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United Healthcare will be happy to oblige.I guess when that happens I'll give everybody partial breast 30Gy/5fx until someone tells me to stop
Yup. Breast keeps the lights on. And it works. Really well. Why we're contorting ourselves to eliminate our role in this disease is beyond me.30 fractions to 15 fractions to 5 fractions and to be 0 fractions in the not too far off future. Most community clinics are likely not to be an economically viable enterprise in a world where lets say 80% of our breast volume is gone.
30 fractions to 15 fractions to 5 fractions and to be 0 fractions in the not too far off future. Most community clinics are likely not to be an economically viable enterprise in a world where lets say 80% of our breast volume is gone.
@fiji128 delete “likely” from your sentence and you’ve got it.Yup. Breast keeps the lights on. And it works. Really well. Why we're contorting ourselves to eliminate our role in this disease is beyond me.
Lose a high proportion of breast, high proportion of rectal, and 1 fraction bone mets..... I'd hazard to say most community clinics won't be viable.
Re "likely." I'm just a bit more of an optimist!@fiji128 delete “likely” from your sentence and you’ve got it.
COMPLETELY AGREE…I swear these people have never had a clinic of women miserable on their AI. If they did they'd be pushing harder for US trials that try to eliminate the AI, not the 5 radiation treatments in favorable biology patients.
COMPLETELY AGREE
New campaign:
"FIVE for FIVE"
Trials aimed at omitting 5 years of endocrine therapy in favor of using one of the 5-fraction adjuvant radiation regimens (UK FAST, Florence APBI, UK FAST Forward).
Tumor board of the future: "This 73-year-old patient meets CALGB criteria, thus we will be omitting AI and she will receive APBI alone via the Florence regimen..."
Brief Summary: In low risk early stage patients ≥70 years, exclusive Partial Breast Irradiation (PBI) as radiation therapy (RT) approach might be superior in terms of Health-Related Quality of Life (HRQoL), when compared to exclusive endocrine therapy (ET) following breast-conserving surgery (BCS). Assuming an equal rate of disease control, unnecessary long-term toxicity of ET may be avoided. Enrollment 926 participants. Study completion date January 15, 2030 (Ugh).I am so hoping the EUROPA trial comes out no difference in survival or recurrence and we can go on to run QoL analysis and cost analysis (Prolia, dexa scans, chasing hot flashes with other meds, etc).
Brief Summary: In low risk early stage patients ≥70 years, exclusive Partial Breast Irradiation (PBI) as radiation therapy (RT) approach might be superior in terms of Health-Related Quality of Life (HRQoL), when compared to exclusive endocrine therapy (ET) following breast-conserving surgery (BCS). Assuming an equal rate of disease control, unnecessary long-term toxicity of ET may be avoided. Enrollment 926 participants. Study completion date January 15, 2030 (Ugh).
for the record - the breast picture was not from AACR. I saw it on twitter - it's a breast surgeon speaking at ASBS (American society of breast surgeons)
Surgeons are important for referrals, and important for rad onc. Rad onc would be s**t today were it not for (neurological) surgeons.Unfortunately, I’m not surprised. Breast always starts with the breast surgeon and in order to survive, I gladly kissed the ring.
Unfortunately, I’m not surprised. Breast always starts with the breast surgeon and in order to survive, I gladly kissed the ring.
Newly diagnosed breast pts with a core bx? I end up sending our local breast surgeon ports/pegs and the occasional skin cancer as wellI send more patients to the breast surgeons than they send to me
I recently put this up outside and business has picked upConsider yourselves fortunate my friends, I’m too far down the totem poll. Palliative care sees more definitive cases upfront then I do! The community docs have been trained to send all cancers including skin, prostate, lung nodules to “oncology” and there isn’t a damn thing I can do about it… I’ve tried! The system here is setup for private monopolies.
Good thing, I’m employed or I’ll be homeless selling my body for tuna and cigarettes again.
why are Jesus memes the funniest memesI recently put this up outside and business has picked upView attachment 353328
Bc we're from the south? Maybewhy are Jesus memes the funniest memes
Your divine mercy could have a sharper penumbra...I recently put this up outside and business has picked upView attachment 353328
Newly diagnosed breast pts with a core bx? I end up sending our local breast surgeon ports/pegs and the occasional skin cancer as well
n=1PCPs often send me suspicious breast masses and BIRADS 4+ mammograms and I order the biopsy. If the diagnosis is already made, PCPs will often dual-refer to me and the surgeon.
So how did you train your PCPs to change their referral practices? If I were in their shoes, I’d just rather have one reflexive referral for each problem, which would usually be either an oncologist or the specialist surgeon (ENT, urology, etc).PCPs often send me suspicious breast masses and BIRADS 4+ mammograms and I order the biopsy. If the diagnosis is already made, PCPs will often dual-refer to me and the surgeon.
PCPs often send me suspicious breast masses and BIRADS 4+ mammograms and I order the biopsy. If the diagnosis is already made, PCPs will often dual-refer to me and the surgeon.
Dear lord, how will you ever manage endocrine therapy and treatment sequencing without involving a medical oncologist up front?PCPs often send me suspicious breast masses and BIRADS 4+ mammograms and I order the biopsy. If the diagnosis is already made, PCPs will often dual-refer to me and the surgeon.
Consider yourselves fortunate my friends, I’m too far down the totem poll. Palliative care sees more definitive cases upfront then I do! The community docs have been trained to send all cancers including skin, prostate, lung nodules to “oncology” and there isn’t a damn thing I can do about it… I’ve tried! The system here is setup for private monopolies.
Good thing, I’m employed or I’ll be homeless selling my body for tuna and cigarettes again.
I’m happy to be the one
So how did you train your PCPs to change their referral practices? If I were in their shoes, I’d just rather have one reflexive referral for each problem, which would usually be either an oncologist or the specialist surgeon (ENT, urology, etc).
Dear lord, how will you ever manage endocrine therapy and treatment sequencing without involving a medical oncologist up front?
And people think I'm weird for ordering Lupron in clinic.
Consider yourselves fortunate my friends, I’m too far down the totem poll. Palliative care sees more definitive cases upfront then I do! The community docs have been trained to send all cancers including skin, prostate, lung nodules to “oncology” and there isn’t a damn thing I can do about it… I’ve tried! The system here is setup for private monopolies.
Good thing, I’m employed or I’ll be homeless selling my body for tuna and cigarettes again.
This doesn’t work in major metros where most primary care work for large systems. And the ones that dont, won’t send their pts anywhere near large systems. Do anesthesiologists and radiologists in multi center hospitals hustle?It’s even easier for them now since they have one person for everything.
It took (a lot of) work. I met with the big PCP groups and other specialties and explained what we (radoncs) did. I gave presentations at the local schools and medical societies as well. It took time but it worked. You have to be willing to work your ass off and provide excellent customer service, communication and patient care. It is not an easy path but sooooo worth it.
This doesn’t work in major metros where most primary care work for large systems. And the ones that dont, won’t send their pts anywhere near large systems. Do anesthesiologists and radiologists in multi center hospitals hustle?
They do. Hustling doing all the work they have piled up before them. More like Charlie Hustle than rad onc hustle! Every time one rad onc hustles it sends another rad onc to the breadline!This doesn’t work in major metros where most primary care work for large systems. And the ones that dont, won’t send their pts anywhere near large systems. Do anesthesiologists and radiologists in multi center hospitals hustle?
It's a delicate needle to thread but I've seen it happen.... Best situation is a pro only PP group that keeps its identity distinct from the hospital.This doesn’t work in major metros where most primary care work for large systems. And the ones that dont, won’t send their pts anywhere near large systems. Do anesthesiologists and radiologists in multi center hospitals hustle?
It's a delicate needle to thread but I've seen it happen.... Best situation is a pro only PP group that keeps its identity distinct from the hospital
Sean Brock left but it's still really good. His cook books are OK but the magic he does is not replicable in a home kitchen like other "farm to table" ish cook books I've liked.HUSK IS SO DAMN GOOD
I agree. Was kinda disappointed recently as I had a great meal in Savannah a few years ago, and pretty good one in Greenville a couple years ago. Have yet to eat at the Nashville Husk, but may not now, as I know of about 50 places I'd rather eat in Nashville as compared to Charleston Husk.Husk has dropped off tremendously since Covid and Sean Brock left. There are much better meals to be had in that city. However, the bar is still great with a great burger.