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Salvage Radiation Therepy- Provider that important?

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Posted 8/29/2010 8:01 PM (GMT 0)
If one is planning SRT, does it make any difference where or who does it, as long as they are an accrediated facility, such as a normal hospital radiology department, clinic or such? You know, the places in every town that radiation is dispensed? We see people being told all the time to select the best surgeon, hospital, brady guy, HT specalist, etc. but not really much is said about how critical it is to be so selective in choosing the place and persons who will do SRT.
Posted 8/29/2010 8:18 PM (GMT 0)
James, unless someone is living in a major urban area, with multiple sites/choices, I think its limited to where you live and how many treatments. Here in Upstate SC, there is only one place to have savlage radiation. Sure, with time/money, one could go to Charlotte, Atlanta, Columbia, or Charleston. But considering that most SRT runs 30-40 treatments, and they are daily treatments spread up to 8 weeks, it would be difficult for most people to have it done outside their immediate area.

Where I went, they have x amount of Radiation Oncologists, and they all work for the same clinic. I used one of their choices 10 years back, and this time, interviewed 3 more of their doctors before choosing one.

I wouldn't think most people live in areas of multiple choices, could be wrong though.

David in SC
Posted 8/29/2010 8:24 PM (GMT 0)
James, I don't have an answer for you but it is an interesting question that I just had to deal with. I could have had SRT 15 minutes from home at a regional hospital, but decised to err on the side of caution and I am having it done at Dana Farber. It is over 2 hours one way by train and bus. Is it worth the time and expense? I probably will never know. It does make me feel better knowing that I am being treated at a top notch facility. I will follow this tread closely. BB
Posted 8/29/2010 8:54 PM (GMT 0)
I am wrestling wiith this very question, and in fact I'll even refine the question. So far, I am not in need of SRT, but that could easily change. If it does, I want to have a plan in place. Part of that plan is in place: I will make an appointment with Dr. Hussein a top-notch medical oncologist at Umich., about 2 hours from my house.

But, if I need srt, supposedly the best place is at Umich. But our local hospital is a major mid-Michigan regional medical center. Supposedly they have a top-notch radiation department. According to a doctor friend of mine, he would stay local because they have the exact same equipment at Umich and the radiation docs are very good.

So, my refined question: assuming the equipment is the same, do I stay here? In other words, assuming a good vs. a top-notch radiation expert with the same equipment, is it a big difference? I really would like to stay 10 minutes away rather than 2 hours away. If I did go to Ann Arbor (Umich) I would probably look at renting a place and just come home for long weekends. I would have to be convinced that it is worth it, medically-speaking.

Mel

Posted 8/29/2010 9:30 PM (GMT 0)
I agree with Mel. My regional facility has new equipment and a brand new facility. The doctors were well regarded locally. My main concern was with the experience and expertise of the docs and techs. I took the same approach as with surgery. If they are doing very many procedures for PCa recurrence the they must be better than a smaller facility doing fewer radiation treatments for PCa.
Posted 8/29/2010 9:36 PM (GMT 0)
Hi James,

I was quite concerned with this question prior to my treatment. There are four providers in the immediate area. Two hospitals and two private practices. I interviewed all of them. There are two aspects to the treatment. the technology used and the radiation oncologist/planner's experience. Here is my short list of things to ask.

1. Who does the radiation planning?
2. What is their experience in doing the planning?
3. What is the machine to be used?
4. How often is the machine calibrated?
5. Who does the calibration?
6. When was the last calibration on the machine to be used on me?
7. What is the radiation doctor's track record with patients in terms of side effects and disease remission.

As it turned out my radiation oncologist writes programs for radiation treatment for others as well as his own use. He has something of a reputation in this arena and owns a company that provides the software for the machines. I felt then and now that I was in good hands.

I also made an inquiry to Cyberknife about their machine. At the time they had two doctors on staff who answered questions and both agreed that it would not have been the right treatment for me since there was evidence of spread to the nodes.

Best of luck to you.
Don
Posted 8/29/2010 9:47 PM (GMT 0)
Just like surgeons some radiation oncologists have much better track records in reducing side affects. It's difficult to locate these on your own. As long as the radiation oncologist was recommended by your oncologist or surgeon and has the latest equipment and has experience treating reoccurrances you should be OK.
JT
Posted 8/30/2010 12:18 AM (GMT 0)
Another aspect that I didin't get across is whose experience is more critical, the doc or the tech's. I know the docs plan the radiation and such, but how much do they have to do with the actual radiating and the patient, once the plan is developed and you are lying on that table the first time? Do these guys really need much specialised knowledge to lay out what 'may' be a standard radiation scan of a pelvic area. I am beginning to suspect the actual critical point would be the person who actually lines you up and pushes the buttons each time. How specialized are these docs in their 'plan' and experience neded? Or maybe they just use a cookie cutter approach for us?
Posted 8/30/2010 1:31 AM (GMT 0)
What really makes this difficult, this field of treatment is changing rapidly...New, more powerful, faster, more accurate beam radiation machines are being installed at a hospital or treatment center near you...Of course, NOBODY knows the finer details of operating these machines until they gain some experience. Do YOU want to be the provider of that experience?? I'm sure they make many dry runs on artificial targets before the first human is placed on the table, but still...

On the other hand, this new equipment offers never before achieved improvements in beam targeting and dose accuracy which SHOULD markedly improve treatment outcomes.. it will be years before we know..In the meantime, insurers are starting to balk at the costs of providing these cutting edge treatments...

So I would be looking for a Radiation Oncologist who specializes in treating prostate cancer and has done many patients successfully...Ask your other doctors who THEY recommend..Because of the TIME involved, traveling to a distant "center of excellence" can turn out to be prohibitively expensive for many people...You can enter these doctors names in Google and find their history and background. I was shocked when I poked around a little investigating an R-doc I really liked and trusted. (he had treated my daughter) Turns out he had four red flags, administrative actions, taken against him, including one from the DEA..he had practiced in 5 different states...

Another one, Dr Reggie Westmacott, was trained and practiced as a surgeon and Urologist..he suffered a nasty bicycle accident which ended his career as a surgeon. So he went back to school and now practices as a Radiation Oncologist in Denver, treating prostate and other urinary cancers. His unusual background makes him an excellent R-doc... So James, just dig, dig dig until you find the man you are looking for..
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