Michael Shusterman, MD
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mshusterman.bsky.social
Michael Shusterman, MD
@mshusterman.bsky.social
270 followers 34 following 20 posts
GI Medical Oncologist @ NYU Perlmutter Cancer Center, Associate Fellowship Program Director @ NYU Grossman Long Island School of Medicine #meded
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Michael Shusterman, MD @mshusterman.bsky.social · Nov 23
Bolus 5-FU should not be used in the metastatic setting with FOLFOX, FOLFIRI, FOLFIRINOX. There will never be a prospective trial studying this, so try to eliminate bolus 5-FU whenever possible. jnccn.org/view/journal...
jnccn.org
Reposted by Michael Shusterman, MD
sarialtschuler.bsky.social
So excited to see this collaboration with brilliant colleagues published in the Lancet today!

Here's our discussion of the humanities skills (esp. narrative + editing) healthcare practitioners will need in the age of AI scribes. @iandarin.bsky.social @mariaa.bsky.social @laurenfklein.bsky.social
Clinician as editor: notes in the era of AI scribes Every clinician has a strategy. Between patients, before going home, late at night—clinical notes must be written. They are essential for recording patient visits, ensuring continuity of care, arriving at accurate diagnoses, and facilitating communication between doctors, as well as providing medico-legal protection and enabling reimbursement. But these notes are increasingly burdensome to write, thanks in part to the electronic health record (EHR). Artificial intelligence (AI) scribes—computational systems that record clinical encounters and produce narrative summaries—promise much-needed help. Indeed, in many settings, health-care organisations are already adopting this technology. Nevertheless, AI scribes arrive at a moment when the note has already been changing, with legislation increasingly granting patients access to their medical records. Given AI scribes’ promised disruption, it is crucial to consider what clinical notes are and what we want them to be. Both the clinical encounter and the record of it are fundamentally narrative affairs: the clinical encounter unfolds as a story and the note documents that story. Early 19th-century patient records were long, detailed narratives about particular patients and their histories. But these records promise and limitations. became increasingly succinct. Forms replaced paragraphs, and shared terminology replaced personal anecdotes; as historian practice of narrative medicine. John Harley Warner explains, there was a shifting “narrative preference for what was universal and precise over what was This trend continues in notes today with their dispassionate style and specialised terminology, ready to be packaged for health-care coders and billers. A few decades ago, efforts to recentre narrative, especially narrative medicine and narrative-based medicine, emerged to address the depersonalised style of modern medicine exemplified by such notes. So much of medicine i… biases—particularly troubling given medicine’s ongoing research and care disparities. AI-generated summaries can also hallucinate details, making up disturbing interactions if words or phrases resemble training data patterns and inserting inaccuracies. AI can introduce insensitive, incorrect, offensive, or stereotype-based language, gender misattribu- tion, and even diagnostic errors, a set of problems that will be magnified by automation bias—the bias to accept AI decisions and text as more authoritative than human ones. There are also unique challenges posed by the clinical encounter for AI because of, as machine learning researcher Juan Quiroz and his team put it, the “complex nature of the clinical environment and clinical conversation”. In his experience as a practising clinician who is piloting an AI scribe, one of us (IH) has noticed that AI scribes can miss information from longitudinal clinician–patient relationships and non-verbal communication. They sometimes make speech-to-text transcription errors, confuse the clinician’s story with the patient’s, include details not appropriate to the EHR, use potentially judgemental language, omit important details, add plausible but incorrect information, and overstep their purview, making diagnostic suggestions rather than generating summary. Accents make the speech- to-text transcription less accurate. Most AI scribes today work in limited languages. Some of these issues may improve, but the fundamental problem remains: open notes emphasise notes as interpersonal narrative just as AI scribes seek to automate the task. To counter these risks of automation, clinicians using AI scribes should view their new role as note editor—a transition best supported by training in editorial and narrative skills. Most immediately, seasoned clinicians will need to reduce transcription errors, odd word choices, extraneous details, and disclosures inappropriate for the record as well as adding missed details and often rewriting AI-ge…
December 2, 2024 at 6:16 PM
Reposted by Michael Shusterman, MD
opennotes.org
Health anxiety can be terrifying. 🫠😵‍💫

That’s why #OpenNotes launched a new study to help cancer patients manage "scanxiety"—the stress of awaiting test results.

“We are working towards a future where patients feel more supported.” @cait-desroches.bsky.social

bit.ly/3DjlxQN

#btsm #cancer #medsky
OpenNotes Study Aims to Mitigate Scanxiety & Misinformation in Cancer Care - Open Notes
Led by OpenNotes, the study, "Mitigating Misinformation & Scanxiety for Cancer Patients," focuses on reducing the stress and confusion patients may face when receiving medical test results electronica...
bit.ly
December 17, 2024 at 9:06 PM
Reposted by Michael Shusterman, MD
halletjulie.bsky.social
🦓 Appendiceal NETs - exceedingly rare stage IV

From single-centre at Moffitt
👥124 over 15 years
‼️10 stage IV👉🏻 8 synchronous

Spread is rare - worth putting patients through right hemicolectomy ?

Just in time for @nanets.bsky.social experts statement

pubmed.ncbi.nlm.nih.gov/39705801/ 😃
Do Appendiceal Neuroendocrine Tumors Metastasize Post Appendectomy or Right Hemicolectomy? - PubMed
Stage IV appendiceal NETs are exceptionally rare, and distant metastases are synchronous in nearly all cases. The risk of metastatic spread after resection of local appendiceal NETs is negligible. Pat...
https://pubmed.ncbi.nlm.nih.gov/39705801/😃
December 23, 2024 at 10:23 PM
Reposted by Michael Shusterman, MD
drr-dunne.bsky.social
@nejm.org top 14 most influential articles for 2024

Ponsegromab for cancer #cachexia

Will targeting GDF-15 be a winning strategy in cancer? Sure we will learn more in 2025
December 18, 2024 at 1:54 AM
Reposted by Michael Shusterman, MD
oncbrothers.bsky.social
#Encorafenib + #Ceruximab + mFOLFOX is approved in 1L for BRAFV600e based off #BREAKWATER

- ORR 61% vs 40%
- mDoR: 13.9mos vs 11.1mos
- AEs:GI tox, rash

#cansky #oncsky #gism
December 21, 2024 at 12:36 PM
Reposted by Michael Shusterman, MD
lizzysmyth.bsky.social
Good to see our protocol paper for DECIPHER in press at ESMO GO!

ctDNA 🧬 after surgery will detect pts with HER2➕ gastroesophageal #cancer at high risk of recurring

🧬➕ receive TDxD instead of usual post-op chemo

Hope to #cure some micrometastatic cancers 🙏

www.sciencedirect.com/science/arti...
Evaluating trastuzumab deruxtecan in patients with gastrooesophageal adenocarcinoma who are ctDNA and HER2 positive: DECIPHER
Operable gastrooesophageal adenocarcinoma (GOA) is treated with multimodality therapy which is curative in <50% of patients. Patients in the UK with o…
www.sciencedirect.com
December 1, 2024 at 11:18 AM
mshusterman.bsky.social
Eagerly await the overall survival data, but we also need to see the single arm Nivolumab arm that seems to have disappeared.
November 28, 2024 at 1:05 PM
mshusterman.bsky.social
GI Oncology standard regimen doses are too high for most patients. Retrospective and prospective trials demonstrating benefit of reduced doses or dose escalation. #meded #gionc
November 25, 2024 at 2:23 AM
Reposted by Michael Shusterman, MD
oncbrothers.bsky.social
#Zanidatamab (bispecific antibody against Her2) now FDa approved for unresectable/metastatic HER2+ biliary tract cancer based #HerizonBTC01:

- Single arm Ph2B study, 20 mg/kg IV Q2W
- mDoR 14.9mos
- mOS 15.5mos
- AEs: Diarrhea, ⬇️EF
- Do you get Her2 IHC on all Bx?

#gism #OncSky #MedSky
November 23, 2024 at 7:29 PM
mshusterman.bsky.social
10 year follow-up data from COLOFOL trial demonstrates no benefit to more intensive surveillance in Stage II or III colorectal cancer. How will this change with CTDNA? jamanetwork.com/journals/jam...
Follow-Up Testing and 10-Year Mortality in Patients With Stage II or III Colorectal Cancer
This prespecified secondary analysis of the COLOFOL randomized clinical trial examines overall and colorectal cancer–specific mortality rates in patients with stage II or III colorectal cancer who und...
jamanetwork.com
November 23, 2024 at 3:45 AM
mshusterman.bsky.social
Bolus 5-FU should not be used in the metastatic setting with FOLFOX, FOLFIRI, FOLFIRINOX. There will never be a prospective trial studying this, so try to eliminate bolus 5-FU whenever possible. jnccn.org/view/journal...
jnccn.org
November 23, 2024 at 1:14 AM
Reposted by Michael Shusterman, MD
jama.com
Polycythemia vera is a clonal myeloproliferative neoplasm that causes erythrocytosis and is typically associated with a JAK2 gene variant. This narrative review investigates the diagnosis, symptoms, and management of polycythemia vera.

https://ja.ma/3UUmfcY
Figure showing treatment of polycythemnia vera.
November 18, 2024 at 9:07 PM
Reposted by Michael Shusterman, MD
oncothor.bsky.social
You unsure of how to monitor responses in NET patients after PRRT? All these different scans and blood tests confusing? Worry not, this team has you covered...
A must read for all involved in radioligand therapy.
#NETsSky #OncSky
onlinelibrary.wiley.com/doi/10.1111/...
<em>Journal of Neuroendocrinology</em> | BSN Journal | Wiley Online Library
Peptide receptor radionuclide therapy (PRRT) is an effective treatment for both oncological and hormone control and is a widely accepted standard of care treatment for patients with neuroendocrine ne...
onlinelibrary.wiley.com
November 17, 2024 at 4:08 PM
Reposted by Michael Shusterman, MD
oncothor.bsky.social
Must read for NET providers - the CommNETs/NANETS statement on NET biomarkers. An extremely useful document, detailing the clinical utility of NET biomarkers after thorough review of the evidence. The short of it is that most are not recommended for routine use.

jamanetwork.com/journals/jam...
Biomarkers to Inform Prognosis and Treatment for Unresectable or Metastatic GEP-NENs
This study provides a guidance document to educate clinicians and patients on biomarkers informing prognosis and treatment in unresectable or metastatic gastroenteropancreatic neuroendocrine neoplasms...
jamanetwork.com
November 17, 2024 at 5:41 PM