Treatment Course Interruption/Delay Due to Weekend Breaks: Acknowledging and Confronting Personal and Professional Biases.

Rades et al (1), in the American Society for Radiation Oncologyesponsored journal Practical Radiation Oncology, describe a retrospective European multicenter study examining palliative radiation therapy for metastatic epidural spinal cord compression of 4 Gy in 5 fractions and whether an overall treatment time of 5 days was superior to that of 7 days; no outcome improvement was seen for treatment administered without hiatus. Given the recent emphasis in the International Journal of Radiation Oncology, Biology, Physics on ethics in radiation oncology, this article provides a prime opportunity to examine a well-designed study from an ethical viewpoint (1, 2). For practical purposes, the question of whether a 5 4 Gy regimen for treating metastatic epidural spinal cord compression provides any difference in clinical outcome when administered over 5 consecutive days versus over a 7-day period is frankly asking whether the 2-day hiatus associated with a weekend break during treatment adversely impacts patient outcomes. With the lifestyle considerations accompanying radiation oncology as a careerdparticularly as the competitiveness of the specialty in the United States has increased from filling all of its National Residency Matching Programeoffered positions for the first time in 2003 to the present-day environment in which it rivals more traditionally competitive subspecialties, such as neurosurgerydthe inherent bias of desiring an internationally respected platform to affirm that