By Michael J. Katin, MD
"What's in a name?" Romeo and Juliet, act ii, scene
It remains unclear as to whether recent concern about diminishing reimbursement
for cancer treatment will lead to a new era of cooperation between the specialties
of radiation oncology and medical oncology to try to settle their differences
and work together for the good of the patient, or to turn on each other
like rats in a cage. Ironically, having the patient undergo radiation therapy
may seem more appealing when you're a medical oncologist working in a capitated
system, and vice versa. If we take the optimistic approach that the outcome
may wind up being a new sense of siblinghood, it might be good to start
eliminating causes of antagonism.
Several of these come to mind instantly but one may be on the verge of
resolving itself. This would be the jealousy the traditional radiation oncologist
would have of medical oncologists for having cornered the market on nifty
treatment names and abbreviations.
The previous generations of radiation oncologists (then known as radiation
therapists) had in their armamentarium orthovoltage, cobalt therapy, radium
needles, and then linear accelerators. "Orthovoltage" was a term probably
nonrecognizable to the average person, who would probably think it had something
to do with buying Christmas tree lights. "Cobalt" and "radium" had the connotation
of unleashing force able to burn through steel and flesh, hardly consumer-friendly.
Even during the early days of medical oncology, however, it was recognized
that you had to have treatments with name recognition by patients and physicians,
and ideally give you an idea about what they were supposed to accomplish.
The simplest examples may be MOPP, what you wanted to do to Hodgkin's
disease, and CHOP,
what you wanted to do with non-Hodgkin's lymphomas. This sometimes took
some ingenuity, such as using "oncovin" instead of "vincristine" in order
to create a vowel. Of course, there would be no validity to the idea that
many combinations were devised to come up with names that sounded good rather
than due to rigorous scientific analysis of drug synergism. Thus evolved
the cousins CYVADIC and CYVADAC, and our all-time favorites, when you really
want to show you want to kill lymphoma, ProMACE-CytaBOM and COP BLAM.
This approach also involved giving memorable names to single agents and
even adjunct medications. Sodium 2-mercaptoethane sulfonate could have been
called "sodium 2-mercaptoethane sulfonate," but "Mesna" was easier to remember
(unless you were a dyslexic trying to join an organization for geniuses).
Sometimes the naming backfired. "Carmustine" was not as slick as "BCNU"
but at least didn't give the connotation of saying good-bye. But no one
has ever matched the simplicity of "Flomax."
In the meantime, the best that radiation oncology was able to come up
with was "linear accelerator" or "linac" if you wanted to go wild. The question
was, what exactly did it do that had to do with therapy? Or was it a way
to speed up lines at the supermarket?
And then we really went wild with "3-dimensional conformal therapy." The
patients didn't exactly line up around the block for that one. It was then
that the veil was lifted from our senses and it was obvious that we had
to compete for the attention of the public. And suddenly patients were actually
asking their primary physicians for things we, not the medical oncologists,
could deliver. Was it due to the increasing awareness of prostate brachytherapy,
in which you could get Theraseeds, Oncoseeds, IoGold seeds, Brachyseeds,
and Echoseeds? Or did it have to do with the radiosurgery choices of the
X-Knife, Gamma Knife, or Cyber Knife, which seem odd since the whole purpose
was to avoid using a knife. And now patients come in expecting to have a
BAT used during prostate treatment, with the name recognition getting to
the point that many people in our specialty can't reverse gear to tell you
what the letters stand for (bilateral assisted tomography?) And you still
have to be careful that the name sounds positive. With great apologies to
the developers, I would guess that most people would think "SCIM" radiation
therapy sounds like something superficial rather than definitive.
Even our organizations have recognized this. "ASTR" was not obviously
pronouncable but "ASTRO" is a stroke of genius. And I think there's no question
that the American Endocurietherapy Society made tremendous progress when
it switched from "AES,"
which sounds like a Southerner describing a part of the body, to become
the Anerican Brachytherapy Society, aka the legendary
"ABS." ACRO had a good name to start with and it even lends itself to
interesting derivatives (e.g. ACROphobia, ACROmegaly, etc.).
Now that patients are coming to the office asking for IMRT (how can you
not want to be treated with a SmartBeam), wanting to have Peacocks
to go with their BATS,
and demanding to get planned on an ACQSIM, it can be concluded that we have
definitely closed, if not demolished, the name gap.
Or, as Tony Soprano might say, "CytaBOM....CytaBING."