Would you be happy adminstering chemo?

[Raygun77]

In concurrent chemoradiotherapy. It seems a bit silly involving a med onc solely to administer concurrent temodar- which serves as a radiosensitiser anyway- for GBM postop patients. I'm not sure if other examples of concurrent chemoradiotherapy are similar but I assume all the drugs would have some potentiating effect on radiotherapy (otherwise would be adjuvant) thus would fall in the realm of rad onc?

Additionally, do you feel current education in rad onc prepares you to prescribe anti-neoplastic drugs, be they hormonal, cytotoxic or other, that directly relates to radiation? I'm thinking in radiation targeted therapies and what not.

I hope rad onc has not moved to solely the custodian of radiation alone!

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[medgator]

I hope rad onc has not moved to solely the custodian of radiation alone!

In the US, that's predominantly the case. In the UK however, there are medical oncologists (who just give chemo) and "clinical" oncologists (that give chemo and XRT).

 

[deleted4401]

Temodar or Tamoxifen is one thing, but the idea of administering Cisplatin or Mitomycin or Carbo/Taxol just isn't going to work for outpatient based radiation oncologists.

There is a reason we are called radiation oncologists. We administer radiation.

S

 

[G'ville Nole]

Temodar or Tamoxifen is one thing, but the idea of administering Cisplatin or Mitomycin or Carbo/Taxol just isn't going to work for outpatient based radiation oncologists.

There is a reason we are called radiation oncologists. We administer radiation.

S

+1

To answer your other question, rad onc training in it's current form does NOT prepare you to administer anti-neoplastic agents. As such, it's a dicey situation from a medicolegal standpoint even for those motivated radiation oncologists who do admit patients and administer chemotherapy, i.e. should a patient experience a bad outcome from complications of chemo under a rad onc's care, all a lawyer would need to ask is "During your specialty training, how much time was devoted to the administration of chemotherapy and management of chemotherapy related side effects?" One doesn't have to be a legal expert to predict either a settlement or a decision for the plaintiff!

The other aspect to this question is the ever present turf battle. Medical oncologists in the current climate feel victimized enough as it is by declining reimbursements for chemo administration. Having rad oncs usurp their place at the table, even in something as putatively straightforward as Temodar or Xeloda, would certainly be cause for acrimony, especially in the community setting.

 

[Palex80]

I think this is a US specific issue.

In Europe radiation oncologists are allowed to give chemo and do give chemo to patients receiving radiation.
We are supposed to spend one year of training on the wards and have to give 500 patients chemo in order to complete our training programme.

Generally, radiation oncologists only give the chemo that is supposed to serve as a radiosensitizer during irradiation.
This means we give cisplatin, carboplatin, mitomycin, 5FU, temozolomide, sometimes taxanes and vinorelbine.
The "heavy stuff" however are administered only by the medical oncologists.

For example in the case of NSCLC, we usually leave the patient in the care of the medical oncologists for chemo, since NSCLC patients (IIIA/IIIB) generally receive chemo before and/or after radiation therapy as well.

On ther other hand in cases of cancer when chemo is finished when radiation therapy is done too, like anal, cervic, esophagus, H&N cancer we give the chemo ourselves.

I highly enjoyed this process and you can even do it in outpatient basis.
Especially nowadays with systemic treatment becoming even easier to administer in outpatient basis, it's really not too hard.
Think of all the patients that had to stay get i.v. PCV for gliomas and are now simply swallowing temozolomide or Cetuximab being offered to H&N patients. These are therapies you can generally very well perform on outpatient basis.