Latest news with #radiationOncology
Medscape
2 days ago
- Health
- Medscape
New Glioma Guidelines Incorporate WHO Reclassification
Newly updated guidelines from the American Society for Radiation Oncology (ASTRO) capture the World Health Organization (WHO)'s 2021 reclassification of glioblastoma as grade 4 adult-type diffuse gliomas. The new ASTRO guidelines and the WHO reclassification incorporate newly discovered molecular markers with histologic findings, which allow clinicians to more precisely diagnose and treat these tumors. The term glioblastoma now refers only to IDH wild-type gliomas, which grow more quickly and are more aggressive that IDH mutant gliomas. The guidelines also incorporate the use of newer imaging techniques. The ASTRO guidelines were last updated in 2016. According to guideline co-author Steve E. Braunstein, MD, PhD, the treatment of older and/or medically frail patients was one of the topics the guidelines task force spent the most time discussing. Despite 'dozens and dozens of high-quality clinical trials that have been done, there are still areas where we don't have a clear consensus or a clear, high-level evidence-based approach for treating those patients…who are somewhat older or more medically frail,' Braunstein told Medscape Medical News in an interview. The task force observed that even assessing two or three factors like performance status and age doesn't really capture the patient and how they're going to best respond to therapy. The guidelines offer suggested dose-fractionation regimens for radiation therapy (RT) guided by the patient's age and functional status with shorter courses conditionally recommended for older patients and those with indications of frailty. Supportive care is conditionally recommended in lieu of chemoradiation for patients with markers of severe frailty, who are often at an increased risk for complications from intensive treatments. However, for both groups — older/more frail and severely frail patients — the appropriate treatment approach should flow from a multidisciplinary, patient-centered discussion. 'We recognize that we need to do more to understand these patients in a deeper way in order to bestow upon them appropriate personalized recommendations,' said Braunstein, who is also vice chair of radiation oncology at the University of California San Francisco. Reirradiation Conditionally Recommended for WHO Grade 4 Diffuse Glioma The task force conditionally recommended reirradiation for WHO grade 4 diffuse glioma recurrence for selected adult patients with good functional status, following a multidisciplinary, patient-centered discussion. This discussion would address indications and techniques for reirradiation, specifically diagnostic and treatment considerations and systemic therapy in the reirradiation setting. At least one expert interviewed by Medscape Medical News questioned this recommendation. 'For recurrent glioblastomas, they suggest that reirradiation is an option…the endorsement of that approach is fairly significant,' said Patrick Y. Wen, MD, is director of the Center for Neuro-Oncology at Dana-Farber/Brigham and Women's Cancer Center and Harvard Medical School in Boston. 'In fact, we actually don't know if reirradiation works.' He added that the guidelines could be more balanced in outlining the limitations of reirradiation. 'We all do it because there's nothing else to do, but that doesn't mean it's a great choice.' Wen, who was not involved in the development of the guidelines, said there has only been one randomized trial, which compared Avastin [bevacizumab], which is standard of care, with bevacizumab and radiation. Although patients who received the combination had decreased progression-free survival, there was no improvement in overall survival. Wen noted that there has only been one randomized trial, which compared Avastin [bevacizumab], which is standard of care, with bevacizumab and radiation. Although patients who received the combination had improved progression-free survival, there was no improvement in overall survival. 'So you could interpret that as the only randomized study out there…showing no survival benefit.' There is a trial being conducted by the European Organisation for Research and Treatment of Cancer, the LEGATO trial, that is currently evaluating whether reirradiation and lomustine improves survival compared with standard lomustine chemotherapy alone. The data that do exist supporting the use of reirradiation come entirely from retrospective studies, he added. 'There's huge selection bias with retrospective data because the patients, who you would radiate are the ones that have small tumors and that are probably in decent shape, so they're going to do better.' In addition to making the conditional recommendation for reirradiation, the task force acknowledged care disparities for patients from diverse backgrounds. More Studies Needed to Examine Barriers to Access, Clinical Trial Enrollment 'There are great disparities in the care of patients, who are coming from different backgrounds,' said Braunstein. 'Those are a function of things that could include age, geography, insurance status, ethnic background, and race, among others. We really want to ensure that we're giving every patient with this terrible diagnosis, the opportunity to have the best care possible.' As part of the discussion, the task force reviewed the literature on health disparities and adult high-grade glioma, calling to attention the need for more studies that examine barriers to access and the need to increase clinical trial enrollment for underserved populations. Other key recommendations for patients with grade 4 adult-type diffuse gliomas include: Fractionated RT for those who have undergone biopsy or resection; optimal timing and fractionation schedules for adjuvant RT are included. Concurrent temozolomide chemotherapy and RT are recommended following biopsy or resection. Alternating electric field therapy — a cancer treatment using low-intensity, intermediate frequency electrical fields — is conditionally recommended following RT for those with tumors in the upper regions of the brain (ie, supratentorial disease). Braunstein reported relationships with Elekta GT Medical Tech (consultant) and Icotec Medical (honoraria, travel expenses).
CTV News
10-07-2025
- Health
- CTV News
Ontario doctors warn of increase in DIY medicine
The Ontario Medical Association (OMA) is sounding the alarm on what it says is a concerning increase in the number of patients turning to do-it-yourself medical solutions rather than getting expert advice from doctors. 'We know people are going online,' Dr. David D'Souza said. 'The aspect of looking is not necessarily a problem; it's the interpretation of it.' D'Souza, a radiation oncologist in London, Ont., said patients are often drawn to ideas that seem 'all natural' or that seem to offer 'miraculous' results or options with no unpleasant side effects. He cited a study which found that about a third of the most popular social media posts about cancer from 2018-2019 contained factually incorrect information. 'You might say, well, what's the big deal? What's the problem with it? Well, most of them are potentially harmful,' he said. D'Souza was one of several doctors who took part in a news conference hosted by the OMA Wednesday, calling attention to the rising trend of do-it-yourself medical solutions. Doctors on the panel said they are increasingly encountering self-diagnoses based on internet research or having to answer questions from patients about viral videos suggesting that fast food can cure migraines or that CBD oil can shrink tumours. Some are even trying to treat themselves. 'I had a patient who had a tube going into their kidney because it was blocked – it's called a nephrostomy tube – due to their cancer. And they actually tried to put the twine from a weed whacker in to get out the sludge that was in there,' D'Souza recalled. 'They were asking about actually putting in a little bit of Lysol to clear it out.' While he managed to dissuade them, other patients have chosen to go with alternate treatments based on their own research, sometimes with devastating effects. One young woman, D'Souza recalled, came to him with a diagnosis of cervical cancer. 'She was not ready to accept conventional treatment and decided she was going to pursue other remedies that she had heard about,' D'Souza said. 'She came back two years later, unfortunately, with her disease having progressed and spread, and in a lot of pain, and unfortunately, our ability to control her cancer and give her a long-term good outcome was severely compromised.' Patients making diagnoses with online quizzes Dr. Valerie Primeau, a psychiatrist from North Bay, Ont., said she's seeing more and more people using quick online tools to diagnose themselves with Attention Deficit/ Hyperactivity Disorder (ADHD), bipolar disorder, and other problems. 'The first concern, obviously, is misdiagnosis,' Primeau said. 'And there's certain disorders that are higher risk of misdiagnosis, specifically bipolar disorder.' She noted that if you think you have an illness, that could increase anxiety about having an illness, which could itself have negative health impacts. Best practices around treatment can also change dramatically in just the space of a couple of years, she said, information that medical experts are more likely to be appraised of than online resources. 'So that can be dangerous, as well as being given unfiltered advice about how to manage the illness, which is not likely to be evidence-based,' Primeau said. She estimated around a third of the patients she sees come to her with self-diagnoses and estimates that proportion will increase. 'It's happening more right now, and I foresee it continuing to happen more and more, especially with AI technology getting more and more available and more and more sophisticated,' Primeau said. 'I have patients now that talk to ChatGPT to get advice.' Social media a source of medical misinformation Dr. Alyse Goldberg, a Toronto endocrinologist who focuses on fertility and treating hormonal conditions, said existing technologies, particularly social media, are already driving people to health information that may not be reliable. She showed examples of posts, presented to her by social media accounts she doesn't even follow, which described 'invisible signs of Polycystic Ovary Syndrome (PCOS)' and 'tips' about other disorders she regularly discusses. 'You get targeted in terms of what therapeutic options your physician may be giving you, but then reasons to avoid some evidence-based treatment,' Goldberg said. While some of the solutions presented by the posts might sound amazing, they may not be tested or evidence-based. Nevertheless, seeing the posts could 'fracture the relationship with the physician,' Goldberg said, especially if the patient feels that good options have been 'withheld.' Some of the posts might also push users toward products that aren't effective or appropriate and Goldberg said it's important to think about 'who's trying to make money off of us and use our symptoms of medical experiences in order to self promote.' OMA President Dr. Zainab Abdurrahman said the organization is particularly concerned about the rise in diagnosis and self-treatment among young people, who tend to lean heavily on information from the Internet. 'When you break it down by generations, we're also seeing a higher uptake, especially in some of our very young populations, who are still in their teens and early 20s, who are looking more at social media and in terms of how they quantify how reliable or credible a source is versus other generations,' Abdurrahman said. She also pointed out that combatting misinformation is a wider problem society is grappling with right now. 'We want to come and address and talk about this, and talk about how to get credible information, because we know misinformation and disinformation is something that, as a society we are managing, and health-care is not immune to this.' While there are many pitfalls and problems with self-diagnosis and treatment, doctors point out that it can be beneficial to do some research from legitimate sources if it leads you to consult a physician who can more accurately diagnose a problem. The doctors also stress that it's important for medical professionals to be communicative with their patients rather than judgmental, recognizing that sometimes a prescribed course of treatment can leave patients feeling like they don't have control. 'Rather than coming back with a judgmental tone, I embrace the fact that they are communicating,' D'Souza said. They also acknowledge that access to family doctors, and financial barriers to certain kinds of medical tests and assessments could also be driving people into the arms of Dr. Google, where quick answers are easy to come by. 'Our phones now are intelligent. They listen to us and they look at our trends,' Primeau points out. 'And if we talk about something that we're concerned about, they will show us posts that relate to that. So the answers seem more immediate, and people want that. People are looking for answers, and they get that validation from that access on social media.'
CTV News
09-07-2025
- Health
- CTV News
Risky DIY medicine on the rise as patients turn to Internet for quick answers, Ontario doctors warn
The Ontario Medical Association (OMA) is sounding the alarm on what it says is a concerning increase in the number of patients turning to do-it-yourself medical solutions rather than getting expert advice from doctors. 'We know people are going online,' Dr. David D'Souza said. 'The aspect of looking is not necessarily a problem; it's the interpretation of it.' D'Souza, a radiation oncologist in London, Ont., said patients are often drawn to ideas that seem 'all natural' or that seem to offer 'miraculous' results or options with no unpleasant side effects. He cited a study which found that about a third of the most popular social media posts about cancer from 2018-2019 contained factually incorrect information. 'You might say, well, what's the big deal? What's the problem with it? Well, most of them are potentially harmful,' he said. D'Souza was one of several doctors who took part in a news conference hosted by the OMA Wednesday, calling attention to the rising trend of do-it-yourself medical solutions. Doctors on the panel said they are increasingly encountering self-diagnoses based on internet research or having to answer questions from patients about viral videos suggesting that fast food can cure migraines or that CBD oil can shrink tumours. Some are even trying to treat themselves. 'I had a patient who had a tube going into their kidney because it was blocked – it's called a nephrostomy tube – due to their cancer. And they actually tried to put the twine from a weed whacker in to get out the sludge that was in there,' D'Souza recalled. 'They were asking about actually putting in a little bit of Lysol to clear it out.' While he managed to dissuade them, other patients have chosen to go with alternate treatments based on their own research, sometimes with devastating effects. One young woman, D'Souza recalled, came to him with a diagnosis of cervical cancer. 'She was not ready to accept conventional treatment and decided she was going to pursue other remedies that she had heard about,' D'Souza said. 'She came back two years later, unfortunately, with her disease having progressed and spread, and in a lot of pain, and unfortunately, our ability to control her cancer and give her a long-term good outcome was severely compromised.' Patients making diagnoses with online quizzes Dr. Valerie Primeau, a psychiatrist from North Bay, Ont., said she's seeing more and more people using quick online tools to diagnose themselves with Attention Deficit/ Hyperactivity Disorder (ADHD), bipolar disorder, and other problems. 'The first concern, obviously, is misdiagnosis,' Primeau said. 'And there's certain disorders that are higher risk of misdiagnosis, specifically bipolar disorder.' She noted that if you think you have an illness, that could increase anxiety about having an illness, which could itself have negative health impacts. Best practices around treatment can also change dramatically in just the space of a couple of years, she said, information that medical experts are more likely to be appraised of than online resources. 'So that can be dangerous, as well as being given unfiltered advice about how to manage the illness, which is not likely to be evidence-based,' Primeau said. She estimated around a third of the patients she sees come to her with self-diagnoses and estimates that proportion will increase. 'It's happening more right now, and I foresee it continuing to happen more and more, especially with AI technology getting more and more available and more and more sophisticated,' Primeau said. 'I have patients now that talk to ChatGPT to get advice.' Social media a source of medical misinformation Dr. Alyse Goldberg, a Toronto endocrinologist who focuses on fertility and treating hormonal conditions, said existing technologies, particularly social media, are already driving people to health information that may not be reliable. She showed examples of posts, presented to her by social media accounts she doesn't even follow, which described 'invisible signs of Polycystic Ovary Syndrome (PCOS)' and 'tips' about other disorders she regularly discusses. 'You get targeted in terms of what therapeutic options your physician may be giving you, but then reasons to avoid some evidence-based treatment,' Goldberg said. While some of the solutions presented by the posts might sound amazing, they may not be tested or evidence-based. Nevertheless, seeing the posts could 'fracture the relationship with the physician,' Goldberg said, especially if the patient feels that good options have been 'withheld.' Some of the posts might also push users toward products that aren't effective or appropriate and Goldberg said it's important to think about 'who's trying to make money off of us and use our symptoms of medical experiences in order to self promote.' OMA President Dr. Zainab Abdurrahman said the organization is particularly concerned about the rise in diagnosis and self-treatment among young people, who tend to lean heavily on information from the Internet. 'When you break it down by generations, we're also seeing a higher uptake, especially in some of our very young populations, who are still in their teens and early 20s, who are looking more at social media and in terms of how they quantify how reliable or credible a source is versus other generations,' Abdurrahman said. She also pointed out that combatting misinformation is a wider problem society is grappling with right now. 'We want to come and address and talk about this, and talk about how to get credible information, because we know misinformation and disinformation is something that, as a society we are managing, and health-care is not immune to this.' While there are many pitfalls and problems with self-diagnosis and treatment, doctors point out that it can be beneficial to do some research from legitimate sources if it leads you to consult a physician who can more accurately diagnose a problem. The doctors also stress that it's important for medical professionals to be communicative with their patients rather than judgmental, recognizing that sometimes a prescribed course of treatment can leave patients feeling like they don't have control. 'Rather than coming back with a judgmental tone, I embrace the fact that they are communicating,' D'Souza said. They also acknowledge that access to family doctors, and financial barriers to certain kinds of medical tests and assessments could also be driving people into the arms of Dr. Google, where quick answers are easy to come by. 'Our phones now are intelligent. They listen to us and they look at our trends,' Primeau points out. 'And if we talk about something that we're concerned about, they will show us posts that relate to that. So the answers seem more immediate, and people want that. People are looking for answers, and they get that validation from that access on social media.'
