Onc Daily: Oncologists' Income Up, Prostate Cancer on the Rise

Jennifer Smith

May 21, 2020

Here are the most important stories that Medscape Oncology's editors picked for you to read today:

Oncologist Income and Satisfaction is Up

Oncologists' earnings continued to increase from 2018 to 2019, according to the Medscape Oncologist Compensation Report 2020. On average, the oncologists surveyed earned $377,000 in 2019, which was a 5% increase from the $359,000 reported for 2018.

Furthermore, 84% of oncologists surveyed said they would choose to work in medicine again, and 96% said they would choose to work in oncology again.

The report also provides some insight into the impact of COVID-19 on physician compensation. For example, practices have reported a 55% decrease in revenue since the pandemic began, and 43,000 healthcare workers were laid off in March.

Advanced Prostate Cancers Still Rising in US

The incidence of advanced prostate cancers is still on the rise in the United States, according to data published in the Journal of the National Cancer Institute. From 2012 through 2016, the incidence of regional-stage prostate cancer increased by an absolute 11% per year, and the incidence of distant-stage disease increased by an absolute 5% per year.

It's not clear what is causing the increase, but there is speculation that it is associated with the United States Preventive Services Task Force 2012 recommendation against prostate-specific antigen (PSA) screening in men of all ages. Still, a biostatistician not involved in this study said that recommendation is not entirely to blame because "you need 5 to 7 years of lag time, at a minimum, to influence PSA screening."

FDA Approves Olaparib for Certain Metastatic Prostate Cancers

The US Food and Drug Administration has approved olaparib (Lynparza, AstraZeneca) for patients with metastatic castration-resistant prostate cancer who have deleterious or suspected deleterious germline or somatic homologous recombination repair (HRR) mutations and have progressed after receiving enzalutamide or abiraterone.

The FDA also approved two companion diagnostic devices: the FoundationOne CDx test, which can identify patients carrying HRR gene alterations, and the BRACAnalysis CDx test, which can identify patients carrying germline BRCA1/2 alterations.

Has the Pandemic "Infected" Our Approach to Medicine?

In this commentary, Vinay Prasad, MD, MPH, calls the COVID-19 pandemic a "superinfection…spreading in the hearts and minds of physicians and academics." He writes, "The superinfection has led us to forget longstanding principles of evidence-based medicine, abandon logic and clear-headedness, and lower the bar for adopting unproven standards of care."

Prasad notes that physicians are prescribing anticoagulants for COVID-19 patients, even in the absence of thrombotic events. Some doctors are giving patients COVID-19 "treatments," including vitamin C, zinc, hydroxychloroquine, and tocilizumab, all without substantial evidence that these interventions work.

Prasad also notes a lack of evidence that patients with COVID-19–related acute respiratory distress syndrome should be managed differently from patients with "typical" acute respiratory distress syndrome.

Finally, Prasad laments that disagreements about COVID-19 tend to lack civility. He believes the cause of the aforementioned issues is fear, but physicians must "protect ourselves, our principles, and our medical evidence from fear."

For Patients With Cancer, Anguish Grows Over Deferred Surgery as Risk Rises

NPR reports on how the COVID-19 pandemic has affected patients with cancer. In a survey from the American Cancer Society, more than a quarter of patients with cancer reported delays in treatment. Data have also suggested that cancer screenings have decreased during the pandemic.

NPR profiles one patient, Silver, who was diagnosed with metastatic breast cancer. She received chemotherapy prior to a planned mastectomy, but the mastectomy was postponed because the "cosmetic" part of the procedure is considered nonessential during the pandemic.

Silver had to revert to receiving chemotherapy until the surgery can be rescheduled, but she had to undergo another biopsy before receiving more chemotherapy. That requirement, as well as delays with insurance approvals and new restrictions at chemotherapy centers, caused Silver's chemotherapy to be delayed as well.

"In the five-week delay," she said, "I had gone from three small tumors to a massive, 7- by 3-[centimeter] tumor that was pushing against the skin." Still, Silver is hoping the new chemotherapy will shrink her tumors again and allow her to undergo surgery in the fall.

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