he hit a point of diminishing return in IM? It’s great that a month into a 4 year program, he is still learning something new every single day! American university of the Caribbean prepared him well. This guy has future LK or PW written all over him.
 
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RickyScott said:
So after one year of internship, sounds like he hit a point of diminishing return in IM? It’s great that a month into a 4 year program, he is still learning something new every single day! American university of the Caribbean prepared him well. This guy has future LK or PW written all over him.
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Oh no… an enthusiastic resident! Quick, someone explain to this young doctor the dread he should feel for his future, nay his very soul!

Would you guys prefer it if the residents we happy or miserable?

You lament the “Charting outcomes” while pouncing on med students and residents who show the smallest inkling of passion for our field.

Which is it? Do we want people to like rad onc, or are we rooting for declining interest? **honestly asking**
 
Lamount said:
Oh no… an enthusiastic resident! Quick, someone explain to this young doctor the dread he should feel for his future, nay his very soul!

Would you guys prefer it if the residents we happy or miserable?

You lament the “Charting outcomes” while pouncing on med students and residents who show the smallest inkling of passion for our field.

Which is it? Do we want people to like rad onc, or are we rooting for declining interest? **honestly asking**
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To publically declare over the internet that you are learning “new stuff” one month into residency is performative.
 
RickyScott said:
To publically declare over the internet that you are learning “new stuff” one month into residency is performative.
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If we would have had twitter when I was in residency, one month before I graduated I probably would have tweeted “I know everything.” One year later I would have tweeted “My attendings were loopy, and I know nothing.”
 
thecarbonionangle said:
Supposedly optum/UH is getting into the proton game i am hearing so they might be playing ball in multiple ways. CVS was bought by Aetna and they have a former penn RO as rad onc medical director. There might be a lot more to the iceberg tip folks!
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Optum gig in Vegas... Not an evilcore type job either. Interesting. Could be the worst parts of working for evilcore and KP all rolled up into one


Optum Care Cancer Center

Southern Nevada has a powerful resource to help you fight cancer.
www.optumcare.com
 
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RickyScott said:
To publically declare over the internet that you are learning “new stuff” one month into residency is performative.
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Imagine being upset about this


Ricky Scott folks - he will be here and on Twitter all week.
 
Lamount said:
Anything and everything on Twitter is performative. That’s their business model
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I know right?

Aren’t we far along enough in the social media era for people not to get that social media is just the Public
square?


There are a lot worse things to say than ‘I like rad onc’

But Ricky got mad when a Med onc fellow said she liked rad onc

He wants everyone to hate rad onc and for the technical to be cut by half as well.
 
RickyScott said:
I promise to take the bait every single time.
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1659824025206.gif
 
medgator said:
Optum gig in Vegas... Not an evilcore type job either. Interesting. Could be the worst parts of working for evilcore and KP all rolled up into one


Optum Care Cancer Center

Southern Nevada has a powerful resource to help you fight cancer.
www.optumcare.com
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Seems strange that OptumCare would actually own and run a oncology center themselves as there is no indication that they even do this type of stuff on their own main website.

Description
Optum Care is seeking for a Board-CertifiedRadiation Oncologist to join our OptumCare Cancer Care Team in Las Vegas NV. This is an outstanding opportunity for a physician who wants to remain clinically active while helping shape the future of cancer care in Southern Nevada. The Cancer Center combines expertise, compassion and understanding. We offer patient-centered care in a professional and compassionate setting. Our goal is to provide every patient and their family with top-quality care, while treating them with the respect and compassion they deserve. The ideal candidate will carry exceptional inter-personal skills with a goal of sharing a vision of unparalleled delivery of care through teamwork, collaboration, innovations, and persistence for excellence.

Position Profile:
-The Radiation Oncologist team consists of 4 Physicians
-Well established referral process with 10 Medical Oncologist as part of the group
-On average 8 to 10 new consults per week
-Pore Linear Accelerator machines
-We offer Brachy Therapy services
-Varian machines and software
-Excellent staff, nurses, and MA’s
-This is a F/T employed opportunity with benefits, 401k with match, UHG Employee Stock Purchase Plan, PTO, CME, and more.
 
They’re skipping the middle man. Time will tell if that’s good or bad
 
fiji128 said:
Seems strange that OptumCare would actually own and run a oncology center themselves as there is no indication that they even do this type of stuff on their own main website.
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Think of it as an evolution to the current optum/evilcore/HealthHell model... Now everyone will get 0-5 fractions for everything and you can be the lowest bidder for "cancer services" in the area to other insurers.
 
jondunn said:
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We will see more and more selection (ie a natual Darwinian type selection) of doctors who are "built" to survive in a corporate, functioning-as-employee world. I don't think med school and even residency experience quite prepares *all* the people who select medicine/being a doctor for the environment that they will find themselves in once they become doctors. It would be like putting a camel in the North Pole and going "let's see how it does."
 
TheWallnerus said:
We will see more and more selection (ie a natual Darwinian type selection) of doctors who are "built" to survive in a corporate, functioning-as-employee world. I don't think med school and even residency experience quite prepares *all* the people who select medicine/being a doctor for the environment that they will find themselves in once they become doctors. It would be like putting a camel in the North Pole and going "let's see how it does."
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It's true... many of us went into medicine with the hopes of being wealthy without having to deal with white collar BS. It is an odd situation that we have let ourselves get into... where we have all of the knowledge and very little of the power. Gets me to thinking... what would happen if there were physician unions? Is such a thing allowed? If nurses can do it, why can't we?
 
Lamount said:
It's true... many of us went into medicine with the hopes of being wealthy without having to deal with white collar BS. It is an odd situation that we have let ourselves get into... where we have all of the knowledge and very little of the power. Gets me to thinking... what would happen if there were physician unions? Is such a thing allowed? If nurses can do it, why can't we?
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Some would argue that you already have a union/guild...the ABR.
 
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