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How to evaluate a radiation oncologist

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Posted 3/5/2017 7:03 PM (GMT 0)
I don't need it yet, but I might need early salvage radiation treatment. Before I had surgery I met with a radiation oncologist where I live, in Williamsburg, Va., and found him to be a pleasant person who seemed knowledgable, spent plenty of time with me, answered all questions, etc. At the end of our meeting I had no idea how to decide if he is good at what I would hire him for, killing cancer without causing unnecessary SEs.

His office is extremely convenient to me, but that does not seem like the best criterion for hiring a doctor. One option would be to drive 45 minutes each way to VCU Medical Center in Richmond, or 40 minutes to Hampton for proton therapy.

So, here is question I'd like to pose to the group: how do you determine how skilled and competent an oncologist is? Are there data about individual doctors? Should I go to a major center rather than a local doc?

Thanks to everyone in this very helpful group!

Post Edited (fiddlecanoe) : 3/5/2017 1:14:28 PM (GMT-7)

Posted 3/5/2017 8:49 PM (GMT 0)
Actually, I think convenience is a BIG factor. A lot of ROs can do a good job. With 35 or so treatments, every day travel is going to be important, especially with a full bladder or when your urinary tract gets increasingly irritated and you will need to pee a lot more.

There's a list of questions in the sticky for the newly diagnosed, which I'll paste below:

Questions for a Salvage Radiation Interview.

1. How many patients have you treated with adjuvant/salvage radiation?
2. How has your practice of salvage treatment changed, if at all?
3. What is the probability that I need salvage treatment? Do you calculate that from a nomogram?
4. Do you think I should get a Decipher test to find my probability of metastasis in the next 5 years? Do you know if my insurance covers it?
5. How large a dose do you propose for the prostate bed? (should be near 70 Gy)
6. Do I need pre-treatment, concurrent or adjuvant ADT?
a. Why? 
b. What's the evidence that it's useful?
c. For how long?
7. How do you decide whether to treat the pelvic lymph nodes? 
a. If so, at what dose? (50 Gy)
b. How do you plan to prevent bowel toxicity? 
c. How will you account for the separate movement of that area and the prostate bed?
8. What do you think of doing this in fewer treatments (hypofractionation)?
9. What kind of machine do you use? (e.g., RapidArc, Tomotherapy, Vero, etc.) Why do you prefer that one?
10. What is the actual treatment time for each treatment? (faster is better)
11. What kind of image guidance do you propose? fiducials in the prostate bed? Using the fixed bones only? Soft tissue?
12. How will inter- and intra-fractional motion be compensated for?
13. What measures do you propose to spare the bladder and rectum?​ (ask about treatment margins and dose constraints)
14. ​What side effects can I reasonably expect, and how do we handle them?​(discuss in detail!)
15. What probability of a cure can I reasonably expect, given my stats? Is there a nomogram you use to come up with that?
16. How will we monitor my progress afterwards, both oncological and quality of life?
17. What's the best way for us to communicate if I have a question or issue?
Posted 3/5/2017 9:10 PM (GMT 0)
If and when the time comes I would talk with all three and pose many of the questions from TA's list, especially what type of machine they use. The technology has come a long way in the last 10 years. I would think a local hospital may be more likely to have older equipment but it's just a guess.

My drive was 20 minutes each way and there were times I "just made it" home before needing to go. After surgery there was some bowel urgency, after radiation urgency doesn't really describe it. I guess you could map out some potty stops along the way because I know it would not be possible for me to make 45 minutes without a rest stop.

I thought I had done it all until I had to empty my loose bowels pre-treatment and not pee at the same time to retain my full bladder. It can be done, not fun but doable.

Jon
Posted 3/5/2017 10:28 PM (GMT 0)
I had proton treatment in Jacksonville, FL at UFPTI, but decided to stay in Amelia Island for 8 weeks during treatment. It was a 45 minute drive each way 5 times a week. They asked that I be at the facility 30 minutes before treatment to begin drinking water before treatment. I never had any problems with urinary issues during the drive.
Posted 3/6/2017 4:47 AM (GMT 0)
That's a great list of questions. The RO in Williamsburg said in our meeting that he uses the most up-to-date equipment, but did not say what kind, probably perceiving that it would have meant nothing to me.

Temporarily relocating to a radiation facility is a great idea, but I can't do it. Or, I suppose I could, but only at great inconvenience.

I had not thought about the problems that might come with the long drive.

FC
Posted 3/6/2017 4:08 PM (GMT 0)
Radiation is used for all sorts of cancers. You should not have a problem staying physically close and finding excellent practitioners. Your urologist should be able to provide referrals. Also just reach out to the different centers in your area and ask how experienced with SRT they are.
Posted 7/22/2017 11:37 AM (GMT 0)
What are the advantages and disadvantages of proton therapy? Had Prostectomy in 2009, PSA rising have ED and incontinent. Is proton therapy correct for radiating the prostate bed?
Posted 7/22/2017 12:07 PM (GMT 0)
It has been shown that proton is no better than photon for PCa. It is much more expensive and most insurance will not cover it. Even the radiology association does not recommend it for PCa. It does offer advantages with other types of cancer, but not PCa. For SRT it has never been used much but is being used in a clinical trial referred to by TallAllen in another post.
Posted 7/22/2017 1:49 PM (GMT 0)
/prostatecancerinfolink.net/tips-tools/pick-radonc/
9 tips for picking a RO
Posted 7/22/2017 2:06 PM (GMT 0)
The above list is very good. I took TA's list with me but only asked a few of them. Also the link directly above this has some very good criteria for evaluation.

I am in much the same situation. There is a RO whose office/treatment facility is literally right around the corner from me. Takes about ten minutes to get there. He does exclusively genitourinary radiology. He is mature and patient and seems very knowledgeable. The staff is friendly. I specifically asked about the equipment and it is the Varian RapidAcr, which I presented here a few days ago and everyone appears to feel that it is good technology. Additionally their computers are linked to my Urologists' office so all records are available to both.

On the other hand, I could drive about an hour away to go to Moffitt, which is a large, nationally known cancer center. They have several RO's on staff, none of whom I know. My wife was treated for lymphoma at an affiliated hospital and she is now in full remission. It was difficult, a long drive, hassles with scheduling and screwed up communication between offices... lost orders and such. It was a traumatic experience even if we DIDN'T have cancer.

So my advice would be to go with what is convenient. Remember you are in this for the long haul. Most likely you will get to know everyone at the local office by name and they will know you. At the remote hospital you may recognize a few people but will always be a case number.

Good luck!
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