More tests, not always best

Aracelli and Miguel Martinez
Alexis Nees, M.D. (foreground), and Lisa Newman, M.D., read the results of breast imaging, a procedure recommended by ASCO to be discussed by patient and provider in some instances.

Association of cancer physicians provides top five tests and treatments to reconsider

Patients facing a cancer diagnosis deal with anxiety about the future, not feeling well and the high cost of care. That's why the American Society of Clinical Oncology (ASCO) took a careful look at which tests and treatments that oncologists order aren't supported by evidence showing they help patients live longer and which, in fact, could be harmful.

"The issue is that many of the things we do are based on things somebody thinks are best practice and, often, there are not data to support their use," says Kathleen A. Cooney, M.D., medical director at the U-M Comprehensive Cancer Center. "For example, excessive use of testing without adequate data can sometimes be dangerous to patients."

Cooney says patients often go through unnecessary tests and procedures that are invasive, stressful and otherwise negatively affect a person's quality of life (such as missing work). In some cases, patients receive false positive results that lead to further anxiety and over-treatment. ASCO's recommendation is not intended to deny any patient care or treatment, but to protect patients by only providing care proven to help.

The ASCO study was conducted as part of a national effort called Choosing Wisely® that challenged the medical community at large to identify five practices that are expensive, are routinely used and for which there is insufficient proof that the practice helps patients.

Unnecessary and excessive spending in any area also drives up medical costs to patients. As cited in the ASCO study, the Congressional Budget Office estimates 30% of care delivered in the United States goes toward treatment that doesn't help patients' health. Cancer costs alone are increasing approximately 15% a year.

"These tests and treatment options should not be considered unless a patient and provider have worked together to discuss options," Cooney says. "The Top Five List doesn't trump a clinical assessment.

Hopefully this list will help stimulate dialogues about individual goals of cancer treatment and appropriate diagnostic testing and follow-up."

ASCO's Top Five list for oncology

  • Chemotherapy for patients with advanced cancers who have seen little or no benefit from prior treatment.
     
  • PET, CT and radionuclide bone scans in low-risk prostate cancer patients.
     
  • PET, CT and radionuclide bone scans in low-risk breast cancer patients
     
  • Surveillance testing and imaging for breast cancer survivors with no symptoms
     
  • White cell-stimulating factors for primary prevention of fever/infection associated with neutropenia (a low number of a type of white blood cells) in low-risk patients

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Thrive Issue: 
Summer, 2012