Radiation Oncology   

Patient did not tolerate NSAIDs and referred 2 weeks after hip surgery for RT.

Are these toxicities expected to improve over time?

Specifically, headaches thought not to be related to increased ICP.

NCCN states that per an AS paradigm for low risk and FIR prostate cancer, a PSA should not be collected any more than every 6 months, with DRE, mpMRI ...

If so, what do you typically prescribe?

How do you incorporate this into your follow-up care and how do you instruct the patient?

For example, when would you recommend clinical exam for surveillance versus imaging with MRI, CT or PET? 

This would apply to gynecologic and GI cancers as well. And as long as the patient's partner is within the recommend age of <45 yo

There was a recall on viscous lidocaine and many of our patients cannot find it. What would you recommend as alternatives?

If so, for how long afterwards do you think the patient needs to continue the exercises?

How do you counsel patients and caregivers? Do you prescribe medications (''appetite stimulants'') with the goal to improve appetite even if they do n...

NCCN cervical cancer guidelines added a new statement - Patients who have received prior pelvic radiation therapy and have osteoporosis may benef...

Patients in their later 40s with favorable intermediate-risk prostate cancer s/p 7000cGy/28 EBRT only.

The patient is on a dose of 22 mg of methotrexate weekly for severe rheumatoid arthritis. If you would discontinue the methotrexate, how long would y...

I feel like it’s nearly impossible to take carafate QID and avoid food and medications for 1-2 hours before and after. How do you counsel patien...

If so, when do you resume?

The serum testosterone is minimally low at 250 and the patient has some fatigue.

How is your approach different from or similar to those who undergo surgical menopause? 

I have heard of long-term pentoxifylline and Vitamin E daily combination that can prevent and even reverse radiation fibrosis (Delanian et al., PMID 1...

Assume a life expectancy of approximately 5-10 years. What factors would influence your consideration of intermittent ADT vs. watchful waiting?

Patient had significant GI side effects with Trental. (This particular case involved a second course of radiation for a secondary lung cancer 30+ year...

How soon is too soon after surgery to check PSA?

 Is there any available therapy?

What do you tell men who want to know if their testosterone has recovered?

If a patient had prior breast conserving treatment and now has inflammatory breast disease, would you prophylactical send the patient to a cardiologis...

What medications (ibuprofen, steroids, muscle relaxers) due you use? Are there any non-medication management options?

Some patients will go on to develop asymptomatic intermittent hematuria which can persist... In patients with scant hematuria, what's your routine car...

If this is bothersome to the patient, are there any topic ointments or medications that can help if used? 

Do you allow patients with breast cancer on tamoxifen to use black cohosh?

Does the answer change on proximity/distance from breast (i.e. what if pelvis or lower extremity?)

In follow up to @Jacqueline Casillas presentation at ASCO 2021 regarding models of survivorship care delivery for AYA patients. 

 If so, for how long?

What non-pharmacological interventions do you recommend? Do you routinely prescribe prophylactic laxatives to patients initiating opioids? How do you ...

Would your counseling change if she reported a history of unplanned pregnancy? Is there any wording or waiver you might be able to use warning her of ...

There does not appear to be any guidance from the most recent published protocols on this topic. For individuals with dementia, recommendations call f...

If so, what is your time threshold for when you'll start PCP prophylaxis--when you anticipate steroid courses greater than 1 week? 1 month? 3 months?&...

Are there exercises, massage techniques, or support garments that are effective at preventing or reversing lymphedema of the breast?

After optimizing symptoms and reversible factors, and attempting cognitive-behavioral interventions and exercise, do you recommend pharmacologic agent...

What do you do/say when a discussion of evidence-based information doesn't convince a patient that this is her best chance of cure? Some patients even...

The recent NELSON trial evaluates screening in a slightly different population than the USPSTF/NLST criteria. Which will you follow?

If this upstages the patient, do you modify treatment recommendations?

Do you encourage patients to take a break from/stop taking Fosamax or similar medications for their osteopenia or osteoporosis in order to prevent dev...

Obviously, patient and caregiver preferences are paramount. But, what factors do you consider? Does expanded hospice (e.g., Medicare Care Choices) inf...

This applies to both de novo cases and patients who have previously received injectable agents.

When a physical exam is important and telehealth is not a good option, should we be proactive and reschedule or should we continue to see them as sche...

For those of us who are just starting out in practice, do the seasoned pros have any advice?

What concerns do you have about a colonoscopy? 

This question has come up most frequently with respect to the flu vaccine recently. Also, frequently this has been asked about the shingles vaccine an...

Indefinitely seems to be a typical recommendation, but rarely done.

Should this be part of the follow up?

Would estrogen cream be helpful in this scenario?

At what point would you introduce the discussion of weight management, whether for risk reduction or overall health?

Please share your tips on dealing with short and long term xerostomia.

Do your recommendations differ if patients are pre or postmenopausal given the data?

If a patient is due for their yearly mammogram on the breast that has been diagnosed with cancer but is still undergoing active treatment (chemo or ra...

Which appetite stimulants are the most effective? How do you respond to patients who request medical marijuana?

In view of higher risks of rectal cancer after pelvic radiation, is more frequent screening warranted?

Any absolute contraindications?

Do you have a "threshold" quantity/dose of opioids above which you are uncomfortable prescribing?

I have a patient who will be climbing to the base camp of Mount Everest. Does a climb to 15,000 feet increase her risk? Should she wear a compression ...

In particular, for men who have no strong indication for ADT?

Studies have shown increased rate of endocrine dysfunction in these patients: https://www.ncbi.nlm.nih.gov/pubmed/26011172 https://www.ncbi.nlm.nih....

Do you refer all patients who are felt to be at high risk to a genetic counselor for testing or are you comfortable performing a MyRisk panel in your ...

In a patient who has a rising PSA, palpable nodule, MRI findings etc., is it ethical to treat the patient with inadequate information and ri...

If so, how do you manage counseling for someone with low health literacy?

If a patient has a gynecological cancer, how long should one wait after RT before a screening colonoscopy can be completed?

In patients with new bone pain and without any evidence of bone metastases receiving GnRH agonists, how do you manage pain symptoms?

Two retrospective studies from Stanford showed that patients who received ADT had an increased risk of dementia and Alzheimer's. Is this finding ...

Is there a role for routine use of additional or alternative imaging modalities for these patients, such as tomosynthesis, MRI, or ultrasound?  I...

Do you routinely ask all women of childbearing potential to have a pregnancy test? If so, do you get a pregnancy test before their CT simulation or th...

Does your recommendation change depending on the agents they received?

Our lung cancer screening program does not enroll anyone who has previously been deemed to be a nonsurgical candidate.  I see that there is no ev...

Do you treat patients who are clinically hypothyroid but biochemically euthyroid?

Are there specific subsets for whom these results should change management?

With ultra-sensitive PSA, it's unclear to me whether a doubling from 0.01 to 0.02 or 0.02 to 0.04 is significant. Is there a certain value that you wo...

A 40 year old patient receiving post-op RT for  breast cancer asked me if there is any risk for her becoming pregnant after completing RT. Eric H...

The 2013 ASCO guidelines and current NCCN guidelines recommend yearly mammograms but our radiologists are still recommending mammograms every 6 m...

More specifically, which cardiac risk factors do you look for? Diabetes? Previous MI? Dyslipidemia? Peripheral vascular disease? CHF?

How should we counsel young women who are receiving treatment for GI/GYN malignancies?

What schedule is best for preventing fibrosis and for patient compliance?