Less chemotherapy for patients with certain advanced cancers, as well as more judicious use of costly imaging techniques, could help patients with cancer receive higher-value care, the American Society of Clinical Oncology (ASCO) announced today.
The announcement is part of the Choosing Wisely campaign (described here in a Viewpoint published in the April 4 issue of JAMA), a collaborative effort between the American Board of Internal Medicine Foundation and 9 specialty medical organizations. The campaign aims to boost the quality of care for patients and cut medical spending by identifying “top 5 lists” of commonly used tests or interventions in each specialty that have not been proven to improve patient outcomes and encouraging clinicians to avoid these practices. Top 5 lists for each of the 9 specialties are available at the Choosing Wisely website.
“As oncologists, we have a responsibility to help ensure that all cancer care is high-value care,” said ASCO president Michael P. Link, MD, in a statement. “That means providing the highest quality of care to our patients, while avoiding treatments that have little or no proven benefit. In the process, we also do our part to address the unsustainable cost increases that threaten our nation’s health care system.”
A multidisciplinary team of oncologists created ASCO’s top 5 list based on a review of the literature and existing guidelines for cancer care. For example, the team found that many cancer patients are subjected to chemotherapy in their final weeks of life—despite little evidence that chemotherapy will yield any benefit to them. So they recommend that oncologists avoid anticancer therapies in patients with advanced solid tumors and focus instead on palliative care, which has been shown to improve patients’ quality of life and to sometimes extend life.
Additionally, ASCO suggests that oncologists avoid the use of advanced imaging technologies to assess early-stage breast or prostate cancers that are unlikely to spread, forgo the use of advanced imaging or blood tests for biomarkers of cancer to monitor for recurrence in patients who have been successfully treated for breast cancer and have no symptoms suggesting a recurrence, and refrain from administering treatments to stimulate the production of white blood cells in patients at low risk of febrile neutropenia.