INTENSE THERAPY BEATS HEAD CANCER
Dr. Jai Maharaj
BBC
Saturday, September 20, 2003
The patients all received the same amount of radiotherapy
Short, intense courses of radiotherapy are more effective
in treating head and neck cancer, scientists have found.
Giving patients six sessions a week instead of five
improved the management of their tumours.
In addition, patients with laryngeal cancer were more
likely to conserve their voices if they had the faster
treatment.
The study of almost 1,500 patients was presented to the
European Cancer Conference in Copenhagen.
These findings are unequivocal
Dr Jens Overgaard, Aarhus University Scientists from the
Aarhus University Hospital, Aarhus, Denmark, gave
patients either five or six sessions per week,
administering the same dose overall to each patient.
When patients were examined five years after the
treatment, it was found tumours were better controlled in
those who had received six treatments per week.
Accelerated radiotherapy was also linked to a small
increase in survival rates compared with those given five
treatments per week.
Patients were more likely to be ill if they were given
the more intensive course of treatment, although they
recovered quickly.
'No shades of grey'
Professor Jens Overgaard said: "Although all patients in
the accelerated treatment arm did better, some did better
than others, and we are currently trying to identify
those groups where the benefit is largest. "
But he said there was no doubt about the benefits of the
more intensive treatment: "There are no shades of grey.
"These findings are unequivocal - accelerated treatment
is definitely better in this cancer, both in terms of
disease-specific survival and in quality of life."
Professor Michele Saunders of Cancer Research UK said:
"This accelerated radiotherapy protocol is already being
used in the UK and will be the subject of a randomised
controlled trial to be organised by the National Cancer
Research Institute."
The research is published in The Lancet.
Read the complete news at:
http://news.bbc.co.uk/1/hi/health/3122428.stm
Jai Maharaj
http://www.mantra.com/jai
Om Shanti
Panchaang for 25 Bhadrapad 5104, Saturday, September 20, 2003:
Shubhanu Nama Samvatsare Dakshinaya Jivana Ritau
Kanya Mase Krishna Pakshe Manta Vasara Yuktayam
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Vanij-Vishti Karan Dashami Yam Tithau
Hindu Holocaust Museum
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The truth about Islam and Muslims
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o Not for commercial use. Solely to be fairly used for the
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Anth
to validate?
Ant
"Dr. Jai Maharaj" <use...@mantra.com> wrote in message
news:health-075...@news.mantra.com...
Peter Moran
"Anth" <an...@anon.com> wrote in message
news:3f6d8335$0$33799$65c6...@mercury.nildram.net...
> If this beats head cancer then why does it need further randomised
controls
> to validate?
> Ant
The study said ---
> > > Professor Michele Saunders of Cancer Research UK said:
> > "This accelerated radiotherapy protocol is already being
> > used in the UK and will be the subject of a randomised
> > controlled trial to be organised by the National Cancer
> > Research Institute."
It is rare within medicine for the results of a single study to be accepted
as final.
Peter Moran
Rich Andrews
@news.brisbane.pipenetworks.com:
A single study does not a truism make. Remember "Cold Fusion" from the
early 90's?
r
--
"Any sufficiently advanced technology is indistinguishable from
magic."
Arthur C. Clarke (1917 - ), "Technology and the Future"
Bronsing
Peter Moran <mor...@gil.com.au> wrote in message
news:3f6e9...@news.brisbane.pipenetworks.com...
And with good reason. Often, significant results mean a maximum P value of
0.05. This means that there is still a 1 in 20 chance of achieving the same
or more extreme data sets by chance without there being a real difference.
So, any study that shows significant results still need to be validated to
exclude - as much as possible - chance effects.
--
Robert Bronsing
Can't you see?
It all makes perfect sense,
expressed in dollars and cents, pounds, shillings and pence
(R. Waters)
Orac
"Peter Moran" <mor...@gil.com.au> wrote:
Indeed. It usually takes at least two or three good randomized studies
to convince people or a larger number of less well-designed trials. This
is particularly true when the reported effect is not large.
--
Orac |"A statement of fact cannot be insolent."
|
|"If you cannot listen to the answers, why do you
| inconvenience me with questions?"
Steve Harris sbharris@ROMAN9.netcom.com
> In article <3f6e9...@news.brisbane.pipenetworks.com>,
> "Peter Moran" <mor...@gil.com.au> wrote:
>
> > "Anth" <an...@anon.com> wrote in message
> > news:3f6d8335$0$33799$65c6...@mercury.nildram.net...
> > > If this beats head cancer then why does it need further randomised
> controls
> > > to validate?
> > > Ant
> >
> > The study said ---
> >
> > > > > Professor Michele Saunders of Cancer Research UK said:
> > > > "This accelerated radiotherapy protocol is already being
> > > > used in the UK and will be the subject of a randomised
> > > > controlled trial to be organised by the National Cancer
> > > > Research Institute."
> >
> > It is rare within medicine for the results of a single study to be accepted
> > as final.
>
> Indeed. It usually takes at least two or three good randomized studies
> to convince people or a larger number of less well-designed trials. This
> is particularly true when the reported effect is not large.
COMMENT:
And particularly when the result is not conducive to the comfort of
radiation medicine specialists, who didn't enter the field to work
weekends. Do you know what effort has already gone in to "showing"
that 5 days a week radiotherapy is just as good as 6 and 7 ?? A lot!
So this "accelerated radiotherapy" result, if it holds, is a true
disaster in the field, a mighty smelly brown thingy in the punch bowl.
Things haven't been this bad since they started telling neurologists
they had to come in from Sunday golf in order to see stroke patients
for the new emergency clot-busting. "Say WHAT??" the whole profession
said.
SBH
Orac
sbha...@ix.netcom.com (Steve Harris sbha...@ROMAN9.netcom.com)
wrote:
Heh heh. Or since radiologists working at some trauma centers were told
that they had to take in-house call to read trauma films at night and on
weekends and couldn't just leave the initial "wet" readings to
residents. Or since AIDS turned infectious disease specialists (who,
back before the mid-1980's usually had a very cushy consultant role)
into de facto primary care doctors for AIDS patients, with all the
attendant headaches that come with being primary care doctors to a group
of sick patients. Now if we could only find a treatment that would
require dermatologists to come in on nights or weekends. ;-)
But all joking aside, radiation oncologists have always had to deal with
the occasional emergency that required night or weekend treatment, such
as spinal cord compression by tumor with neurologic deficit or superior
vena cava syndrome from obstruction of the superior vena cava with
tumor. There is also a a fairly large developing literature on
hyperfractionated radiation therapy, which requires even more frequent
small doses seven days a week; so it's not as if they haven't been
studying treatments that might disturb their weekends...
Steve Harris sbharris@ROMAN9.netcom.com
> But all joking aside, radiation oncologists have always had to deal with
> the occasional emergency that required night or weekend treatment, such
> as spinal cord compression by tumor with neurologic deficit or superior
> vena cava syndrome from obstruction of the superior vena cava with
> tumor. There is also a a fairly large developing literature on
> hyperfractionated radiation therapy, which requires even more frequent
> small doses seven days a week; so it's not as if they haven't been
> studying treatments that might disturb their weekends...
COMMENT:
My god, don't radiation oncologists get a lot of mileage out of cord
compression by tumor and superior vena cava syndrome. These are rare
enough to be good trivia quiv for student docs (what are the only true
radiation oncology emergencies..). But ask a rad onc guy to honestly
tell you if he personally has ever had to come in on a weekend to
treat a case, and you'll get an embarrassed "no." Or "yeah.... once in
my training." They saw it because as a *fellow* or whatever, they had
to come in and do it <G>.
As for hyperfractionated dose therapy, don't tout it until you see how
it's done. Some is 7 days a week, but a good fraction of the studies
are twice a day for 5 days a week. Guess which 5?
SBH
Steph
"Steve Harris sbha...@ROMAN9.netcom.com" <sbha...@ix.netcom.com> wrote in
message news:79cf0a8.03092...@posting.google.com...
> Orac <or...@wlsfanmail.com> wrote in message
news:<orac-4E8D07.0...@host9.newsfeeds.com>...
> > But all joking aside, radiation oncologists have always had to deal with
> > the occasional emergency that required night or weekend treatment, such
> > as spinal cord compression by tumor with neurologic deficit or superior
> > vena cava syndrome from obstruction of the superior vena cava with
> > tumor. There is also a a fairly large developing literature on
> > hyperfractionated radiation therapy, which requires even more frequent
> > small doses seven days a week; so it's not as if they haven't been
> > studying treatments that might disturb their weekends...
>
>
> COMMENT:
>
> My god, don't radiation oncologists get a lot of mileage out of cord
> compression by tumor and superior vena cava syndrome. These are rare
> enough to be good trivia quiv for student docs (what are the only true
> radiation oncology emergencies..).
About 10% of the common cancer get spinal cord compression, or threatened
compression at some time..
> But ask a rad onc guy to honestly
> tell you if he personally has ever had to come in on a weekend to
> treat a case, and you'll get an embarrassed "no." Or "yeah.... once in
> my training." They saw it because as a *fellow* or whatever, they had
> to come in and do it <G>.
>
Happens to me 5-6 times per year
> As for hyperfractionated dose therapy, don't tout it until you see how
> it's done. Some is 7 days a week, but a good fraction of the studies
> are twice a day for 5 days a week. Guess which 5?
>
> SBH
I think you have an attitude, based on very few facts..
Orac
sbha...@ix.netcom.com (Steve Harris sbha...@ROMAN9.netcom.com)
wrote:
> Orac <or...@wlsfanmail.com> wrote in message
> news:<orac-4E8D07.0...@host9.newsfeeds.com>...
Man, you seem to have a bug up your butt about radiation oncologists.
You seem to be downright hostile here. I actually did some of my lab
research in a very prestigious radiation oncology department; so I know
a few radiation oncologists. I count the Chairman of the particular
department where I did my research as a friend and someone who has
helped my career greatly. Those guys worked hard, although admittedly
they were in an academic medical center and had to do research along
with patient care.
Steve Harris sbharris@ROMAN9.netcom.com
> > My god, don't radiation oncologists get a lot of mileage out of cord
> > compression by tumor and superior vena cava syndrome. These are rare
> > enough to be good trivia quiv for student docs (what are the only true
> > radiation oncology emergencies..).
>
> About 10% of the common cancer get spinal cord compression, or threatened
> compression at some time..
Irrelevent, since the "threatened" are by far the largest fraction of
this group, and treating them doesn't consitute weekend emergency
care.
>
> > But ask a rad onc guy to honestly
> > tell you if he personally has ever had to come in on a weekend to
> > treat a case, and you'll get an embarrassed "no." Or "yeah.... once in
> > my training." They saw it because as a *fellow* or whatever, they had
> > to come in and do it <G>.
> >
>
> Happens to me 5-6 times per year
Really? 10% of your patients and it gets you only 5 times a year?
Once in every 10 weeks? Your own two factoids don't even agree, if I
was to take them a face value. Which of course I don't, for reasons
explained above.
Let's see you back the fact of 5 to 6 rad-onc emergencies a year, with
your department chairman or program's phone number. I will check it,
you know. Right now-- Oh, anonymous rad onc wonk, I think you're
BS'ing us. Prove me wrong.
> > As for hyperfractionated dose therapy, don't tout it until you see how
> > it's done. Some is 7 days a week, but a good fraction of the studies
> > are twice a day for 5 days a week. Guess which 5?
> >
> > SBH
>
> I think you have an attitude, based on very few facts..
Un-huh. How many accelerated regimin patients do you do yourself?
Please describe. As for facts, I have medline, same as you. Why don't
you look up 10 hyperfractionation studies at random, and get back to
us? The literature is full of hyperfractionation studies which are not
accelerated. Or are 6 days a week and not 7. Here's the first example
I pulled off medline. Hell, they can't even do people on weekends for
a formal phase III study.
Int J Radiat Oncol Biol Phys. 2000 Aug 1;48(1):7-16.
Comment in:
Int J Radiat Oncol Biol Phys. 2000 Aug 1;48(1):1-2.
Int J Radiat Oncol Biol Phys. 2000 Aug 1;48(1):3-6.
Int J Radiat Oncol Biol Phys. 2001 Apr 1;49(5):1517-8.
Int J Radiat Oncol Biol Phys. 2001 Oct 1;51(2):563.
A Radiation Therapy Oncology Group (RTOG) phase III randomized study
to compare
hyperfractionation and two variants of accelerated fractionation to
standard
fractionation radiotherapy for head and neck squamous cell carcinomas:
first
report of RTOG 9003.
Fu KK, Pajak TF, Trotti A, Jones CU, Spencer SA, Phillips TL, Garden
AS, Ridge
JA, Cooper JS, Ang KK.
Department of Radiation Oncology, University of California San
Francisco,
94143-0226, USA. f...@radonc17.ucsf.edu
PURPOSE: The optimal fractionation schedule for radiotherapy of head
and neck
cancer has been controversial. The objective of this randomized trial
was to
test the efficacy of hyperfractionation and two types of accelerated
fractionation individually against standard fractionation. METHODS AND
MATERIALS: Patients with locally advanced head and neck cancer were
randomly
assigned to receive radiotherapy delivered with: 1) standard
fractionation at 2
Gy/fraction/day, 5 days/week, to 70 Gy/35 fractions/7 weeks; 2)
hyperfractionation at 1. 2 Gy/fraction, twice daily, 5 days/week to
81.6 Gy/68
fractions/7 weeks; 3) accelerated fractionation with split at 1.6
Gy/fraction,
twice daily, 5 days/week, to 67.2 Gy/42 fractions/6 weeks including a
2-week
rest after 38.4 Gy; or 4) accelerated fractionation with concomitant
boost at
1.8 Gy/fraction/day, 5 days/week and 1.5 Gy/fraction/day to a boost
field as a
second daily treatment for the last 12 treatment days to 72 Gy/42
fractions/6
weeks. Of the 1113 patients entered, 1073 patients were analyzable for
outcome.
The median follow-up was 23 months for all analyzable patients and
41.2 months
for patients alive. RESULTS: Patients treated with hyperfractionation
and
accelerated fractionation with concomitant boost had significantly
better
local-regional control (p = 0.045 and p = 0.050 respectively) than
those treated
with standard fractionation. There was also a trend toward improved
disease-free
survival (p = 0.067 and p = 0.054 respectively) although the
difference in
overall survival was not significant. Patients treated with
accelerated
fractionation with split had similar outcome to those treated with
standard
fractionation. All three altered fractionation groups had
significantly greater
acute side effects compared to standard fractionation. However, there
was no
significant increase of late effects. CONCLUSIONS: Hyperfractionation
and
accelerated fractionation with concomitant boost are more efficacious
than
standard fractionation for locally advanced head and neck cancer.
Acute but not
late effects are also increased.
Publication Types:
Clinical Trial
Clinical Trial, Phase III
Multicenter Study
Randomized Controlled Trial
PMID: 10924966 [PubMed - indexed for MEDLINE]
Orac
sbha...@ix.netcom.com (Steve Harris sbha...@ROMAN9.netcom.com)
wrote:
> "Steph" <st...@vancouver.island> wrote in message
> news:<_v4db.27751$TM4.19144@pd7tw2no>...
> >
> > sbha...@ix.netcom.com (Steve Harris sbha...@ROMAN9.netcom.com)
> > wrote:
> > > But ask a rad onc guy to honestly
> > > tell you if he personally has ever had to come in on a weekend to
> > > treat a case, and you'll get an embarrassed "no." Or "yeah.... once in
> > > my training." They saw it because as a *fellow* or whatever, they had
> > > to come in and do it <G>.
> > >
> >
> > Happens to me 5-6 times per year
>
>
> Really? 10% of your patients and it gets you only 5 times a year?
> Once in every 10 weeks? Your own two factoids don't even agree, if I
> was to take them a face value. Which of course I don't, for reasons
> explained above.
>
> Let's see you back the fact of 5 to 6 rad-onc emergencies a year, with
> your department chairman or program's phone number. I will check it,
> you know. Right now-- Oh, anonymous rad onc wonk, I think you're
> BS'ing us. Prove me wrong.
Personally, I think *you're* getting way out of control here and need to
take a chill pill. I don't know what your major malfunction is or what
your beef is with radiation oncologists, but your attacks are getting
increasingly petty and you're getting increasingly nasty for no apparent
reason.
[Tirades snipped]
Matti Narkia
<Orac-529521.2...@news4.srv.hcvlny.cv.net> Orac <Or...@wabcmail.com>
wrote:
Is that so? IMHO Dr. Harris (who unlike most of the other MDs or "MD"s in the
usenet has the honesty and courage to write with his own name) has been
sticking to subject with his usual colorful and witty style, and backing his
statements with evidence, while your latest comment is sadly devoid of facts.
Prove him wrong, if you can, instead of resorting to ad hominem.
--
Matti Narkia
Orac
Matti Narkia <mn...@despammed.com> wrote:
"Colorful and witty"? More like unnecessarily nasty to me.
As for facts, my record on this newsgroup speaks for itself regarding
the use of facts and scientific studies. In this instance, my question
was not for the most part over facts but over why Dr. Harris has such a
hostile attitude towards radiation oncologists.
> Prove him wrong, if you can, instead of resorting to ad hominem.
I was not using "ad hominem" attacks when I was pointing out that his
attacks were becoming increasingly petty and nasty. That was arguably
true, based his own words and the obvious attitude behind them, and it
is my opinion that he was getting out of control.
As for "proving him wrong," that was not the point of my post, and you
know it. The question was not about whether Dr. Harris was right or not.
Indeed, I never even really addressed that question all that much. It
was about why his naked hostility towards radiation oncologists and
wondering why he had such an attitude. I have no interest in continuing
any further a pissing contest with him (or you) over whether radiation
oncologists are as lazy as he apparently thinks they are.
So I'll boil it down to the essence and leave open the question to both
Dr. Harris and you:
Why such undisguised contempt for radiation oncologists? It's a simple
question.
Steve Harris sbharris@ROMAN9.netcom.com
> Personally, I think *you're* getting way out of control here and need to
> take a chill pill. I don't know what your major malfunction is or what
> your beef is with radiation oncologists, but your attacks are getting
> increasingly petty and you're getting increasingly nasty for no apparent
> reason.
I've given my reasons and my beefs in detail and you seem to have
difficulty understanding them. Your problem.
I'm one of the few physicians here who posts under my own name, taking
open responsiblity for what I say. And I give my reasons for my
opinions, citing literature and experience where I can. That means I'm
open to getting my nose rubbed in it. For example, had I not been able
to find any 5 day a week hyperfraction studies, I've had looked pretty
silly. But I found them being done in San Francisco (they are done all
over the world, actually), and so my point is made. It's not my fault
if you don't get it.
Who are you, oh anonmyous one?
Steve Harris
toolz toolz
money they recieve. Some might feel they are ripping the public off. Some
might even feel that rad, is not effective on many, if not most cases. AND
some might think that you are an ass.
Steve Harris sbharris@ROMAN9.netcom.com
> Man, you seem to have a bug up your butt about radiation oncologists.
> You seem to be downright hostile here. I actually did some of my lab
> research in a very prestigious radiation oncology department; so I know
> a few radiation oncologists.
So what? So do I. I know very well they rarely (read: almost never)
work weekends. They are rather like dermatologists and most kinds of
pathologists. Personally this doesn't bother me, except when it
appears to be warping scientific perspective. Which (looking at the
literature) I see that it has.
There is no reason for the large number of trials of hyperfractionated
radiation that look at 5 and 6 day weeks. If it's worth giving
radiation more than once a day, it's certainly worth giving on
weekends. Giving radiation only during banker's hours isn't being done
for the benefit of the *patients*. They've got cancer, and would just
as soon be done on a few weekends (five of them for the average
course). In fact, not a few patients need to drive into a large city
if they are getting radiated by any kind of expensive or rare machine
(conformal, cyberknife, protons and other hadrons-- you name it), and
THOSE patients and their caregivers would be VERY happy to not deal
with as many days of weekday traffic. Even those coming in from far
out of town and temporarily staying close to the radiation center may
have an accelerated course which might be shortened from 7 weeks to 5
if treatment was every day, thus saving 2 weeks of hotel expenses. No,
for the patients it's a wash, or even an inconvenience, not to get
therapy on weekends. The studies, and the standard treatment
schedules, were constructed the convenience of doctors. If it turns
out that doing that kills some fraction of people because it's not
quite as good, then it's a real ethical embarrassment. How come the
rad onc people didn't set up the studies sooner to find THAT out?
> I count the Chairman of the particular
> department where I did my research as a friend and someone who has
> helped my career greatly. Those guys worked hard, although admittedly
> they were in an academic medical center and had to do research along
> with patient care.
Yeah, so? I think you have me mistaken for the nuts who don't think
radiation therapy for cancer is a good thing, that medical doctors are
misguided, and so on. Wrong. For the record, I believe that *radiation
oncology is a noble profession* on the whole, and that radiation
treatment (in conjunction with chemo and even alone) is quite capable
of curing many cancers. It's nearly painless, and when it works, it's
very nearly magical.
I saw a case recently of a nearly magic cure using the proton facility
at Loma Linda. But you know what? It was 5 days a week treatment. The
proton accelerator at Loma Linda, one of only 2 or 3 in the country
(don't know if Texas is online yet) just sits there idle on weekends.
Is that because there aren't patients who could use it then? No. Is
weekend idling of the proton accelerator because there are great
studies showing that protons 5 days a week are just as good as protons
6 or 7 days a week? No. No such studies exist. Hmmm. It sits there
idle because it's convenient, and by analogy it's assumed that protons
behave like photons, and some not very well-checked older studies on a
few types of cancer (not all) show that pHoton therapy does as well 5
days a week as 7.
These same studies have been clung to by radiation oncologists for 30
years or more. They were easy to believe because it was convenient.
And they were generalized as necessary, as for example in the pRoton
radiation schedules being designed from the old pHoton studies.
Induction is easy when the result is pleasing, and no bother.
But now turn that around and you'll see induction doesn't work so well
when it's not convenient. Protons got a 5 day per week schedule
because it supposedly worked for photons-- no better reasoning than
that. But now that there are beginning to be studies which suggest
that accelerated therapy with photons is better for some head and neck
cancers, do you think that the proton people will go to
hyperfractionation or 7 days a week (including sabbath at Loma Linda)
on the very same kind of evidence?
**Not on your life.** They'll say that the evidence can't be expected
to apply to the unique proton accelerator. Suddenly, when the golf
game is threatened, now professional scepticism sets in.
I'm merely pointing out that that kind of thinking is not science. As
a scientist and physican I know that very well. So what's *your*
problem?
SBH
J
> So what's *your*problem?
(a bunch of cross-posts snipped)
Mine is this "fetish" that Jay/Jai seems to have to post to alt.support.cancer on just about any subject
he chooses to post about and in CAPS subject line.
Any chance some/any/all of you who reply could look wayyyyy up to your headers on any of Jay's posts, and
delete alt.support.cancer from the cross-posts?
If you want Steph in on these, add back in sci.med.diseases.cancer ???
And it's really quite easy to do.
He reads that newsgroup also and it would then be in the same newsgroup hierarchy as sci.med.
J - alt.support.cancer
Orac
sbha...@ix.netcom.com (Steve Harris sbha...@ROMAN9.netcom.com)
wrote:
> Orac <Or...@wabcmail.com> wrote in message
> news:<Orac-529521.2...@news4.srv.hcvlny.cv.net>...
> > Personally, I think *you're* getting way out of control here and need to
> > take a chill pill. I don't know what your major malfunction is or what
> > your beef is with radiation oncologists, but your attacks are getting
> > increasingly petty and you're getting increasingly nasty for no apparent
> > reason.
>
>
> I've given my reasons and my beefs in detail and you seem to have
> difficulty understanding them. Your problem.
It's not so much the reasons, but the intensity of the dislike and the
nastiness I don't understand. Your stated reasons and studies perhaps
are not the whole story, I suspect.
> I'm one of the few physicians here who posts under my own name, taking
> open responsiblity for what I say.
That's nice.
>And I give my reasons for my
> opinions, citing literature and experience where I can.
As do I, as you would know if you've read my posts outside of this
thread.
>That means I'm
> open to getting my nose rubbed in it.
As am I. One time I had to admit a mistake to, of all people, Ilena,
because I had quoted the wrong study. Very embarrassing. Fortunately, a
rare occurrence.
>For example, had I not been able
> to find any 5 day a week hyperfraction studies, I've had looked pretty
> silly. But I found them being done in San Francisco (they are done all
> over the world, actually), and so my point is made. It's not my fault
> if you don't get it.
I got your point. What I don't get is why it matters so much to you,
enough to send you scurrying off to look up studies that make your
unflattering point about radiation oncologists. Perhaps if I knew what
specialty you were...
> Who are you, oh anonmyous one?
LOL! I'm hardly anonymous around here. But, if you're really curious,
e-mail me. If you ask me real nice, I might even explain why I now post
under a 'nym. I didn't always.
Orac
"toolz toolz" <medt...@earthlink.net> wrote:
> "Orac" <Or...@wabcmail.com> wrote in message
> news:Orac-3C9810.1...@news4-ge1.srv.hcvlny.cv.net...
> > Why such undisguised contempt for radiation oncologists? It's a simple
> > question.
> >
> Are you realy this dumb? Some might feel that they do very little for the
> money they recieve. Some might feel they are ripping the public off. Some
> might even feel that rad, is not effective on many, if not most cases. AND
> some might think that you are an ass.
Some, on the other hand, KNOW you are an ass.
Eric Bohlman
news:Orac-6B7DDF.2...@news4.srv.hcvlny.cv.net:
> In article <79cf0a8.03092...@posting.google.com>,
> sbha...@ix.netcom.com (Steve Harris sbha...@ROMAN9.netcom.com)
> wrote:
>> I've given my reasons and my beefs in detail and you seem to have
>> difficulty understanding them. Your problem.
>
> It's not so much the reasons, but the intensity of the dislike and the
> nastiness I don't understand. Your stated reasons and studies perhaps
> are not the whole story, I suspect.
Some people just come across very strongly in Usenet discussions, and Steve
happens to be one of them (based on my reading of several years' worth of
his writings). It's simply the nature of the medium. Such people usually
*don't* come across that way in Real Life[tm], *not* because they were
adopting a particular persona on Usenet, but merely because their body
language, tone of voice, etc. compensate for their very direct delivery. I
didn't see all that much hostility in his tone initially, though I see some
(understandable) defensiveness now.
He can be quite opinionated, but only on matters where there's plenty of
room for legitimate disagreement. I've never seen him espouse anything
that I would consider a crank position, at least in medical matters.
Matti Narkia
<Orac-3C9810.1...@news4-ge1.srv.hcvlny.cv.net> Orac
<Or...@wabcmail.com> wrote:
>
>So I'll boil it down to the essence and leave open the question to both
>Dr. Harris and you:
>
>Why such undisguised contempt for radiation oncologists? It's a simple
>question.
Contempt? Hardly. But IMHO patients, who are receiving radiation therapy twice
a day, because it has supposedly been proven to be more effective than once a
day therapy, are entitled to wonder, why on earth they should have a two day
break every 5 days, when hyperfractionation is so great? And feel a little
pissed off, when they come to obvious conclusion. It seems that the problem
here is that that apparently you don't accept the conclusion I mean, but
haven't provided any other plausible explanation either.
Similarly, true scientists and doctors with high ethical standards, who come to
the same conclusion, may feel to express their dissatisfaction with the status
quo occasionally with a bit colorful language to get their point noticed.
--
Matti Narkia
Steve Harris sbharris@ROMAN9.netcom.com
> > I've given my reasons and my beefs in detail and you seem to have
> > difficulty understanding them. Your problem.
>
> It's not so much the reasons, but the intensity of the dislike and the
> nastiness I don't understand. Your stated reasons and studies perhaps
> are not the whole story, I suspect.
You're wrong. I have nothing personally against any rad onc guy. I
merely report what I see. In this case, I think the science is being
warped by personal interest, and that (if you believe that latest
studies) may well be resulting in people dying because a certain class
of doctors resists working weekends.
I'm incensed about that in the same way I'm incensed about a lot of
things wrong with medicine. For example, radiologists, who make nearly
as much as cardiac surgeons, and more than general surgeons, are
overpaid. Surgery is damned difficult. Pediatricians (in all their
subspecialties) are underpaid by comparison with adult specialties
(pediatric heart surgeons make about half of what adult heart surgeons
do-- go figure). As a sometime internist and geriatrician I can say
all these things without being self-serving. I merely point out
glaring stupidities and unfairnesses in medicine, and you can make of
my opinions what you will. Yes, the profession of medicine matters to
me. Doesn't it matter to you? If not, I invite you to bugger off, and
leave this forum to people who care about what they are discussing.
> >For example, had I not been able
> > to find any 5 day a week hyperfraction studies, I've had looked pretty
> > silly. But I found them being done in San Francisco (they are done all
> > over the world, actually), and so my point is made. It's not my fault
> > if you don't get it.
>
> I got your point. What I don't get is why it matters so much to you,
> enough to send you scurrying off to look up studies that make your
> unflattering point about radiation oncologists.
Citing the literature, which is damning, was brought on by Steph
saying "I think you have an attitude, based on very few facts.." That
tends to provoke citation of facts. Why don't you get this?
I haven't heard a peep from Steph since. If he comes back trying to
defend 5 day a week hyperfractionation studies, he's going to look
pretty silly. So I suspect we won't hear back from him with many
specifics, or much science.
Is radiation oncology a fine subspecialty? Sure. Are they overpaid?
No, they don't make as much as radiologists, either. Are most rad onc
people decent and honest guys? Sure. Does the rad onc profession
have a giant boil on its collective butt, regarding the problem of
weekend treatment? Yes, indeed. All these things are true at the same
time. The boil needs to be lanced, for the good of the specialty, the
patients, and medicine as a whole.
>Perhaps if I knew what specialty you were...
What good would that do? I know of no medical specialty which has a
hereditary dislike of radiation oncologists. If there were any, they
certainly wouldn't be mine.
SBH
Orac
sbha...@ix.netcom.com (Steve Harris sbha...@ROMAN9.netcom.com)
wrote:
> Orac <Or...@mac.com> wrote in message
> news:<Orac-6B7DDF.2...@news4.srv.hcvlny.cv.net>...
>
> > > I've given my reasons and my beefs in detail and you seem to have
> > > difficulty understanding them. Your problem.
> >
> > It's not so much the reasons, but the intensity of the dislike and the
> > nastiness I don't understand. Your stated reasons and studies perhaps
> > are not the whole story, I suspect.
>
> You're wrong. I have nothing personally against any rad onc guy. I
> merely report what I see. In this case, I think the science is being
> warped by personal interest, and that (if you believe that latest
> studies) may well be resulting in people dying because a certain class
> of doctors resists working weekends.
Well, that's a rather harsh charge. I can fully understand that not
going through weekends can be inconvenient and costly to patients. You
simply have not yet convinced me that not doing radiation through
weekends is costing lives. You may be right, but I'd say the question
isn't settled. Also, consider that you're not asking that rad onc guys
just deal with emergencies seven days a week, but that they deal with
routine non-urgent cases seven days a week.
It seems somewhat arbitrary to me to single out radiation oncologists,
given that pretty much all of medicine operates on a five day a week
schedule, much like most of the non-retail and non-food service business
world (although certainly some primary care docs now have evening and
Saturday hours). For example, surgeons take call on weekends, but most
of us don't see nonemergency patients on weekends, nor do most of us do
elective surgery on weekends if we can avoid it (unfortunately, we often
can't avoid it because all too often there just isn't any other time to
get the case done). The same is true of many medical specialties. One
example in particular hit close to home when a family member was
admitted to the hospital with unstable angina on a Friday night, and the
cardiologist didn't do an angioplasty until Monday. Granted, his angina
did stabilize to where he was pain-free, but even so, I was pissed,
because it made my relative wait in the CCU two days more than necessary
on a heparin drip.
> I'm incensed about that in the same way I'm incensed about a lot of
> things wrong with medicine. For example, radiologists, who make nearly
> as much as cardiac surgeons, and more than general surgeons, are
> overpaid.
Well, take heart, as they are not overpaid as much as they used to be,
at least, if you're talking about the radiologists who don't do invasive
procedures. Insurance companies seem to be decreasing reimbursements for
reading films, as they are for many other things. In contrast, the
radiologists who do do invasive procedures are becoming more
surgeon-like every year, both in both hours and the tendency to be
called in at all hours of the day and night for emergencies.
>Surgery is damned difficult.
Tell me about it. Eight years in a surgical residency, counting
research, taught me that. It's even more damned difficult if one tries
to run a lab at the same time.
>Pediatricians (in all their
> subspecialties) are underpaid by comparison with adult specialties
I'd tend to agree here for the most part.
> (pediatric heart surgeons make about half of what adult heart surgeons
> do-- go figure).
It's probably a volume issue. Although being a pediatric heart surgeon
requires far more skill and creativity than just doing CABGs and valves
(as adult heart surgeons do), there aren't nearly as many pediatric
patients needing heart operations. The very first clinical rotation I
did as a medical student was in pediatric cardiac surgery. (Through some
quirk, I happened to be assigned to surgery as my first rotation and the
first subrotation of that happened to be an elective.) I was thoroughly
impressed. It may indeed have been that first impression that was part
of what led me into surgery.
>As a sometime internist and geriatrician I can say
> all these things without being self-serving. I merely point out
> glaring stupidities and unfairnesses in medicine, and you can make of
> my opinions what you will.
I already have.
>Yes, the profession of medicine matters to
> me. Doesn't it matter to you?
If it didn't, I would simply have ignored your outburst.
>If not, I invite you to bugger off, and
> leave this forum to people who care about what they are discussing.
Oh, no. As much as you might like to, you can't get rid of me that
easily.
> > >For example, had I not been able
> > > to find any 5 day a week hyperfraction studies, I've had looked pretty
> > > silly. But I found them being done in San Francisco (they are done all
> > > over the world, actually), and so my point is made. It's not my fault
> > > if you don't get it.
> >
> > I got your point. What I don't get is why it matters so much to you,
> > enough to send you scurrying off to look up studies that make your
> > unflattering point about radiation oncologists.
>
> Citing the literature, which is damning, was brought on by Steph
> saying "I think you have an attitude, based on very few facts.." That
> tends to provoke citation of facts. Why don't you get this?
>
> I haven't heard a peep from Steph since. If he comes back trying to
> defend 5 day a week hyperfractionation studies, he's going to look
> pretty silly. So I suspect we won't hear back from him with many
> specifics, or much science.
>
> Is radiation oncology a fine subspecialty? Sure. Are they overpaid?
> No, they don't make as much as radiologists, either. Are most rad onc
> people decent and honest guys? Sure. Does the rad onc profession
> have a giant boil on its collective butt, regarding the problem of
> weekend treatment? Yes, indeed. All these things are true at the same
> time. The boil needs to be lanced, for the good of the specialty, the
> patients, and medicine as a whole.
Ah, and I suppose you're just the guy to lance it. ;-)
> >Perhaps if I knew what specialty you were...
>
> What good would that do? I know of no medical specialty which has a
> hereditary dislike of radiation oncologists. If there were any, they
> certainly wouldn't be mine.
Curiosity, and experience that tells me that certain "long hour"
specialties have a tendency to resent specialties with the better
lifestyle, particularly if they are perceived as being paid more.
And don't get me started on dermatologists...
Matti Narkia
<Orac-B8F3E1.1...@news4.srv.hcvlny.cv.net> Orac
<Or...@wabcmail.com> wrote:
>
>It seems somewhat arbitrary to me to single out radiation oncologists,
>given that pretty much all of medicine operates on a five day a week
>schedule, much like most of the non-retail and non-food service business
>world (although certainly some primary care docs now have evening and
>Saturday hours)
The analogy is not very good here. First, hospitals do not operate on a
five day week schedule. Patients are not thrown out for the weekends,
nursing staff does its job almost like on any weekdays, and doctors are
seeing patients in the wards, although these doctors are usually not the
same ones patients see on weekdays, but often junior doctors. True,
elective surgery is usually not done during the weekend, but this probably
has hardly any effect in the outcome, the patient most likely has already
waited for the operation for weeks, months or even years anyway.
The radiation therapy on the other hand is a sequence of "actions" spread
over 5-7 weeks, where the effect of each action seems to depend on the
timing of the previous actions. And the latest research seems to suggest
that too big time interval between any two actions may negatively affect
mortality. So IMHO it's not at all arbitrary to single out radiation
oncologist now, especially considering the latest research results. That's
not to say that no other specialty doesn't deserve to be singled out, too.
BTW, being a layman it's somewhat unclear to me to what extent radiation
oncologist's presence is required during routine radiation sessions.
Radiation oncologists plan the treatment and periodically follow its
progress, but at least here in Finland the specialized nursing and
technical staff takes care of the actual operation of the equipment. If
the treatment were to be given also during weekends, it seems to me, that
perhaps presence of radiation oncologists would be required only for to be
prepared for the emergencies. If it is so, perhaps much smaller number of
radiation oncologists were needed at work on weekends than during the
week. And what about radiation physicists? During the week they are
supposed, among other things, to deal with the potential equipment
problems, but these problems could naturally occur also during weekend?
Should their presence also be necessary? If so, that could pose even a
bigger problem than to get radiation oncologists to do shift work
including weekends, because according to my understanding in a typical
hospital the number of radiation physicists is smaller than the number of
radiation oncologists, so there are less of them to share the shifts.
Steve Harris sbharris@ROMAN9.netcom.com
> Well, that's a rather harsh charge. I can fully understand that not
> going through weekends can be inconvenient and costly to patients. You
> simply have not yet convinced me that not doing radiation through
> weekends is costing lives. You may be right, but I'd say the question
> isn't settled.
Well, here's a review which essentially says it's costing lives to do
it the conventional way (and you know what that is). Feel free to read
the author's cites and argue with his conclusions. The very recent
multicenter trial results reported this month which began this thread,
add additional evidence over that reported in this review.
Eur J Cancer. 2003 Mar;39(5):560-71.
Altered fractionation and combined radio-chemotherapy approaches:
pioneering new
opportunities in head and neck oncology.
Bernier J, Bentzen SM.
Department of Radio-Oncology, Oncology Institute of Southern
Switzerland, San
Giovanni Hospital, CH-6504 Bellinzona, Switzerland. jber...@iosi.ch
Squamous cell carcinoma of the head and neck (HNSCC) are increasingly
treated by
multimodality approaches combining surgery, radiotherapy and
chemotherapy.
Randomised controlled trials have demonstrated major improvements in
loco-regional tumour control from altered fractionation radiotherapy,
accelerated fractionation and hyperfractionation, as compared with
conventional
fractionation. This experience is summarised, and the limit as to how
far these
modifications can be taken is discussed. It is emphasised that
radiation
fractionation will need to be optimised separately in multimodality
strategies.
Combined chemotherapy and radiotherapy has also been shown in phase
III trials
to produce an improved survival and an improved disease control.
Chemotherapy
may be given as neoadjuvant, concurrent or adjuvant treatment and the
biological
rationales for each of these, and the data supporting them, are
reviewed.
Although, large meta-analyses have shown concurrent chemoradiation to
be the
most effective, there is still a strong rationale for trying to
develop
neoadjuvant and adjuvant schedules. New, more active drugs may be
important in
this context. As therapy is becoming more intense, a careful recording
and
reporting of treatment-related morbidity is a crucial element in
estimating the
therapeutic gain from competing therapeutic management strategies.
Development
of non-cytostatic drugs and individualization of therapy using
molecular
prognostic markers are exciting areas of research with a great
potential for
improving therapy in the next decade and these are briefly discussed.
Finally, a
number of avenues for further research are identified.
Publication Types:
Review
Review, Tutorial
PMID: 12628834 [PubMed - indexed for MEDLINE]
>Also, consider that you're not asking that rad onc guys
> just deal with emergencies seven days a week, but that they deal with
> routine non-urgent cases seven days a week.
COMMENT
No. What these articles are saying is the "routine" head and neck
cancer cases (at least) ARE urgent. Each and every one of them. Just
like heart attacks and pulmonary emboli and strokes and all the rest
of the stuff all the other branches of medicine deal with on weekends.
Certainly the mortality of your averaged localized head and neck
squamous cell cancer is on par with most of the genuine emergencies in
medicine, and how you treat it just as influential in whether or not
the patient survives long term or dies messily a few months down the
line.
> It seems somewhat arbitrary to me to single out radiation oncologists,
> given that pretty much all of medicine operates on a five day a week
> schedule, much like most of the non-retail and non-food service business
> world (although certainly some primary care docs now have evening and
> Saturday hours). For example, surgeons take call on weekends, but most
> of us don't see nonemergency patients on weekends, nor do most of us do
> elective surgery on weekends if we can avoid it (unfortunately, we often
> can't avoid it because all too often there just isn't any other time to
> get the case done).
COMMENT:
You'll have a hard time finding me another specialty which blows off
99% of its patients to not getting weekend treatment, when literally
for decades there has been evidence in both animal and human trials
that this might not be a good thing to do for a good fraction of that
patient population.
>The same is true of many medical specialties. One
> example in particular hit close to home when a family member was
> admitted to the hospital with unstable angina on a Friday night, and the
> cardiologist didn't do an angioplasty until Monday. Granted, his angina
> did stabilize to where he was pain-free, but even so, I was pissed,
> because it made my relative wait in the CCU two days more than necessary
> on a heparin drip.
COMMENT:
There you go. Though I have to say, not quite a comparable situation.
It's only been recently with the new stents that angioplasty itself
has been proven to affect long term mortality and morbitity at all, so
I rather doubt there's much evidence yet that people die if they don't
get it within hours, vs. a couple of days. If such data existed then
we'd be close to the situation with rad onc, with the caveat that it's
far more difficult to do angioplasty on weekends than radiation on
weekends (since the former requires full open chest capability backup,
and the latter requires nothing but a couple of rad techs).
Rad onc people not radiating on weekends is a situation a little
closer to an ICU that decides to just not do any "routine" suction or
respiratory toilet on their ventilator patients on weekends, because
the respiratory care techs all want weekends off. Or not delivering IV
antibiotics to pneumonia patients on weekends because the pharmacy
techs want Saturdays and Sunday's off. Cancer cells divide every day.
They don't take weekends off any more than microbes or mucus-making
tracheal cells do.
> > I'm incensed about that in the same way I'm incensed about a lot of
> > things wrong with medicine. For example, radiologists, who make nearly
> > as much as cardiac surgeons, and more than general surgeons, are
> > overpaid.
>
> Well, take heart, as they are not overpaid as much as they used to be,
> at least, if you're talking about the radiologists who don't do invasive
> procedures. Insurance companies seem to be decreasing reimbursements for
> reading films, as they are for many other things. In contrast, the
> radiologists who do do invasive procedures are becoming more
> surgeon-like every year, both in both hours and the tendency to be
> called in at all hours of the day and night for emergencies.
Yes. And, actually, I don't begrudge the talented cowboy catheter
jockey their pay. I see no evidence in the most recent US stats I can
find of what you say for the rest of radiologists, however. I'm
waiting, but I don't see it.
> > (pediatric heart surgeons make about half of what adult heart surgeons
> > do-- go figure).
>
> It's probably a volume issue. Although being a pediatric heart surgeon
> requires far more skill and creativity than just doing CABGs and valves
> (as adult heart surgeons do), there aren't nearly as many pediatric
> patients needing heart operations.
There aren't, but so what? So long as you have enough ped heart cases
to keep a surgeon as busy as possible full time, then you have a
situation that admits of a fair comparison. For example, Primary
Children's Hospital in Salt Lake City. Surgeons there make something
like 250 K for a caseload that would make many an adult heart surgeon
two or even three times that. And they're repairing ridiculously
complicated congenital problems in acorn-sized hearts. It's criminal.
No, I'll tell you the basic problem: children don't have any money
<g>. And young children getting congenital heart surgery, have
parents of the age of anybody else with small children. Most folks of
the age to have small children at home don't have much money either.
> > Is radiation oncology a fine subspecialty? Sure. Are they overpaid?
> > No, they don't make as much as radiologists, either. Are most rad onc
> > people decent and honest guys? Sure. Does the rad onc profession
> > have a giant boil on its collective butt, regarding the problem of
> > weekend treatment? Yes, indeed. All these things are true at the same
> > time. The boil needs to be lanced, for the good of the specialty, the
> > patients, and medicine as a whole.
>
> Ah, and I suppose you're just the guy to lance it. ;-)
We all do our part.
SBH
Steph
>
>
> We all do our part.
>
And I expect you work in the good ol' USA?