October, 2013

Braving Atlanta

By Michael J. Katin, MD

The 55th Annual Meeting of the American Society for Radiation Oncology was held September 22 through 25 and is now in the record books. The theme was "Patients: Hope-Guide-Heal." Attendance seemed down, and several reasons can be theorized. Decreasing revenues from radiation oncology practices made it difficult for many in our field to be able to afford airfare to Atlanta, and last year's closure of several discount carriers made more inexpensive travel unavailable. Next, the Atlanta area did not have an adequate number of lower-priced hotel rooms that could allow attendees to sleep indoors rather than have to wander the streets all night. Finally, with the "Sunshine Act" having taken effect as of August 1, equipment vendors and pharmaceutical companies are unlikely to be able to provide meals, and medical personnel are afraid to accept them, due to concern as to how this will be implemented. Not all radiation oncologists, physicists, dosimetrists, and therapists are yet experts in how to maximally reduce nutritional expenditures

For those who did not attend, here is a synopsis of the proceedings. The emphasis this year was on patient-centered care, which is always the case in community settings and occasionally in academic centers. Those who were fortunate enough to attend the opening ceremonies will never forget the appearance by Fergie of Atlanta's own Black-Eyed Peas, capped off her performance by twerking with the ASTRO Board of Directors. The four plenary session presentations all dealt at least in part with quality of life issues. This was appropriate considering the theme of the meeting, and the concept of quality of life was then explored further by an unannounced address by Vice-President Joe Biden, who went over the ramifications of the Affordable Care Act in terms of how all Americans will now be able to obtain health care until 2017, when all procedures will be denied. Mr. Biden then concluded by twerking with the ASTRO Gold Medalists.. Mr. Biden's talk, however, had been delayed by 21 hours due to an also-unannounced presentation by Senator Ted Cruz of Texas, whose speech included the retelling of a classic story.

Speaking further of quality of life, it is appropriate to commend the ASTRO leadership for providing exhibitor space to the following:

The Department of Agriculture: distributing information and instruction on how radiation oncologists and their staff can apply for assistance under the SNAP program.

Hormel Foods, for their display regarding recipes for SPAM and their new product for these difficult times, SPAM Helper.

Jerry's Pawn Shop, Atlanta's premiere downtown facility, allowing attendees to cash in jewelry, watches, I-pads, or cell phones to allow them to get adequate funds to get home.

The content of the presentations at the 55th Annual Meeting of ASTRO once again represented the cutting edge of oncology knowledge. In fact, with 363 oral presentations 143 digital poster discussion abstracts (144 minus one withdrawn), and 1,446 poster viewing abstracts (1,460 minus 14 withdrawn), it's hard to believe there's anything left to discover!!

Here are the annual selections for the outstanding contributions to science:

CATEGORY 1: Rahm Emanuel award

2753: "The Impact of Superstorm Sandy on the Care of Radiation Oncology Patients." We couldn't treat anybody while the electricity was off, so we might as well get a publication out of it.

2782: "Emergency Preparation for Radiation Oncology: Lessons Learned from a Natural Disaster." If they can get a publication out of it, so can we. Plus we learned that compared to trauma and obstetrics emergencies, nobody really cared about us.

2762: "Decreased Radiation Utilization During the Economic Crisis of 2008-2009" Maybe people couldn't afford to get cancer.

CATEGORY 2: Frontiers of science

3161: "Significance of Daily Fractionated Administration of Wortmannin Combined with Gamma-Ray Radiation in Terms of Local Tumor Responses and Lung Metastatic Potential." Wortmannin....of course! It was obvious!

2286: Is Ca 19-9 Response Following Chemoradiation Therapy for Borderline Resectable Pancreatic Cancer an Early Surrogate for Eventual Survival Outcomes?" According to the text, correlation between markers and survival have been poorly studied.

2293: "Ca 19-9 Kinetics Following Radiation Therapy Correlated With Outcomes in Patients With Pancreatic Adenocarcinoma." Except by these guys, 7 posters down from you.

CATEGORY 3: Get out the survey meter

3063: "Qualitative and Quantitative Distress Assessment of Cancer Patients Using the NCCN Distress Thermometer." Celsius, Fahrenheit, or Kelvin?

2969: "Geriatric Assessment in Radiation Oncology Clinic: A Pilot Study."Yes, most older patients have geriatric problems.

3: "RTOG 0841: Two-Item Questionnaire Effectively Screens for Depression in Cancer Patients Receiving Radiation Therapy." Don't Worry? Be Happy? since it's a questionnaire

CATEGORY 4: Don't try this at home

3182: "EGFR-Mediated Nuclear Delivery Improves the Genotoxic Effect of Fe3O4@TiO2 Nanoparticles." Note: B-loop nanoparticles, not scrambled nanoparticles, can bind EGFR and importin-beta from EGFR-expressing HeLa cells. That's what I was doing wrong!

3141: "Botulinum Toxin Confers Radioprotection in Murine Salivary Glands." Plus the mice had difficulty expressing happiness or anger afterward. Be prepared for half the vials to go missing.

CATEGORY 5: Trying to keep the customer satisfied

2945: "Poor Performance Status and Transportation Requirements Predict for Failing to Complete a Course of Radiation Therapy." Good argument for having a Gilbert McFletcher House.

2990: "Initial Findings With the Use of a Novel Performance Metric to Identify Institutional Rates of Radiation Discontinuation." 5% of patients discontinued radiation therapy early and 0.9% expired while on treatment. Might be able to do something about that 5%. Might be hard to change the decision of the other 0.9%.

CATEGORY 6: Translational Research

3655: "Problems Encountered During Cultural Adaptation of the EPIC Questionnaire for Prostate Cancer Into Punjabi and Chinese." One can only imagine how badly wrong this could go.

3057: "Cancer Treatment Consent Forms Are Still Difficult to Read." Maybe translating isn't the problem.

CATEGORY 7: Future perfect

2748: "Standardizing the Radiation Oncology Medical Student Elective: A Novel Curriculum and Evaluation of Student Satisfaction." 52% of those who took the four-week radiation oncology elective at the University of Pennsylvania between 2008 and 2012 were visiting students!!!!!!

2785: "Gender Distribution in Radiation Oncology Residency Compared to Other Specialty Residencies: A 20-Year Perspective." The percentage of female residents entering radiation oncology was no higher (32.3%) in 2011 as in 1994, with only two other specialties showing no significant increase. Again proving that women are smarter than men.

2788: "United States Radiation Oncology Residency Diversity Over the Past 20 Years." Overall diversity of radiation oncology residents has changed minimally. Or does that mean we were already ahead of everybody else?

2787: "Publication Misrepresentation Among Radiation Oncology Residency Applicants." 22.5% of all applicants in 2011 had applications with incorrect manuscript citations compared to 9% of applicants in 2004. It is hoped their accuracy will improve when they're treating patients.

And, finally,
CATEGORY 8: Most rational contribution to our specialty (tie)

2423: "Successful Patient of Acceptance of Randomization Within the PACE Study (Prostate Advances in Comparative Evidence)." The PACE Study is designed to answer whether robotic radiosurgery SBRT is non-inferior to laparoscopic prostatectomy, and whether robotic radiosurgery SBRT is non-inferior to intensity-guided intensity modulated radiation therapy. It seems encouraging that so far 54% of the patients agreed to randomization, although it then turns out that is the combination of only 26% to surgery vs. SBRT and 70% for SBRT vs. IMRT. It also seems somewhat defeatist that the intention is to look for non-inferiority rather than superiority, but it's a start.

1086, 2013, 2124, 2137, 2147, 2182, 2328, 2357, 2575, 2686, 2789, 2866, 3070, 3218, 3364: The fifteen withdrawn presentations. Appreciation goes to the authors for realizing that their material was not ready for prime time.