Rad Onc Twitter

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Scrubs forever - saw the light during Covid and never looked back
Dropped the tie during final year of residency
Somebody will benefit nicely when I finally get around to bringing 90% of my old work wardrobe to Goodwill

None of the other doctors at my hospital wear dress clothes either, so I'd certainly be odd man out
 
communitydoc13 said:
Lands End all day every day. OluKai shoes. Mustard stain on shirt 2/5 days. Big ass beard.

Good to be away from the big city in some ways.
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My OluKai x Rumpl slippers are the greatest shoes I have ever owned. I wear them all over the place but haven't yet pulled the trigger for work. Well done!
 
OTN said:
My OluKai x Rumpl slippers are the greatest shoes I have ever owned. I wear them all over the place but haven't yet pulled the trigger for work. Well done!
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I have never seen these! Probably too casual for work for me, but they look awesome. Huge fan of Rumpl blankets, have several for camping, shows, etc.
 
OTN said:
I tried to post this on the thread about the Washington Post article re: physician pay, but it's been closed so I'll do it here:

www.aboutamazon.com

Amazon Clinic expands nationwide to provide messaging and video visits for common health conditions

With Amazon Clinic, customers in all 50 states and Washington, D.C. can receive convenient, affordable, and trusted care from the comfort of home.
www.aboutamazon.com www.aboutamazon.com

I think it should be pretty obvious by now why the article was published.
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Is this not Uber for Medicine where PCPs are the taxi drivers?

Tired of your overworked family med clinic? Sit down at your home office and clock in for a few hours of telehealth. Work as long or as short as you want. Any time of day.

Patients spend more for 5-star rated docs (instead of the first available APP!) - Uber Med Black

Not too much of a stretch to think it would come to specialties - at least for consults/second opinions.
 
DireMoose said:
Is this not Uber for Medicine where PCPs are the taxi drivers?

Tired of your overworked family med clinic? Sit down at your home office and clock in for a few hours of telehealth. Work as long or as short as you want. Any time of day.

Patients spend more for 5-star rated docs (instead of the first available APP!) - Uber Med Black

Not too much of a stretch to think it would come to specialties - at least for consults/second opinions.
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"Leaders of the field" could probably do well in this sphere?

Patients, are you dissatisfied with your community oncology opinion? Now you can pay $X cash/out of pocket for a 30 minute virtual visit with me the expert and we'll evaluate your podunk community treatment plan and let you know where it's not as good as ours. Then you can decide if its worth coming to Houston/NYC/Rochester etc.

Sounds like a money maker to me
For the right price I'd do some tele-second opinions a few evenings per week
 
metallica81788 said:
"Leaders of the field" could probably do well in this sphere?

Patients, are you dissatisfied with your community oncology opinion? Now you can pay $X cash/out of pocket for a 30 minute virtual visit with me the expert and we'll evaluate your podunk community treatment plan and let you know where it's not as good as ours. Then you can decide if its worth coming to Houston/NYC/Rochester etc.

Sounds like a money maker to me
For the right price I'd do some tele-second opinions a few evenings per week
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There's a company called 2ndMD that does this. Had a patient (or their insurance) contract them. Ended up endorsing my plan. Don't think they reviewed dosimetry tho.
 
Here is something kind of neat from #radonc twitter today. SWRO is touting a pro-life anti-abortionist (@lopezverasandri)

Let's see if SWRO reads SDN 😉 They certainly don't read Spanish. Always be true to yourselves, babies!

2023-08-31 13_29_34-Sandra (@lopezverasandri) _ X.png
2023-08-31 13_29_54-Sandra (@lopezverasandri) _ X.png
 
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evilbooyaa said:
Re-tweets are not necessarily endorsements is the easy defense of that...

But not sure how being pro-life means someone is incapable of being in SWRO....
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This reminded me of how the ASTRO message board thing is highly censored, but then for whatever reason they just let it fly during the discussion of conference locations in pro-life states LOL
 
TheWallnerus said:
Here is something kind of neat from #radonc twitter today. SWRO is touting a pro-life anti-abortionist (@lopezverasandri)

Let's see if SWRO reads SDN 😉 They certainly don't read Spanish. Always be true to yourselves, babies!

View attachment 376313View attachment 376314
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Yea, not sure you what you're implying here? Being pro-life should have you kicked out or they should not tout any pro-life members if they dare to speak up on the topic?

Edit: Or you just saying given the current climate this will most assuredly turn into a witch hunt?
 
RadOncMegatron said:
Yea, not sure you what you're implying here? Being pro-life should have you kicked out or they should not tout any pro-life members if they dare to speak up on the topic?

Edit: Or you just saying given the current climate this will most assuredly turn into a witch hunt?
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um, all the above possible I think. WE WILL SEE.
 
NotMattSpraker said:
This is what you want. Rad Oncs of all leanings should be supported.

Unless of course they are pro-SOAP, then they should be ruthlessly cancelled. You are a fundamentally bad person if you feel differently. 🙂
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Pro lifers are actually a better fit radonc given the distribution of jobs.
 
Don’t know the backstory… what does this have to do with abortion?
 
Ray D. Ayshun said:
What's he got? I don't have "X"
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Well, looking at that thread on Twitter / X, it appears that he was first diagnosed with a cervical lymph node CUP, which then turned out to be a primary in the tonsil with met(s) to the neck, after imaging. Perhaps p16+?
He then had a tonsillectomy + neck dissection and will now undergo radiotherapy + chemotherapy. The fact that he is going to get chemotherapy, likely means there was a positive margin or extracapsular extension on the nodes.

Poor fellow, he is getting the full package of treatment.
 
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temujim said:
Rad onc as a field would be fools to turn noses up at our own "pharma". So yeah, guess what'll happen...
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I wish there was more of a culture of ownership like in urology. I kind of marvel how urologists are so eager to hold on to patients that they’re now managing metastatic prostate patients until they need chemo. Rad oncs should be fighting to own anything that has to do with ionizing radistion
 
Palex80 said:
Well, looking at that thread on Twitter / X, it appears that he was first diagnosed with a cervical lymph node CUP, which then turned out to be a primary in the tonsil with met(s) to the neck, after imaging. Perhaps p16+?
He then had a tonsillectomy + neck dissection and will now undergo radiotherapy + chemotherapy. The fact that he is going to get chemotherapy, likely means there was a positive margin or extracapsular extension on the nodes.

Poor fellow, he is getting the full package of treatment.
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Oof. Could've been cured with RT + chemo now he's stuck with trimodality.

Another patient negatively affected by the strong push for TORS.
 
The problem with our pharma is the cost and the risk. Firstly, it is poorly reimbursed unless you are getting the facility/hospital fees. Secondly, if the patient does not show up, then you are left holding the bag for tens of thousands of dollars worth of drug.
 
NotMattSpraker said:
It is surprising and also unsurprising that Orator and Pace-A did not make a bigger pro-radiation splash.
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Both trials too small and both trials prematurely closed.
And yes, I know why ORATOR was closed, but my H&N surgeons keep telling me "I've never had anyone die during a TORS". 😳
 
Palex80 said:
Both trials too small and both trials prematurely closed.
And yes, I know why ORATOR was closed, but my H&N surgeons keep telling me "I've never had anyone die during a TORS". 😳
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Just this week we were discussing the 12 patient trial that made immunotherapy preferred for a small subset of patients with rectal cancer.

I realize the risk/benefit landscape is different. But lack of equipoise on the part of surgeons is not a reason to discard prospective data.
 
Palex80 said:
Both trials too small and both trials prematurely closed.
And yes, I know why ORATOR was closed, but my H&N surgeons keep telling me "I've never had anyone die during a TORS". 😳
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Surgeon: "The only thing ORATOR shows is that you shouldn't have surgery in Canada".

My response to that nonsense is that my radiation is better than canadian radiation, so now what?

Anyway I'm 100% sure this PR guy pinged all his ASTRO rad onc friends.... and they couldn't convince him that initial radiation was a better way to go.... well just says a lot about the field. And then to put it on Twitter. Really smh.
 
TheWallnerus said:
Will be proton based
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Great, so he'll be at higher risk for ORN too. Really unfortunate for this guy who works for ASTRO. He's going to be a walking billboard of the pitfalls of economics based (TORS + RT + CHEMO, protons for H&N) rather than evidence based care.
 
Palex80 said:
Both trials too small and both trials prematurely closed.
And yes, I know why ORATOR was closed, but my H&N surgeons keep telling me "I've never had anyone die during a TORS". 😳
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I always love it when surgery shows something commonly done as being worse, the argument (from a subset of surgeons) is always "well those surgeons just SUCK"

Anyone getting TORS for p16+ OPhyx should have it done with a goal of omitting adjuvant radiation.
Anyone getting TORS who ends up needing trimodality should be considered a FAILURE on the part of the surgeon.
 
evilbooyaa said:
I always love it when surgery shows something commonly done as being worse, the argument (from a subset of surgeons) is always "well those surgeons just SUCK"

Anyone getting TORS for p16+ OPhyx should have it done with a goal of omitting adjuvant radiation.
Anyone getting TORS who ends up needing trimodality should be considered a FAILURE on the part of the surgeon.
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Totally agree
 
evilbooyaa said:
I always love it when surgery shows something commonly done as being worse, the argument (from a subset of surgeons) is always "well those surgeons just SUCK"

Anyone getting TORS for p16+ OPhyx should have it done with a goal of omitting adjuvant radiation.
Anyone getting TORS who ends up needing trimodality should be considered a FAILURE on the part of the surgeon.
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This my thought as well when i saw the post. Dk the full details but sad if this is what happened. He ended up with unnecessary toxicity…
 
temujim said:
Even the ASTRO PR guy doesn't believe that radiation better than surgery? And advertises it?

smh
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He should believe it. We are going back to the bad old days.
I have seen so many TORS disasters that it is just tragic. Results with chemo/XRT alone on these patients has been fantastic for decades, and de-escalation and improved radiation technique offers a much better path forward.
Yet, just like in the bad old days, the surgeons are cutting first and asking for rad onc consults only afterwards.
And the thing of it is, if PCPs were aware they would be in a position to stop it.
Sadly, we are not in a position to do anything about it - same old, same old.
 
Even in well selected patients, many are going to need adjuvant RT or CRT.

But, some won't.

I'm not sure what I would do, but if PET-CT was negative in the neck and tumor was small and accessible without messing up my speech/swallow/breathing, I'm not sure I would immediately say no to TORS.

"@JeffWhite" is an ASTRO communications person... but

Jeff White is a human being with preferences, knowledge and he can choose to do whatever he wants. Maybe rolling the dice to avoid RT or CRT was worth it for him. Many people feel that way. It's okay. It doesn't mean anything other than that's what they chose. I know someone in an RT department, a good friend who choose surgery for their cancer (in a site where surgery or RT were both reasonable). I don't think it's because he thinks RT sucks. It is the path he chose.

It doesn't mean he doesn't believe in RT as a curative treatment. He and his doctors were in the room and they own the decision.

I hope he has a good outcome.
 
RealSimulD said:
Even in well selected patients, many are going to need adjuvant RT or CRT.

But, some won't.

I'm not sure what I would do, but if PET-CT was negative in the neck and tumor was small and accessible without messing up my speech/swallow/breathing, I'm not sure I would immediately say no to TORS.

"@JeffWhite" is an ASTRO communications person... but

Jeff White is a human being with preferences, knowledge and he can choose to do whatever he wants. Maybe rolling the dice to avoid RT or CRT was worth it for him. Many people feel that way. It's okay. It doesn't mean anything other than that's what they chose. I know someone in an RT department, a good friend who choose surgery for their cancer (in a site where surgery or RT were both reasonable). I don't think it's because he thinks RT sucks. It is the path he chose.

It doesn't mean he doesn't believe in RT as a curative treatment. He and his doctors were in the room and they own the decision.

I hope he has a good outcome.
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I think someone has their eye in politics in the future!
 
RealSimulD said:
I don’t know that it’s political to respect someone’s agency and wish them well
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Granted I don’t know the details of his case, but we all know of certain surgeons who push for treatment regardless of risk of outcomes and we all know some patients who make bad choices. This could either be one or both but going definitive RT or chemoRT would have been the better option.

Of course I don’t want the man to die or suffer, but we should try our best to avoid situations like this from happening. If there was a potential risk factor where upfront surgery wasn’t the best option, maybe it shouldn’t have been offered.
 
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