Now, he's the one actually taking my questions far too seriously. Did I not say in post #44 and in my original post that I was being completely ironic?
My post was in response to f_w's comment (post #41) and was sent before I had a chance to read your response (#44) admitting your sarcasm. I'm a top-down reader.
Doctor&Geek said:
My cynicism and rhetorical argument has more to do with the lack of any substantive argument dictating that we shouldn't pursue RT on *weekends or holidays*, not having any rest day, period. I completely accept the reasoning and evidence that rest days ARE GOOD. What I don't accept is the faulty assumption that rest days have to occur on weekends or holidays, when it's "convenient" for providers to take a day off.
Answer these questions then:
Do you accept that when rest days occur, as long as they occur, don't matter?
The day of the week obviously doesn't matter. However, the timing matters -- giving a certain number of rest days after a certain amount of treatment has been given.
Do you accept that why no RT is given on the weekends specifically is given for economic reasons, and not for any radiobiologically relevant reasons?
Absolutely.
I think we're in agreement that:
1) Breaks are necessary.
2) Giving breaks on Saturday/Sunday is not biologically different than giving the breaks on Tuesday/Wednesday
However, for economic and practical reasons, it makes a lot more sense for the department to give all patients breaks on weekends, when the department is closed, than to run a continuous 7 day a week operation as you had suggested.
It hasn't been already pointed out that:
a) patients are treated on an as-needed basis on weekends for emergencies
b) breaks can be given mid-week for excessive toxicities
Is it not better for patient choice to allow RT be provided on weekends?
Sure, there are a lot of things that could be done to increase patient choice: allow them the option of weekend treatments, treat later in the day, to pick the order of beam delivery ("Hey, Bob, do you want your AP first, or PA?"), decide when they want port films taken, and designer tattoos (the Bart Man one is really popular). Too bad this ain't Burger King.
I haven't ever heard patients ask to get treated on the weekend. Going through a six or seven week course of treatment, five days/week, is hard enough. Weekends are much deserved. I imagine if I polled my patients to see if they wanted to come in on their saturdays and sundays (especially with this being the Bible belt), not one would elect to do so.
There may be a few patients -- those who work, as you already mentioned -- who would potentially benefit from weekend treatments by not having to miss work days. Unfortunately, out of the 7 days in a week, 5 are treatment days, and there are only 2 weekend (non-work) days. So this isn't going to significantly benefit them, and as you mentioned, most patients aren't in the workforce.
So what's the point?
Can patient volume be increased by allowing RT to be provided on the weekends?
If thruput were limited by the number of patients who could be treated on a machine daily, then expanding to a 7-day workweek would eliminate that bottleneck and indeed increase patient volume. Only in the busiest of centers is the number of treatment days per week the limiting factor. In most places, it is the number of patients consulted on that determines patient volume, and adding 2 days to the workweek does not change the referral volume. In this latter instance, proving RT on weekends would not impact patient volume, but would decrease efficiency by almost 30%.
It's really difficult for me to argue with you, considering that you yourself admit that the only way any intelligent person could interpret my original post was with a sense of irony. I admit it as such (twice!) but then you proceed to pretend that I really was, in fact, being totally serious.
Again, it was posted before you confessed taking an ironic stance.
I can understand completely if there are good economic or administrative reasons for not pursuing RT on weekends. What I can't accept is a rationale saying that "it's good for the patient", at least based on the evidence shown here. I'm totally prepared to be proven wrong on these points.
Please see above for the economic impact. I can elaborate more on this if you desire, but I shouldn't have to.
I don't think any other poster in here stated that no treatment on the weekend
per se is what's good for the patient. It's the break in treatment that matters. No one split hairs over that (except you, but that was irony).
I think the original post was something about a non-rad onc doctor trying to bully a radonc resident into treating an inpatient over the weekend, since they were "already in house anyway." The point being made is that the doctor does not understand why we treat that way. They shouldn't be expected to know anything about radiobiology, but it would be helpful to educate them a little when issues like that come up. Instead of responding with, "We don't treat on weekends!#$452one12435" or, "The only person here on Saturday is housekeeping and they ain't gonna treat you!", one could say something like "the patient's tissues need to be given time to recover from radiation, so they'll be off this weekend, but we'll resume treatment again on Monday" or something even more contrived.
There's a lot that other doctors don't understand about radiation, the way it works, etc., so they see a break over the weekend as a lost opportunity.
). What I meant was you shouldn't be pushed into "urgent" XRT when that's not the case at all. 
