Thoughts from a PGY-5

[Mandelin Rain]

NEED more scarb CONTENT!!!!

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[deleted1002574]

SCARB NEEDS A BLOG, A TIKTOK, AND A YOUTUBE CHANNEL. I will subscribe. Or, shall I say, 'scarbscribe'

 

[RadOncG]

All of my fellow PGY-5s I have talked with - including those at my program and other programs - received offers for jobs that were not publicly advertised or posted. This is of course anecdotal, but nonetheless a large n. Again, we all have jobs, not fellowships, in highly desirable cities.

Just trying to introduce a dose of reality!

I believe you 100% and without any hesitation.

I also believe you are attacking a straw man. I don't remember anyone saying there will be zero jobs available. I don't remember anyone saying that connections and unadvertised positions are unimportant.

Can you imagine a medical student student reading this post? "Wow, someone knows radiation oncology residents that got jobs...sign me up"

There will always be jobs available every single year. The question that is debated is are there enough jobs given what we know.

 

[KHE88]

The only reason I'm replying is to make sure to stamp out the fake news.

So how do you think this is possible. Prostate cancer is, as you know, the most common cancer in men. Number of new cases per year has dropped by ~33% over the last 10y, and we are about 25y out from the advent of PSA testing. The incidence held steady as you can see for many years after this advent (1990-95 time frame).

"Better-regarded sources" is weasel wording and a logical fallacy. Who's predicting this increased incidence in the U.S.? Smoking is on the downswing thus lung CA decreasing, prostate CA trends as noted above. You have previously cited one source which says the number of incident cases will increase in America by <1 million over the next 20 years and this will thus equal a ~1% rise in incidence per year. Surely you can realize that if this one single source's modeling is even mildly off... and follows the recent trend...

... incidence may flatline or decrease.*


I will call you out for weasel wording again ("would agree with me"... that's nice!), and that "someone" is me. And it wasn't a claim. I was simply citing a source which revealed that at a lung nodule clinic at MGH they saw about 140 patients/year which yielded about 8 lung SBRTs a year. Draw conclusions from that as you will. But I have also cited national data showing that over a 10y period about 30,000 (out of ~150,000) patients at most got lung SBRT which translates to about 3,000 cases per year. We can be very confident that no more than ~15,000 patients per year are getting lung ca SBRT in the U.S. This number is where I get the ~3 lung SBRTs for every rad onc in America (on average) metric.

Back to your "better-regarded sources" and my "claims." Hopefully I have not made any "claims" per se. And my sources here were SEER, the CDC, The Oncologist, the JNCI, and the Red Journal. And a few random internet links for fun. However you have made claims which are, from my end, impossible to falsify. This does give you the virtue of never being provably wrong.


*even the CDC's 2015 modeling was off. They predicted ~1.9 million cases for 2020 in 2015. But now that we are five years in the future from 2015, and actually in 2020, we can better see the actual 2020 number will be about ~1.8 million for 2020. About 5% less than what the CDC predicted just 5y ago.

One day I am going to be reading through a patient chart and stumble across a 7 page assessment and plan from an outside radiation oncologist for a ypT1cN1a breast cancer with about 75 cited papers (with a final recommendation of forward planned IMRT of course)

And then I will know I've discovered who the scarb is.

 

[Pointless]

I believe you 100% and without any hesitation.

I also believe you are attacking a straw man.

Guys, let's leave the straw man out of this. He's been through enough already, being made of straw and all.

 

[RickyScott]

@scarbrtj killing it

Where is @20181121 to respond

i will respond for him: HPV cancers are also increasing because all that vaccine stuff is bunch of bull, and this will create need for more cervical brachytherapy fellowships Smoking rates are also going up so we will see increases in lung, bladder, pancreas, and heart cancers. They will all double at least to offset the doubling of residents. We will probably also treat more breast DCIS in future,

 

[evilbooyaa]

Let's avoid direct call outs of other SDN members when there is nothing productive to say. Basically, don't @ other SDN members just for the purposes of calling them out.

Fight the urge to act like a hype man in the forum. It's not necessary. 1 post deleted and warning given.

 

[deleted1002574]

If you were going to delete anything, I think my post (even with the witty 'scarbscribe') was probably one that should go...

 

[evilbooyaa]

If you were going to delete anything, I think my post (even with the witty 'scarbscribe') was probably one that should go...

Your post was not attacking another SDN member.

I suppose being a positive hype man by saying "Poster X is da mannnnnnn!" is OK, but being the negative hype man (often the same hype man, I concede) that says "Ohhhhh Poster Y, how you gonna respond to that yo momma joke you lil' bitch".

I imagine you weren't looking for a serious response, but here we are.

If scarb ever starts a youtube channel we all know who we have to thank.

Regardless, let's get back on topic

 

[Spiced Meats]

Always fun to go through current ASTRO job postings

Cook County Hospital / Chicago - "Where the life you save may one day take your own"

Yikes, yeah you might not be a good fit for our job. If treating lower socioeconomic and minority patients isn't your thing that's ok but most of them haven't killed me.
Maybe rad onc twitter is right - a culling of the field might get rid of this wrong type of oncologist.

 

[deleted1002574]

Yikes, yeah you might not be a good fit for our job. If treating lower socioeconomic and minority patients isn't your thing that's ok but most of them haven't killed me.
Maybe rad onc twitter is right - a culling of the field might get rid of this wrong type of oncologist.

There was LITERALLY a TV show called "ER" starring George Clooney based on Cook County hospital and this actually happened on the show. You may be too young to remember it, so it's where the Casamigos tequila guy-slash-social activist got famous (prior to his stint on Facts of Life). So, cool it! Sounds like you would be terribly un-fun to work with, so NO THANK YOU.

Culling people from society with no sense of humor would also be great, but in general, culling of all kinds seems .. sort of "Hunger Games" don't ya think?

 

[Spiced Meats]

There was LITERALLY a TV show called "ER" starring George Clooney based on Cook County hospital and this actually happened on the show. You may be too young to remember it, so it's where the Casamigos tequila guy-slash-social activist got famous (prior to his stint on Facts of Life). So, cool it! Sounds like you would be terribly un-fun to work with, so NO THANK YOU.

Culling people from society with no sense of humor would also be great, but in general, culling of all kinds seems .. sort of "Hunger Games" don't ya think?

Well I've been described as the radiation oncology department's indian George Clooney and having an adequate sense of humor so the jokes on you.

Also "the market" will do the culling apparently so no guilt for me.

 

[scarbrtj]

There was LITERALLY a TV show called "ER" starring George Clooney based on Cook County hospital and this actually happened on the show. You may be too young to remember it, so it's where the Casamigos tequila guy-slash-social activist got famous (prior to his stint on Facts of Life). So, cool it! Sounds like you would be terribly un-fun to work with, so NO THANK YOU.

Culling people from society with no sense of humor would also be great, but in general, culling of all kinds seems .. sort of "Hunger Games" don't ya think?

Rad onc trivia: a rad onc appeared briefly one time on ER, was shown in non-flattering (lazy) light as I recall. Not quite as bad as the rad onc portrayal in The Doctor but still.

 

[deleted1002574]

Unfunny. This is the new generation of rad onc...

And, being complimented on having George Clooney's "adequate" sense of humor (Indian or otherwise) is like being told that you have Louie CK's looks and self control.

(That's funny, kiddos!)

 

[20181121]

Friends, I’ve stated in prior posts why I think the predictions of the future here will turn out to be wrong - I don’t have the time to address everything point by point. You can take a look back at my prior posts, and you can feel free to disagree.

Separately, I am glad someone commented on the insensitivity and unprofessionalism of the post about the different cities and patient populations represented by the job postings mentioned. I get that it may have been intended as a joke, but it strikes me as part of a common sentiment here. It’s fine if you don’t want to live somewhere, but we can’t forget that these are (collectively) our patients, and more importantly, our fellow man.

 

[radoncgrad2019]

Friends, I’ve stated in prior posts why I think the predictions of the future here will turn out to be wrong - I don’t have the time to address everything point by point. You can take a look back at my prior posts, and you can feel free to disagree.

Separately, I am glad someone commented on the insensitivity and unprofessionalism of the post about the different cities and patient populations represented by the job postings mentioned. I get that it may have been intended as a joke, but it strikes me as part of a common sentiment here. It’s fine if you don’t want to live somewhere, but we can’t forget that these are (collectively) our patients, and more importantly, our fellow man.

Also can’t forget that for every one of these locations there are multiples of urologists, derms, radiologists, ENTs, breast surgeons, neurosurgeons, orthos, etc that are sending you patients. They clearly are choosing to live there

 

[deleted1002574]

What a bunch of sniveling weenies and shrinking violets! We live in an era of 24 hour porn on smart phones, constant vulgarity on TV and the radio, a world where sarcasm and satire rule, and if someone makes a joke about different cities and practices, that is “insensitive and unprofessional”. I know I can guarantee within 3-4 years the age group of the two people who are just so offended. What a complete farce. You are becoming caricatures of yourselves.

How did an entire generation make a culture out of getting offended?

Friends, I’ve stated in prior posts why I think the predictions of the future here will turn out to be wrong - I don’t have the time to address everything point by point. You can take a look back at my prior posts, and you can feel free to disagree.

Separately, I am glad someone commented on the insensitivity and unprofessionalism of the post about the different cities and patient populations represented by the job postings mentioned. I get that it may have been intended as a joke, but it strikes me as part of a common sentiment here. It’s fine if you don’t want to live somewhere, but we can’t forget that these are (collectively) our patients, and more importantly, our fellow man.

 

[Mandelin Rain]

We live in an era of 24 hour porn on smart phones, constant vulgarity on TV and the radio, a world where sarcasm and satire rule,

And that's just the White House..... bazinga!

























Seriously though, agree with the main point.

 

[RadOncG]

Friends, I’ve stated in prior posts why I think the predictions of the future here will turn out to be wrong - I don’t have the time to address everything point by point. You can take a look back at my prior posts, and you can feel free to disagree.

Separately, I am glad someone commented on the insensitivity and unprofessionalism of the post about the different cities and patient populations represented by the job postings mentioned. I get that it may have been intended as a joke, but it strikes me as part of a common sentiment here. It’s fine if you don’t want to live somewhere, but we can’t forget that these are (collectively) our patients, and more importantly, our fellow man.

"The ABR gave a good exam and I was cyberbullied"

I see academics using the victim hood card more than millennial residents. It is one strategy to deflect tough questions.

The newest academic line to tell medical students I have witnessed: The job market is good. It has always been the same but the expectations have changed. So as it turns out there is no degree of decreased utilization or increased radiation oncologist supply that affects the job market but if you come in with the wrong expectations then there will be a perceived job market issue.

 

[KHE88]

It’s fine if you don’t want to live somewhere, but we can’t forget that these are (collectively) our patients, and more importantly, our fellow man.

Sir/Ma'am, we are all willing to go whereever is necessary to radiate our fellow man. Unless of course there are no biryanis there. That's just inhumane.

In other news, I am deep in talks with the cafeteria staff here. The lunch lady is pretty sure she can make some killer biryanis. Time will tell, but I think there's hope...

 

[deleted1002574]

Sir/Ma'am, we are all willing to go whereever is necessary to radiate our fellow man. Unless of course there are no biryanis there. That's just inhumane.

In other news, I am deep in talks with the cafeteria staff here. The lunch lady is pretty sure she can make some killer biryanis. Time will tell, but I think there's hope...

Really appreciate the enthusiasm. I really do. But, let me put this in a way you may understand. It's not Spams when you have more than one can, right? It's still just Spam. Similarly, it's just biryani, not biryanis. Ya dig?

To avoid deletion, yes, I agree that we should not have to just go anywhere you don't want to go. That is inhumane. @KHE88 - get back to just crushing it financially, earning barrels full of money, with no where to spend. Hopefully, you will FIRE in 8 years.

 

[RickyScott]

but we can’t forget that these are (collectively) our patients, and more importantly, our fellow man.

If your interests truly lie in helping your fellow man, lets advocate docs getting out of an oversupplied specialty like radonc and entering one with shortage/need like medonc, family med, etc. There is virtually no metro under 100,000 in america that is uncovered by a linac and now with the lack of supervisory requirement, no one has to even live in small places- just fly out there one day a week!

Never in my entire career have I heard that a patient in this country has difficulty accessing radiation because of lack of radonc in an area. (linac diff story- it needs to be financially justified)

 

[RadOncDoc21]

And that's just the White House..... bazinga!

























Seriously though, agree with the main point.

I’m pretty sure this will be deleted, but great post!

 

[evilbooyaa]

What a bunch of sniveling weenies and shrinking violets! We live in an era of 24 hour porn on smart phones, constant vulgarity on TV and the radio, a world where sarcasm and satire rule, and if someone makes a joke about different cities and practices, that is “insensitive and unprofessional”. I know I can guarantee within 3-4 years the age group of the two people who are just so offended. What a complete farce. You are becoming caricatures of yourselves.

How did an entire generation make a culture out of getting offended?

OK boomer

But seriously - proclaiming victimhood is common at all levels in American culture nowadays, regardless of when you were born. People can have whatever opinions of whether you are insensitive or unprofessional - at least on the internet you don't have to give a rat's ass about their opinions. I encourage you, ROFD, to not be ageist in your responses, and realize that there are people from every generation that are incredibly sensitive and quick to throw around the 'unprofessional' word. Anecdotally, I have heard the excessive use of the world 'unprofessional' be associated with those in academics as a way to try to exhibit power and control in a nebulous way over their subordinates, and thus people will try it on the internet as well. Unfortunately calling somebody unprofessional on the internet really doesn't mean a whole lot 99% of the time.

I look forward to being told how *I* am insensitive and unprofessional for not deleting a negative opinion that got panties in a bunch.

OP just wants to tell the world it's all going to be OK. When confronted with data, they suggest that one 'look at their previous posts' where they have cited no data. OP, it's OK to have your outlook, and I honestly hope you're right, but the people who disagree with you (and leave thesis like posts to explain why you are wrong) have the right to do so.

 

[deleted1002574]

Here's the problem, @evilbooyaa

The leap goes from me making a one-off line about Cook County Hospital (notorious in the medical and entertainment community - and the line was initially associated actually with another county hospital from a reality trauma show - Charity Hospital in Louisiana) to them saying that "if treating lower SES and minority patients isn't your thing"... do you see how why those shouldn't be connected? Do you see how stating that if I make a remark about a County hospital that means I don't want to take care of the poor or minorities? It's a very odd and quite provocative thing to say and honestly, I don't think most people in my age group do that sort of thing. There is a tendency for *that* generation to basically say "if you joke about something that I care about, you are racist / anti poor / sexist / homophobic"). Which isn't really the case.

I also have a hunch that this doctor that works there is not 100% of the time talking about how great it is to work at County. If they are healthy, they probably have some coping mechanisms - i.e. "gallows humor" that they use among each other, because working at County is rough. It is challenging, the patients' stories will just kill you. If you only focus on that, and can't let go for a moment, you'll burnout quickly.

We can ascribe motives to people however we want to, call them unprofessional or insensitive, but at the end of the day, this is all signaling. No healthy physician, especially in oncology, is not engaging in some form of gallows humor as a way to get through the day. You'll note that I didn't insult individual patients, a race .. it was just a comment that Cook and the adjoining neighborhood have some crime issues.

 

[evilbooyaa]

I get it and why you responded the way you did. I agree with you, but unfortunately Godwin's law or it's derivatives are not uncommon on SDN.

Regardless, the best solution (IMO) to a slight like that, especially on the internet, is a 'lol OK whatever mang', and move on with your life. Happened to me before in the 'Dare you to reply' thread... can't let the little guys get ya riled up, ya know?

 

[scarbrtj]

And that's just the White House..... bazinga!

























Seriously though, agree with the main point.

I’m pretty sure this will be deleted, but great post!

A truly great post. Had the most white space privilege of any post in SDN history I think.

 

[Spiced Meats]

Here's the problem, @evilbooyaa

The leap goes from me making a one-off line about Cook County Hospital (notorious in the medical and entertainment community - and the line was initially associated actually with another county hospital from a reality trauma show - Charity Hospital in Louisiana) to them saying that "if treating lower SES and minority patients isn't your thing"... do you see how why those shouldn't be connected? Do you see how stating that if I make a remark about a County hospital that means I don't want to take care of the poor or minorities? It's a very odd and quite provocative thing to say and honestly, I don't think most people in my age group do that sort of thing. There is a tendency for *that* generation to basically say "if you joke about something that I care about, you are racist / anti poor / sexist / homophobic"). Which isn't really the case.

I also have a hunch that this doctor that works there is not 100% of the time talking about how great it is to work at County. If they are healthy, they probably have some coping mechanisms - i.e. "gallows humor" that they use among each other, because working at County is rough. It is challenging, the patients' stories will just kill you. If you only focus on that, and can't let go for a moment, you'll burnout quickly.

We can ascribe motives to people however we want to, call them unprofessional or insensitive, but at the end of the day, this is all signaling. No healthy physician, especially in oncology, is not engaging in some form of gallows humor as a way to get through the day. You'll note that I didn't insult individual patients, a race .. it was just a comment that Cook and the adjoining neighborhood have some crime issues.

What a leap. I'm just hearing wah wah someone didn't find me funny it must be their millenialism. This is such classic boomerism, plz submit to the Laughter is the Best Medicine section in the reader's digest and maybe your peers will enjoy.

Maybe I didn't catch a reference but I did see a negative sentiment ascribed to my patients, on a public forum, that I hear often so I responded. There's pleeenty about my work that I bitch/joke about but that's unrelated.

In fairness we do occasionally take care of prisoners but the adjoining neighborhood to County is the West Loop which has like 16 Michelin stars.
Take the L.

 

[deleted1002574]

Incidentally, I would have loved to work with your group at Cook and take care of those good people. I'm about 110% sure I wouldn't get an interview if I applied, so I will just mildly poke fun at the institution, instead. That being said, The Girl and The Goat is f'in overrated, I don't care what you have to say about that, and the diner isn't much better.

 

[Lamount]

The claim was MGH treats 8 SBRT lung patients referred specifically from their lung nodule program. I believe this was in context of an argument that lung screening will greatly increase the demand for XRT as a downstream effect.

That's still somewhat misleading as, logically, most patients who's lung cancer is found during screening should likely meet with a surgeon first anyway... right? Lobectomy is the standard of care until something like VALOR tells us otherwise. Most of my referrals for early stage lung SBRT come from surgeons for patients who are inoperable or decline surgery.

 

[Mandelin Rain]

That's still somewhat misleading as, logically, most patients who's lung cancer is found during screening should likely meet with a surgeon first anyway... right? Lobectomy is the standard of care until something like VALOR tells us otherwise. Most of my referrals for early stage lung SBRT come from surgeons for patients who are inoperable or decline surgery.

Only if you assume that Harvard doesn’t have multidisciplinary clinic or rounds where patients are directed from nodule clinic to the correct treatment.

I think that is a very poor assumption.

 

[Lamount]

Only if you assume that Harvard doesn’t have multidisciplinary clinic or rounds where patients are directed from nodule clinic to the correct treatment.

I think that is a very poor assumption.

You think medical operability is always determined at thoracic tumor board? Who do you suppose orders the PFTs and determines operability?

 

[PhotonBomb]

You think medical operability is always determined at thoracic tumor board? Who do you suppose orders the PFTs and determines operability?

i know right? i don't get what MR is saying

 

[RickyScott]

That's still somewhat misleading as, logically, most patients who's lung cancer is found during screening should likely meet with a surgeon first anyway... right? Lobectomy is the standard of care until something like VALOR tells us otherwise. Most of my referrals for early stage lung SBRT come from surgeons for patients who are inoperable or decline surgery.

I think the point is that increased lung cancer screening will do next to nothing for radonc volume. In fact, lung cancer will plummet with less smoking

 

[PhotonBomb]

I think point That increased lung cancer screening will do next to nothing for radonc volume. In fact, lung cancer will plummet with less smoking

next to nothing?

are you dumb?

the more lung cancers diagnosed, the more that need treatment, some proportion of which will include radiation.

WHY ARE PEOPLE SO LOW IQ HERE

 

[RickyScott]

next to nothing?

are you dumb?

the more lung cancers diagnosed, the more that need treatment, some proportion of which will include radiation.

WHY ARE PEOPLE SO LOW IQ HERE

We have established ct screening program and I get about 1-2 cases a year through it. Maybe half of those 1-2 cases would have come as stage 3 if were not screened and (am loosing out on those 30 treatments) the other half I am losing out on treating brain and bone Mets.
Again MGH radonc gets 8 cases/year through their screening program?

 

[PhotonBomb]

We have established ct screening program and I get about 1-2 cases a year through it. Maybe half of those 1-2 cases would have come as stage 3 if were not screened. Again mgh radonc gets 8 cases/year through their screening program?

bottom line - if more lung cancer diagnoses are happening in the country at large, more cases will need radiation. bottom line. it really is quite simple. from a cancer business point of view, it is a good thing, just like PSA screening was back in the day. I think the jury is out on whether it is good for patients or not (no OS benefit or overall cancer mortality benefit)

 

[RickyScott]

bottom line - if more lung cancer diagnoses are happening in the country at large, more cases will need radiation. bottom line. it really is quite simple. from a cancer business point of view, it is a good thing, just like PSA screening was back in the day. I think the jury is out on whether it is good for patients or not (no OS benefit or overall cancer mortality benefit)

But there will be less lung cancer diagnoses as smoking plummets. 45% 1960s to 15% today. It’s really dramatic.

CDC says smoking rates fall to record low in US

An estimated 14 percent of adults in the U.S., or 34.3 million people, smoked cigarettes in 2017, according to the Centers for Disease Control and Prevention.

www.google.com

 

[radoncgrad2019]

yeah in the long term diagnoses will go down - less smoking, more HPV vaccines


Med onc done too

 

[Mandelin Rain]

You think medical operability is always determined at thoracic tumor board? Who do you suppose orders the PFTs and determines operability?

Ummm, yes. I’ve worked in community hospitals where CT surgeons, pulmos, and rad oncs review nodules/patients and coordinate treatment. I’m guessing Harvard may be (has been) able to pull this off.

they have a lung nodule clinic. What do you think takes place?

 

[scarbrtj]

next to nothing?

are you dumb?

the more lung cancers diagnosed, the more that need treatment, some proportion of which will include radiation.

WHY ARE PEOPLE SO LOW IQ HERE

Here is a graph of smoking incidence: \
And if this were a graph of lung cancer screening incidence: /
This would be a graph of lung cancer incidence, best case: ⁠—*

"The more lung cancers diagnosed, the more that need treatment, some proportion of which will include radiation." An incomplete statement, ergo, because the causative agent for the screened-for disease is becoming less prevalent. You are right: we can increase the numerator with screening. But you can't increase the numerator past the denominator. I.e., you can't diagnose more people with lung cancer than there are people. So there needs to be a brisk uptick in screening to outdo the rapid decline in causative agent exposure.

And the "some proportion" which will include radiation is, based on reported literature, about one out of 20 screened patients. (In general, about one out of 16 diagnosed lung cancer patients are lung SBRT patients... ~1/4 are Stage I, and ~1/4 of those get SBRT... nationwide.) Inside screening, about 1/7 of patients that get *any* treatment, once it's determined they might or do have cancer, get lung SBRT. Which says to me that screening tends to find about half the rate of SBRTable patients than doing no screening does. So paradoxically heavy lung CA screening might decrease the SBRT incidence (and possibly the RT incidence) in lung CA. (I don't know how much IQ it takes to suss this. But it's late and I'm too lazy to spell it out.)

* spoiler alert: it's not actually flat

 

[scarbrtj]

next to nothing?

are you dumb?

the more lung cancers diagnosed, the more that need treatment, some proportion of which will include radiation.

WHY ARE PEOPLE SO LOW IQ HERE

Could be less than nothing, not next to nothing. Further elaborated, IQ-controversial version.

1. JK Jang, JC Ye, SM Atay, et al. Temporal Trends in the Utilization of Stereotactic Body Radiotherapy for Non-Small Cell Lung Cancer in the United States. IJROBP 2019;105:E511.
2. Roberts TJ, Lennes IT, Hawari S, et al. Integrated, Multidisciplinary Management of Pulmonary Nodules Can Streamline Care and Improve Adherence toRecommendations. The Oncologist 2019;24:1-7.
3. Stage at Diagnosis | Cancer Trends Progress Report

 

[elementaryschooleconomics]

Could be less than nothing, not next to nothing. Further elaborated, IQ-controversial version.

1. JK Jang, JC Ye, SM Atay, et al. Temporal Trends in the Utilization of Stereotactic Body Radiotherapy for Non-Small Cell Lung Cancer in the United States. IJROBP 2019;105:E511.
2. Roberts TJ, Lennes IT, Hawari S, et al. Integrated, Multidisciplinary Management of Pulmonary Nodules Can Streamline Care and Improve Adherence toRecommendations. The Oncologist 2019;24:1-7.
3. Stage at Diagnosis | Cancer Trends Progress Report

Dropping knowledge with papyrus font.

Or is it? What font is that?

 

[PhotonBomb]

This liberal use of assumptions and hand waving with numbers shtick has really run its course *EDITED BY MODS*

 

[RickyScott]

Could be less than nothing, not next to nothing. Further elaborated, IQ-controversial version.

1. JK Jang, JC Ye, SM Atay, et al. Temporal Trends in the Utilization of Stereotactic Body Radiotherapy for Non-Small Cell Lung Cancer in the United States. IJROBP 2019;105:E511.
2. Roberts TJ, Lennes IT, Hawari S, et al. Integrated, Multidisciplinary Management of Pulmonary Nodules Can Streamline Care and Improve Adherence toRecommendations. The Oncologist 2019;24:1-7.
3. Stage at Diagnosis | Cancer Trends Progress Report

It is very possible my IQ is less than residents following me from more competitive years, so this should be pretty obvious!
Never mind that smoking plunged by 2/3 since 1960s (which are today’s 70 yr olds with lung ca) Essentially 9/10 screened cases end up with surgery and one with 4 fractions of sbrt.
If they were not screened, maybe half pts would present with stage 4 and most would get palliative xrt at some point. The other half would probably get long course xrt as treatment for stage 3. (Also possible screening may detect disease earlier on in copd pts in which pts are more likely to be candidates for surgery. Again, almost every screened nsclc seems to be surgical candidate! )

This is not prostate ca where 90% + will not progress nor is the incidence of males in population significantly decreasing (just among radonc chairs)

 

[RickyScott]

This liberal use of assumptions and hand waving with numbers shtick has really run its course - but like Trump, it gets you likes from the ‘little people’ as Evil calls them - so you do you!

Smoking plummeting by 2/3 is a liberal assumption and that this will impact lung cancer incidence is a liberal assumption?

 

[PhotonBomb]

Smoking plummeting by 2/3 is a liberal assumption and that this will impact lung cancer incidence is a liberal assumption?

We are talking about lung screening effect (and scarb’s Nonsense) not the smoking use decline, which will decrease a number of cancer diagnoses hopefullly.

 

[RadOncG]

We are talking about lung screening effect (and scarb’s Nonsense) not the smoking use decline, which will decrease a number of cancer diagnoses hopefullly.

Pretest probability significantly impacts future effects on radiation utilization related to screening.

Is there a particular number that you see as wrong or are you just offended by all of his numbers?

 

[Mandelin Rain]

Lung screening effect is obvious.

It will convert stage III/IV cancers to stage I/II cancers. This is literally the reason why screening(of any sort) exists.

We treat the vast majority of stage III/IV lung cancers with 10-35 fractions of radiation. Often multiple times.

We DON’T treat the vast majority of stage I/II lung cancers. When we do, it’s usually once for 3-5 fractions.

I know I’m dumb, and making controversial assumptions, But lung screening should be seen as a great thing for our patients and a net loss for rad onc work.

This is, of course, independent of smoking incidence which will independently reduce rad onc work from a number of different cancers.

 

[deleted774703]

Lung screening effect is obvious.

It will convert stage III/IV cancers to stage I/II cancers. This is literally the reason why screening(of any sort) exists.

We treat the vast majority of stage III/IV lung cancers with 10-35 fractions of radiation. Often multiple times.

We DON’T treat the vast majority of stage I/II lung cancers. When we do, it’s usually once for 3-5 fractions.

I know I’m dumb, and making controversial assumptions, But lung screening should be seen as a great thing for our patients and a net loss for rad onc work.

Thanks @scarbrtj for dropping knowledge including in other thread RE other specialities use of RT (unfortunately you're right sigh)

@Mandelin Rain I don't think what you are saying is controversial

Lung cancer screening is either likely good overall or possibly modest to no benefit to society (see Twitter thread by Vinay Prasad, David Palma)

Also agree with you that screening will likely decrease the number of RT cases due to stage migration + since vast majority of screen detected lung cancer undergoes Sx.

For patients this is no issue, but for determining number of radoncs needed in USA, it does make a difference.