WSJ says local cancer docs can’t keep up

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lol

“Oncologists at magnet cancer centers that dot the U.S. develop expertise in just a few cancer subtypes. They draw from a rapidly expanding arsenal of new drugs for specific and sometimes rare cancers, including experimental ones that aren’t widely available.

But most people get treated locally to be near home and jobs. Local oncologists, faced with a range of cancers, can’t stay up-to-date on everything. The National Comprehensive Cancer Network updated its nearly 90 guidelines across cancer types more than 200 times in the past year.

A third of 120 patients who sought a second opinion at Memorial Sloan Kettering Cancer Center in New York had their treatment changed, a 2023 review found. MD Anderson Cancer Center in Houston said about one in five of its new patients are rediagnosed or restaged. Patients at academic centers have better outcomes for cancers including lung and multiple myeloma, studies show.”
 
First few paragraphs are interesting. Local med onc didn't want to refer a bladder CA pt with a localized nodal recurrence for radiation and instead wanted to just continue IO.

There are definitely some bad med oncs out there and academic places probably catch that out in the boonies.

The relevance to the rest of us out in suburban/urban practices with competent community docs? 🤷🏾
 
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Oh boy. I stopped after 4 paragraphs. We start by paying homage to the vague idea of personalized medicine. Then we tell the story of someone who had recurrent bladder cancer in a regional lymph node whom the local med onc wanted to treat with IO alone. They were saved by an academic specialist who recommended radiating the pelvis. Literally nothing about this anecdote has anything to do with personalized medicine. To be fair, its a largely fictitious entity to begin with. But I didn't need to read on to know this was presenting general oncology as something it is not for most diseases.

Look, you can get bad care anywhere. Im sure we all have our anecdotes to prove it.
 
ramsesthenice said:
Oh boy. I stopped after 4 paragraphs. We start by paying homage to the vague idea of personalized medicine. Then we tell the story of someone who had recurrent bladder cancer in a regional lymph node whom the local med onc wanted to treat with IO alone. They were saved by an academic specialist who recommended radiating the pelvis. Literally nothing about this anecdote has anything to do with personalized medicine. To be fair, its a largely fictitious entity to begin with. But I didn't need to read on to know this was presenting general oncology as something it is not for most diseases.

Look, you can get bad care anywhere. Im sure we all have our anecdotes to prove it.
Click to expand...
"In July his cancer recurred in a lymph node between his abdomen and his lungs"
1729628264109.jpeg
 
Ray D. Ayshun said:
"In July his cancer recurred in a lymph node between his abdomen and his lungs"
View attachment 393959
Click to expand...
Shows how carefully I was reading. Of course, this makes "expert" recommendation for radiation suspect. Not saying its wrong and I can think of situations in which I would do it to, but this does become a classic case of an expert recommending non-standard therapy because (insert any answer aside from high quality evidence you like). Sounds like the community med onc is probably practicing closer to current guidelines.
 
ramsesthenice said:
Shows how carefully I was reading. Of course, this makes "expert" recommendation for radiation suspect. Not saying its wrong and I can think of situations in which I would do it to, but this does become a classic case of an expert recommending non-standard therapy because (insert any answer aside from high quality evidence you like). Sounds like the community med onc is probably practicing closer to current guidelines.
Click to expand...
Id irradiate the node if that was it. At the same time, the expert said the rec wasn't soc but based on experience. It ended up just costing the patient money, but he's happy bc experts with anecdotes are helping and he's in the WSJ.
 
Would you tell your family to go to a specific academic center, if you knew no-one in the area where they live? I suspect that often the answer is yes

In any case, the article is largely fake news
 
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What in the world did I just read!

This is unhinged even for the WSJ.

The American Society of Clinical Oncology maintains a “living guideline” to track how to use them.

“The guideline is almost impossible to read,” said Dr. Julie Gralow, the group’s chief medical officer.
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LOL wow. ASCO writes very good guidelines in my opinion, but I guess Im not going to argue with the woman that oversees them all.

This makes me so super sad 🙁
 
Any expert would have known a cancer that recurs that fast after surgery and immunotherapy is likely a very bad actor and unlikely to benefit much from aggressive local therapy. Not saying its never appropriate to xrt in these circumstances, but presenting the med onc as inexperienced in this scenario is disgusting. But at least huntsman got its 10x!
 
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Schmidt and her Huntsman colleagues wanted to target the returned disease with radiation to slow its spread. It was a bet based on experience, not a widely observed standard of treatment.

“You’re leaning on expert opinion,” Schmidt said.

DiPentino switched to another local oncologist, who worked with Schmidt to start radiation right away. In July, his cancer recurred in a lymph node between his abdomen and lungs. Schmidt and his local doctors put him on a combination of immunotherapies that wasn’t available when he was diagnosed.

“I just thank the Lord that oncology has changed,” DiPentino said. “How lucky am I?”


Huntsman Cancer Center: We have an Antidote Anecdote for Cancer
 
I didn't read the article but at least he got a second opinion in sort of a data-light zone where a number of options are reasonable....

compare that with your 70 year old fav int risk dude that gets on a plane to Houston to be told he should have protons for his prostate cancer in October of 2024.

Also remember - if you've ever read a newspaper article about a subject you know a lot about, and it is alarming how wrong they get it....then you turn the page and read some other news story and buy in 100% to what it's saying about some other subject you don't know much about. Isn't that phenomenon crazy? I think there's a name for this, but I can't remember it.
 
BobbyHeenan said:
I didn't read the article but at least he got a second opinion in sort of a data-light zone where a number of options are reasonable....

compare that with your 70 year old fav int risk dude that gets on a plane to Houston to be told he should have protons for his prostate cancer in October of 2024.

Also remember - if you've ever read a newspaper article about a subject you know a lot about, and it is alarming how wrong they get it....then you turn the page and read some other news story and buy in 100% to what it's saying about some other subject you don't know much about. Isn't that phenomenon crazy? I think there's a name for this, but I can't remember it.
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This would be a good article, too. Unfortunately, I suspect someone from MSK pitched the present article. I suspect someone from MSK also pitched the "brutal rectal RT" article. Nobody's gonna pitch the article idea you mentioned.
 
BobbyHeenan said:
I didn't read the article but at least he got a second opinion in sort of a data-light zone where a number of options are reasonable....

compare that with your 70 year old fav int risk dude that gets on a plane to Houston to be told he should have protons for his prostate cancer in October of 2024.

Also remember - if you've ever read a newspaper article about a subject you know a lot about, and it is alarming how wrong they get it....then you turn the page and read some other news story and buy in 100% to what it's saying about some other subject you don't know much about. Isn't that phenomenon crazy? I think there's a name for this, but I can't remember it.
Click to expand...

You should read it, because it basically reads like an ad stating that everyone should go to academic centers. Cancer is just too hard for the community. Complete with overconfident quotes from academic "experts" in data-light zones and retrospective attribution of causation.
 
NotMattSpraker said:
You should read it, because it basically reads like an ad stating that everyone should go to academic centers. Cancer is just too hard for the community. Complete with overconfident quotes from academic "experts" in data-light zones and retrospective attribution of causation.
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We are not unique. People will always like to think they are exceptional at what they do. But don't anyone think it stops with academic vs community. There are plenty of super-experts at the "top" treatment centers that know better than us lowly academics at public state institutions. I've gotten to the point I refuse to open trials where the sponsoring institution wants to internally review every radiation plan prior to treating. First, you shouldn't open to folks you can't trust to follow instructions. Second, if you think the success of whatever you are testing depends on every case being held to your exceptional standards, why do you think this is worthwhile?
 
You really did not need to specify "community doc" as
1) that's a sub/hoagie (or whatever) and not biryani
2) that Wonder bread spin-off is the antithesis of an artisanal roll
 
radiaterMike said:
You really did not need to specify "community doc" as
1) that's a sub/hoagie (or whatever) and not biryani
2) that Wonder bread spin-off is the antithesis of an artisanal roll
Click to expand...
Depends on which "community" I guess lol. Maybe an Uber eats sashimi platter with just flown in Toro and uni
 
Ray D. Ayshun said:
Jersey Mike's 11. Gift from a patient.
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I was so happy when we got Jersey Mikes here last year. Had plenty of them out East, not so common in the Midwest. Take it over subway or Jimmy Jons any day. Though if we ever got a Publix, I’d be done with them all.
 
NotMattSpraker said:
You should read it, because it basically reads like an ad stating that everyone should go to academic centers. Cancer is just too hard for the community. Complete with overconfident quotes from academic "experts" in data-light zones and retrospective attribution of causation.
Click to expand...

Expert in this case is the first year attending that decided (or it was decided for them), that they specialized in XXXX disease site
 
ramsesthenice said:
I was so happy when we got Jersey Mikes here last year. Had plenty of them out East, not so common in the Midwest. Take it over subway or Jimmy Jons any day. Though if we ever got a Publix, I’d be done with them all.
Click to expand...
Firehouse engineer all day. Publix is great. Can online order through the app and pick it up at the end of a grocery run
 
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thesauce said:
Expert in this case is the first year attending that decided (or it was decided for them), that they specialized in XXXX disease site
Click to expand...

Ding ding = almost always it's decided for them because they want to be at a particular institution or city
 
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