Todd Scarbrough: Dear radiation oncology, there is a much higher rate of radiation oncologist production versus the rate of new cancer incidence- A REALLY LONG BUT COOL Thread

Todd Scarbrough, Radiation Oncology Specialist in Anniston, AL ,shared on Twitter:

1. Dear radiation oncology,

There is a much higher rate of radiation oncologist production (“rad onc incidence”) versus the rate of new cancer incidence

A REALLY LONG BUT COOL (BUT NETTLESOME)

Cancer Thread (thanks to the National Cancer Institute and SEER)

2. One of the key elements of this “analysis” is going to hinge on the number of radiation oncologists we have in the U.S. in 2003 and 2020. Whichever source you choose, you get a different number…

3. But about 3 years ago Simul Parikh and I wrote this:
Using peer reviewed sources, we came up with the graph below Looking at the US population in 2003 and 2020, there would be 1.21 radiation oncologists per 100,000 people in 2003 and 1.65 per 100,000 in 2020.

4. Let’s look at cancer incidence (per 100,000 people) trends over time for the main cancers that get radiotherapy by radiation oncologists in the USA.

We have a good list of what those cancers are… thanks to Centers for Medicare & Medicaid Services and RO-APM

5. We aren’t going to look at brain mets or bone mets. Mostly because no good national incidence data is kept for this (afaik).

So we will look at

ANAL

BLADDER

BREAST

CERVIX

CNS

COLORECTAL

H/N

LUNG

LYMPHOMA

PANCREAS

PROSTATE

UPPER GI

UTERINE

6. The methodology will be: set the incidence of 1.21 radiation oncology per 100K people for 2003 at the starting incidence of the cancer incidence per 100K people for 2003 (on a graph) and we will have a visual look at the slope of the incidence of cancer, and radiation oncologists from there.

7. ANAL – 1.8 new cases per year per radiation oncologist – MATCHED SUPPLY.
BLADDER CANCER – 15 new cases per year per radiation oncologist – EGREGIOUS RADONC OVERSUPPLY.

8. BREAST CANCER – 54 new cases per year per radiation oncologist – RADONC OVERSUPPLY.
CERVICAL CANCER – 2.5 new cases per year per radiation oncologist – RADONC OVERSUPPLY.
CNS/BRAIN CANCER – 4.5 new cases per year per radiation oncologist – RADONC OVERSUPPLY.

9. LARYNGEAL CANCER – 2.2 new cases per year per radiation oncologist – EGREGIOUS RADONC OVERSUPPLY.
OROPHARYNX/ORAL CAVITY CANCER – 10 new cases per year per radiation oncologist – RADONC OVERSUPPLY.
NON-HODGKIN LYMPHOMA – 14.6 new cases per year per radiation oncologist – RADONC OVERSUPPLY.

10. HODGKIN LYMPHOMA – 1.6 new cases per year per radiation oncologist – RADONC OVERSUPPLY.
PANCREATIC CANCER – 11.6 new cases per year per radiation oncologist – MATCHED SUPPLY.
PROSTATE CANCER – 52 new cases per year per radiation oncologist – EGREGIOUS OVERSUPPLY.

11. GASTRIC CANCER – 4.8 new cases per year per radiation oncologist – RADONC OVERSUPPLY.
UTERINE CANCER – 12 new cases per year per radiation oncologist – MATCHED SUPPLY.

12. COLORECTAL – 28 new cases per year per radiation oncologist – EGREGIOUS RADONC OVERSUPPLY.

13. LUNG CANCER – 43 new cases per year per radiation oncologist – ***EGREGIOUS*** RADONC OVERSUPPLY.

14. In summary… looking at the ~36% rise in radiation oncologists per 100,000 people in the USA from 2003 to 2020…
I’m glad radiation oncology has such a continued role to play in pancreatic and glad there are 2 new anal cancers per year per radiation oncology in the USA.

15. THOUGHTS: If you’ve been doing radiation oncology for 20y and think you are treating more oligomets/met cases than you used to, it’s because you’re treating less curative/de novo cases.
(NB: new cases per yr per RO are a big overestimate in all the above, too… and are an average)

16. THOUGHTS: Lung cancer incidence is a bit falling off a cliff. Radoncs (used to) treat a lot of lung cancer!

17. THOUGHTS: The most common indication for RT in America is breast cancer; the incidence of radoncs has outpaced breast cancer incidence rise. The incidence (rate rise) of radoncs has really outpaced prostate cancer (2nd most common RT indication) incidence.

18. THOUGHTS: If you think your experience as a radiation oncologist (or department!) doesn’t match the falling incidences above, it means you are lucky or somehow have an “advantage” so to speak versus the “average” radiation oncologist.
The reasons for this could be myriad, of course.

19. THOUGHTS: If RO-APM would have been implemented, it was destined to save money! Why? The national incidence of the main cancers in the model are falling enough that a savings likely would have been baked in.

20. Final thought: You all have permission to use these graphs and data, including you Chirag Shah.
Including you American Society for Radiation Oncology for ROCR presentations etc.”

For more details click here.
Source: Todd Scarbrough/Twitter