Saving Rad Onc

[thecarbonionangle]

The only thing that could “save” rad onc and maybe not for us anytime soon, is good leadership. Even if you had zero people entering residencies and graduating for a few years, you will still have an oversupply. There are too many rad oncs for the jobs available. So rad onc is currently in hospice. It could come out but “leaders” just want another morphine push and maybe a shroom with peanut butter. Enjoy the trip. Some may say I’m a dreamer, but i’m not the only one.

---

Members don't see this ad.

 

[Palex80]

We overwhelmingly overtreat favorable IR prostate cancer presently.

I agree. It is very likely that some biomarker +/- imaging will tell us in a few years which IR patients do not need any treatment. They are already out there, they are rarely utilized nowadays (apart from the indication for ADT). It will only take some more validation.

 

[Ubba]

1. There's a perception among some in this thread that there's an anti-Rad Onc sentiment among us heme/oncs. This is not remotely the case in my training institution, and among the PPs in the field, close relationships with Rad Onc are highly valued. The only exception to this might be the rare PP group that acts as a total mill, herding patients into infusion chairs regardless of patient benefit or outcome. I haven't encountered any of these practices personally, but I've heard they do exist, so maybe they have colored your experiences. Regardless, you should give our field the benefit of the doubt and recognize that the vast majority of us do the right thing by our patients. Now, if the argument is that the NCCN guidelines are biased against Rad Onc, I can't comment on that, and will say that most of us will generally follow the guidelines so as to maintain SOC. But I continue to see plenty of indications for RT in the NCCN and have a strong personal preference to involve Rad Onc for my patients.

2. Med Onc should definitely be split from benign heme fellowship, and I wonder whether a non-surgical oncology residency track should be started. An IM prelim year followed by med onc + rad onc training. The question on this, though, is whether that would entail too much expertise for residents to assimilate. Perhaps not, if such a thing is already done in other countries. Thoughts?

 

[RickyScott]

1. There's a perception among some in this thread that there's an anti-Rad Onc sentiment among us heme/oncs. This is not remotely the case in my training institution, and among the PPs in the field, close relationships with Rad Onc are highly valued. The only exception to this might be the rare PP group that acts as a total mill, herding patients into infusion chairs regardless of patient benefit or outcome. I haven't encountered any of these practices personally, but I've heard they do exist, so maybe they have colored your experiences. Regardless, you should give our field the benefit of the doubt and recognize that the vast majority of us do the right thing by our patients. Now, if the argument is that the NCCN guidelines are biased against Rad Onc, I can't comment on that, and will say that most of us will generally follow the guidelines so as to maintain SOC. But I continue to see plenty of indications for RT in the NCCN and have a strong personal preference to involve Rad Onc for my patients.

2. Med Onc should definitely be split from benign heme fellowship, and I wonder whether a non-surgical oncology residency track should be started. An IM prelim year followed by med onc + rad onc training. The question on this, though, is whether that would entail too much expertise for residents to assimilate. Perhaps not, if such a thing is already done in other countries. Thoughts?

many medoncs are pro radiation, but I have worked with a number at major institutions who are very much anti radiation.

 

[Bequerel]

I think they were anti-radiation because we use to make multiples of them. Now that they’re top dog, I’m hopeful the animosity is over and maybe they feel sorry for us and will throw us a bone

 

[thesauce]

1. There's a perception among some in this thread that there's an anti-Rad Onc sentiment among us heme/oncs. This is not remotely the case in my training institution, and among the PPs in the field, close relationships with Rad Onc are highly valued. The only exception to this might be the rare PP group that acts as a total mill, herding patients into infusion chairs regardless of patient benefit or outcome. I haven't encountered any of these practices personally, but I've heard they do exist, so maybe they have colored your experiences. Regardless, you should give our field the benefit of the doubt and recognize that the vast majority of us do the right thing by our patients. Now, if the argument is that the NCCN guidelines are biased against Rad Onc, I can't comment on that, and will say that most of us will generally follow the guidelines so as to maintain SOC. But I continue to see plenty of indications for RT in the NCCN and have a strong personal preference to involve Rad Onc for my patients.

2. Med Onc should definitely be split from benign heme fellowship, and I wonder whether a non-surgical oncology residency track should be started. An IM prelim year followed by med onc + rad onc training. The question on this, though, is whether that would entail too much expertise for residents to assimilate. Perhaps not, if such a thing is already done in other countries. Thoughts?

I have only associated with anti-radonc medoncs since starting to practice in the community 10+ years ago.

Some notable hallmarks:

Medoncs deciding for themselves when radiation is indicated and don’t discuss it with us or even the patient…EVEN IN CASES WHERE ITS NCCN CATEGORY 1!

When they tell us how many fractions to give (5-fraction rectal, etc). I’ve seen this especially when they’ve gotten into capitated contracts that include RT. Then they complain when they “lose money” on the case because we gave “too much radiation.”

Deciding not to treat a brain met with RT because their systemic therapy has 20% chance of controlling the brain disease (SRS is 90+%).

When they tell the patient that radiation will be too toxic even though they haven’t planned a single case. This came to a head when they told a follicular lymphoma patient with airway compromise and stridor that 2x2 was going to cause significant dysphasia and odynophagia. No I’m not kidding.

 

[StIGMA]

I have only associated with anti-radonc medoncs since starting to practice in the community 10+ years ago.

Some notable hallmarks:

Medoncs deciding for themselves when radiation is indicated and don’t discuss it with us or even the patient…EVEN IN CASES WHERE ITS NCCN CATEGORY 1!

When they tell us how many fractions to give (5-fraction rectal, etc). I’ve seen this especially when they’ve gotten into capitated contracts that include RT. Then they complain when they “lose money” on the case because we gave “too much radiation.”

Deciding not to treat a brain met with RT because their systemic therapy has 20% chance of controlling the brain disease (SRS is 90+%).

When they tell the patient that radiation will be too toxic even though they haven’t planned a single case. This came to a head when they told a follicular lymphoma patient with airway compromise and stridor that 2x2 was going to cause significant dysphasia and odynophagia. No I’m not kidding.

I recently had a med onc NP tell a patient we could modify their definitive case to a palliative case without so much as a note to me. And med onc's advise against RT despite tumor board rec for RT as part of definite therapy (per NCCN). This stuff happens and is frustrating. We don't have full control who we work with or how they act. I think best case is someone is ~95% reasonable...

In general I like the med oncs I work with. My disdain is much more for pharma / NIH priorities.

 

[thesauce]

I had a med onc NP tell a patient how many radiation fractions they would receive, before I saw them (at least it wasn't 0). Shocking.

Yep - I’ve seen that too. They were wrong of course.

 

[yesmaster]

I think they were anti-radiation because we used to make multiples of them. Now that they’re top dog, I’m hopeful the animosity is over and maybe they feel sorry for us and will throw us a bone

It’s the opposite now, med onc’s are top dog and as a result, some rad onc’s are unnecessarily anti-systemic tx. One med onc I worked with legit overused systemic tx but the dude was a boomer and not representative

 

[Fpg1245]

the only true anti RT med oncs I’ve seen are all in the academic setting.

 

[RickyScott]

the only true anti RT med oncs I’ve seen are all in the academic setting.

Yip

 

[anonymuncule]

1. There's a perception among some in this thread that there's an anti-Rad Onc sentiment among us heme/oncs. This is not remotely the case in my training institution, and among the PPs in the field, close relationships with Rad Onc are highly valued. The only exception to this might be the rare PP group that acts as a total mill, herding patients into infusion chairs regardless of patient benefit or outcome. I haven't encountered any of these practices personally, but I've heard they do exist, so maybe they have colored your experiences. Regardless, you should give our field the benefit of the doubt and recognize that the vast majority of us do the right thing by our patients. Now, if the argument is that the NCCN guidelines are biased against Rad Onc, I can't comment on that, and will say that most of us will generally follow the guidelines so as to maintain SOC. But I continue to see plenty of indications for RT in the NCCN and have a strong personal preference to involve Rad Onc for my patients.

2. Med Onc should definitely be split from benign heme fellowship, and I wonder whether a non-surgical oncology residency track should be started. An IM prelim year followed by med onc + rad onc training. The question on this, though, is whether that would entail too much expertise for residents to assimilate. Perhaps not, if such a thing is already done in other countries. Thoughts?

The only country which has a combined MedOnc plus RadOnc specialty afaiw is the UK in the form of ClinOnc

However even with that, ClinOncs will only practise as dual chemo and radiation wielding oncologists in smaller centres (?is this what you guys mean by community practices) but in larger centres (?likewise is this what you call academic centres) ClinOncs will generally do only radiation and the chemo will be done by MedOncs (a UK specialty which basically just does solid organ chemo -- benign and malignant haem is done by haematologists in the UK)