Curbing Unnecessary Cancer Tests and Treatments

ASCO releases its Top Five list of common cancer procedures not supported by evidence

(RxWiki News) Treating cancer is multi-faceted and sometimes may require difficult decisions by doctors and patients. There are many different treatment options as well, some tried and true, and some new and experimental. However, not all tests and treatments have been clinically proven to be beneficial.

The American Society of Clinical Oncology (ASCO) has released a new list of five cancer tests and procedures that physicians should question using due to lack of clinical evidence regarding their value.

This is part of the organization’s participation in the “Choosing Wisely” program to encourage conversations between physicians and patients about the overuse or misuse of medical procedures and tests that provide little benefit and may even be harmful.

"Talk to your oncologist about the value of tests and procedures."

Lowell E. Schnipper, MD, chair of ASCO’s Value of Cancer Care Task Force, is the lead author of the article that outlines the new recommendations.

“As physicians, we have a fundamental responsibility to provide high‐quality, high‐value cancer care for all of our patients,” Dr. Schnipper said in a statement. “That means eliminating screening and imaging tests where the risk of harm outweighs the benefits, and making sure that every choice of treatment reflects the best available evidence.”

The “Choosing Wisely” campaign is sponsored by the American Board of Internal Medicine Foundation (ABIMF) aimed at helping physicians give the right care at the right time.

The ”Top Five” list was developed by ASCO’s Value of Cancer Care Task Force in consultation with ASCO membership, other regional oncology organizations, patient advocates and a review of the latest clinical research.

The ASCO 2013 Top Five list includes the following recommendations:

1. Do not give anti-nausea medicines to patients receiving chemotherapy that generally doesn’t cause nausea and vomiting.

Not all chemotherapy regimens result in side effects that cause nausea and vomiting. ASCO recommends that anti-nausea medications (called anti‐emetics) be reserved for use only with chemotherapy agents that have high potential of causing severe and persistent nausea and vomiting.

2. Do not use combination therapies for treating metastatic breast cancer unless the patient urgently needs symptom relief.

Using more than one chemotherapy agent to treat breast cancer that has spread to other organs (metastatic) has not been shown to prolong survival compared to single agents. Combination therapy can produce more severe side effects that can impact quality of life. As a result, ASCO recommends using chemotherapy agents one at a time in a sequential manner. However, if the patient is having severe discomfort, or the disease is immediately life-threatening, combination therapy may be worthwhile.

3. Do not use advanced imaging technology — PET (positron emission tomography), CT (computed tomography) or radionuclide bone scans — to monitor for cancer recurrence in patients who have undergone initial treatment and have no signs or symptoms of cancer.

Use of these technologies has not been shown to improve outcomes or survival, and can result in false positives (indication that cancer is present when it is not) that can lead to more invasive testing and treatment or expose the patient to additional radiation.

4. Do not perform PSA (prostate specific antigen) tests for prostate cancer screening in men who have a life expectancy of 10 or fewer years.

PSA tests are unlikely to benefit men with chronic diseases or other medical conditions that may limit their life expectancy. Studies have shown that PSA tests do not reduce risks of dying from prostate cancer or any other cause. And PSA tests can lead to harms from unnecessary testing, including biopsies or treatments for prostate cancers that are not life-threatening.

5. Do not use targeted therapies against a specific genetic defect unless a patient’s tumor cells contain a biomarker that may respond positively to the therapy.

Targeted therapies can have tremendous value, but only when used to treat cancers that have the specific molecular defect that the medication is designed to treat. Using these medications on patients without these biomarkers not only adds to the cost of care, but may cause harmful side effects.

“Our core belief is that physicians and patients, when participating in a system that supports evidence-based decision making and efficiency, will arrive at a course of action that optimizes health outcomes and value,” the researchers wrote.

The list was published October 29 in the Journal of Clinical Oncology.

A number of the authors disclosed financial ties with various organizations an enterprises.

Review Date: 
October 29, 2013