Rad Onc Twitter

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RealSimulD said:
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.
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Even in the easiest surgical scenario -- let's say <1 cm right there on the superficial tonsillar fossa, exophytic, without involving pillars, soft palate, or BoT; with no nodes -- just don't buy that surgery less toxic or better control than RT.
 
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fwillison said:
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.
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p16+ OPhx patients need to have a multi-disciplinary evaluation to get appropriate care. The amount of inappropriate TORS nationwide is too high.
 
grenz said:
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
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The private practice urologists in my area are the only ones hanging on to stage IV patients and giving lupron and provenge in the office. The hospital employed urologists don’t bother and send them to medical oncology. Having a clinic full of stage IV prostate patients and collecting E&M charges doesn’t seem worthwhile unless those patients can translate into external beam treatments some how (sbrt oligomets, palliation, etc).
 
I only do short term ADT for high intermediate risk patients. High risk guys I send to med onc or let the urologists deal with it. Metastatic patients are the realm of med onc, imo. If the Uro has them on appropriate therapy, I just leave well enough alone. If not, I refer to med onc under the auspice of “may be a chemotherapy candidate.”

I assumed there was some change in reimbursement for private clinics dispensing and administering ADT, because a few years back all the urologists seemed to suddenly want to do it again.

It’s kind of the perfect thing for an NP to manage.

My God, no one ever orders DEXAs though.
 
DEXA scanners are relatively “cheap.” Anyone ever consider buying a scanner and sending all your post menopausal/hormonal therapy patients who never seem to have had them done?
 
Mandelin Rain said:
DEXA scanners are relatively “cheap.” Anyone ever consider buying a scanner and sending all your post menopausal/hormonal therapy patients who never seem to have had them done?
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Yes.

It's tricky now with all the consolidation and non-competes, unless you already have a PSA/hospital admin that has experience with setting up a JV.

Less common these days than I expected.
 
JustAdocInBox said:
The private practice urologists in my area are the only ones hanging on to stage IV patients and giving lupron and provenge in the office. The hospital employed urologists don’t bother and send them to medical oncology. Having a clinic full of stage IV prostate patients and collecting E&M charges doesn’t seem worthwhile unless those patients can translate into external beam treatments some how (sbrt oligomets, palliation, etc).
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I would have never believed any of it until i saw a GU administer prolia in his office for his long term adt pts
 
madchemist89 said:
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.
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Yeah, that is very true. I have been asking our prostate Rad Oncs to give Abi with pred for high-risk prostate cancer and the uniform answer I get is, we don't get paid to do that. I also wonder how many rad oncs are giving systemic therapy as part of NRG GU 009 or GU 010. We are the worst advocates for our own field.
 
Barcelona PSG said:
Yeah, that is very true. I have been asking our prostate Rad Oncs to give Abi with pred for high-risk prostate cancer and the uniform answer I get is, we don't get paid to do that. I also wonder how many rad oncs are giving systemic therapy as part of NRG GU 009 or GU 010. We are the worst advocates for our own field.
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Innovation in our field is all about, “I’m here, you’re there, so I’m better then you!” We don’t look for new ways to advance the field, just ways to compete and devalue each other. We are our own worst enemy.
 
medgator said:



Not sure how PRO got around to publishing this doozie....
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Why are ASTRO journals publishing these viewpoint articles? We have more insightful and accurate posts on this forum. In my opinion, the journals should be held to a higher standard of publishing actual science or other related articles that impact patient care.

In response to the article, I would again point out the inaccuracy of: "“Radiation Oncology Spreadsheet,” as accessed by many through the Student Doctor Network.[4]"

SDN never officially linked to that spreadsheet. The inability to moderate that spreadsheet for sexist, racist, or other issues that require moderation in our opinion led to the early removal of any direct links from this forum.

I already wrote a letter to the editor in response to that linked article (https://www.redjournal.org/article/S0360-3016(19)30792-8/fulltext). The author of this article doesn't seem to have noticed.

Also the disclosures from the author should not have been published in my opinion. You help write medical plots for TV shows? What does that have to do with the article?

I think our society journals should be better than this.
 
Neuronix said:
Also the disclosures from the author should not have been published in my opinion. You help write medical plots for TV shows? What does that have to do with the article?
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Easy -

The opinion of the article, just like the plot of the television shows, represents a work of fiction.

I would have been highly concerned if the COI had instead been anything related to the practice of Medicine.
 
IMG_4735.jpeg
 
drowsy12 said:
I will admit - rad onc being 'cool' and a desired field by others, including people who I looked up to as smart or elite - that certainly played a role in my interest. is that controversial? Thought that was common
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No, it's not controversial at all.

It's totally normal to the point that I would assume it played a role for virtually all of us, even subconsciously.

The problem is an unhealthy lamentation of its loss.

If someone perceives a certain group as having certain traits, and then works to become a part of that group - they become the shepherd of those traits. But an individual can only influence a group a small amount, nothing a large group (or organization, or institution) does is exclusively the fault of any singular member.

We've been stuck in a denialism phase of what happened to RadOnc for a few years now. There are some objective datapoints we should all be able to agree on, namely:

1) Residency expansion doubled RadOnc physician production.

2) CMS has consistently bundled or cut our reimbursement - with private carriers taking bites wherever possible.

3) There has been a consistent and sustained effort towards reducing our footprint through hypofrac and omission, chiefly in our largest indications of breast and prostate.

4) While there has been some growth in the use of radiation (oligomets, benign disease), it has not kept pace with the reduction seen in breast and prostate.

5) We've been the least competitive specialty in the Match for multiple years.

If anyone wants to point me towards evidence against those five points, believe me - I want to see it.

But: at the end of the day, I am a part of this group as a practicing Radiation Oncologist. My love and obsession with the medicine of radiotherapy has not changed. And neither has been my sustained campaign of advising students to avoid this field if they're interested in strong job prospects.

Whether or not RadOnc is "bottom of the barrel" in the Match literally could not matter less to me or my patients. But it clearly matters to a certain segment of the population, especially those who finished residency in the 1990s and early 2000s.

Rather than acknowledging the math doesn't add up - more doctors, less radiotherapy - certain people, often in influential positions, prefer to invoke ephemeral windmills to aim their lances at.

Instead of wasting time and space on weak spin ("unemployment is low") or conjuring obscure metaphysical theories, they should be actively engaged in constructing their sense of self around something else, like, perhaps, taking excellent care of the patients who trust us with their lives.

In short: the people who interact with you on a day-to-day basis have no idea about NRMP Match data. Unlike an abstract opinion of "the field", the actual "prestige" you, as an individual, attain is entirely within your control.
 
recent tiktok video has RO as #2 most respected and the phrasing was something about us being smart, making lots of money for hospital and working short hours.

I think mainstream doc has no idea RO has fallen. Every person I say this to is shocked. And then they mutter “skinny bitch didn’t seem that smart anyway” just loud enough for me to hear
 
Ray D. Ayshun said:
that reminds me of a joke I once heard. BTW, did you blow bubbles as a kid?
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Is this like in "Good Will Hunting" where Damon asks the guy "BTW do you like apples?" If the guy goes "no," Damon has NOTHING. Embarrassingly, humiliatingly nothing. ("Thank god the guy liked apples" Will must have momentarily thought.) I don't know the bubbles line. And as long as "bubbles" isn't a clown's name... I will tee it up

yes, I blew bubbles as a kid
 
TheWallnerus said:
Is this like in "Good Will Hunting" where Damon asks the guy "BTW do you like apples?" If the guy goes "no," Damon has NOTHING. Embarrassingly, humiliatingly nothing. ("Thank god the guy liked apples" Will must have momentarily thought.) I don't know the bubbles line. And as long as "bubbles" isn't a clown's name... I will tee it up

yes, I blew bubbles as a kid
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Well he's back in town and he wants your new number.

Got that from an old "Amazing Jonathan" set. He's pretty decent. I suspect you saw the Louis CK bit on Good will hunting about that. If not, worth a watch.
 



Indeed, sometimes data is scarce.
I am dealing with a case right now. Metastatic breast cancer, treated with 15 x 3 Gy to the brachial plexus for lymph node mets, 2 years ago.
Progressing now in the exact same spot. Any data on plexus recovery? Should I assume it recovers like spinal cord?
 
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Palex80 said:



Indeed, sometimes data is scarce.
I am dealing with a case right now. Metastatic breast cancer, treated with 15 x 3 Gy to the brachial plexus for lymph node mets, 2 years ago.
Progressing now in the exact same spot. Any data on plexus recovery? Should I assume it recovers like spinal cord?
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I would assume it recovers like cord. The problem is recurrences there can cause terrible plexopathy. I’ve become more aggressive about preventatively irradiating there
 
A_DeMichele said:
I would not assume that human brachial
plexus recovers like monkey’s spinal cord
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I’m laughing because in rad onc whenever we talk long term radiation damage and cord/nerves, inevitably someone says “monkeys.”

We base a lot of human care on monkeys!
*guilty*

*salutes the monkeys who gave their lives*
 
TheWallnerus said:
I’m laughing because in rad onc whenever we talk long term radiation damage and cord/nerves, inevitably someone says “monkeys.”

We base a lot of human care on monkeys!
*guilty*

*salutes the monkeys who gave their lives*
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What is the saying...."having a radiation oncologist evaluate a patient for a potential need for radiation is like having a monkey evaluating a banana for the need to consume it."
 
RickyScott said:
Any “grievance” study has 100% chance pre data collection of being positive. Why even do the work? Just make an assertion.

I bet Black toddlers in the fires had even worse outcomes.
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This is like doing a study where you get daily psas during treatment. Its information that is in no way useful.
 
Ray D. Ayshun said:
This is like doing a study where you get daily psas during treatment. Its information that is in no way useful.
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I did that study during residency.
We found that psa’s were higher in non white patients, and hypothetised that the techs were not always turning on linacs to save electricity.
 
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1694906752907.png


1) California-based Radiation Oncologists are aware of wildfires. They report concern that wildfires negatively affect their patient's ability to present for daily treatments, but no departments surveyed have an official "wildfire" protocol. Unexpectedly, we found that wildfires were also of concern to the Radiation Oncologists themselves, and prohibited their ability to get to the department to directly supervise treatment.

2) We used this data:

1694907037856.png


As well as SurveyMonkey (12% response rate) to discover wildfires caused missed treatments. There were significantly more missed treatments in 2020. There were significantly fewer missed treatments in 2019. In addition to wildfire data, we hypothesize that the COVID-19 pandemic also contributed to missed treatments.

3) We found that missing treatments negatively impacted survival in the cancers previously known to have worse survival with missed treatment. We found that for lung, head and neck, and cervical cancer, there was an increased mortality risk of 1.5-3% per week of missed treatment.

In this novel study exploring the impact of California wildfires on patients receiving radiation therapy, we found that more wildfires were associated with more missed treatments, and more missed treatments increased mortality risk for patients receiving definitive therapy.

This work highlights the importance of hypofractionation in mitigating the impact of California wildfires on patients receiving radiation therapy. Conventional fractionation should be considered a tacit admission of not only greed, but also of a dark desire to impose a burning forest on people in your care, in direct violation of the Hippocratic Oath.
 
elementaryschooleconomics said:
Conventional fractionation should be considered a tacit admission of not only greed, but also of a dark desire to impose a burning forest on people in your care, in direct violation of the Hippocratic Oath.
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Conventional fractionation should be considered a tacit admission of not only greed but (insert crowd pleasing derogatory statement here) in direct violation of the Hippocratic Oath.
 
elementaryschooleconomics said:
View attachment 376816

1) California-based Radiation Oncologists are aware of wildfires. They report concern that wildfires negatively affect their patient's ability to present for daily treatments, but no departments surveyed have an official "wildfire" protocol. Unexpectedly, we found that wildfires were also of concern to the Radiation Oncologists themselves, and prohibited their ability to get to the department to directly supervise treatment.

2) We used this data:

View attachment 376817

As well as SurveyMonkey (12% response rate) to discover wildfires caused missed treatments. There were significantly more missed treatments in 2020. There were significantly fewer missed treatments in 2019. In addition to wildfire data, we hypothesize that the COVID-19 pandemic also contributed to missed treatments.

3) We found that missing treatments negatively impacted survival in the cancers previously known to have worse survival with missed treatment. We found that for lung, head and neck, and cervical cancer, there was an increased mortality risk of 1.5-3% per week of missed treatment.

In this novel study exploring the impact of California wildfires on patients receiving radiation therapy, we found that more wildfires were associated with more missed treatments, and more missed treatments increased mortality risk for patients receiving definitive therapy.

This work highlights the importance of hypofractionation in mitigating the impact of California wildfires on patients receiving radiation therapy. Conventional fractionation should be considered a tacit admission of not only greed, but also of a dark desire to impose a burning forest on people in your care, in direct violation of the Hippocratic Oath.
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congrats on your ASTRO plenary
 
Three out of the four machine learning models tested predicted poorer outcomes among prostate cancer patients treated with SBRT, should a solar flare impact the electrical grid during treatment. Thus, there is a critical need to further research how to power a proton cyclotron in the event of extreme solar weather.
 
Lamount said:
Three out of the four machine learning models tested predicted poorer outcomes among prostate cancer patients treated with SBRT, should a solar flare impact the electrical grid during treatment. Thus, there is a critical need to further research how to power a proton cyclotron in the event of extreme solar weather.
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In the photon world, we just put the linacs in the basement for extra solar flare protection.
 
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