ASCO releases ‘Choosing Wisely’ list of questionable procedures

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The American Society of Clinical Oncology (ASCO) has released its top five list of tests, procedures, and treatments whose common use and clinical value are not supported by available evidence as part of the American Board of Internal Medicine’s Choosing Wisely Campaign.

On the top of the list comes the recommendation that anti-emetic drugs meant for a regimen with a high risk of nausea and vomiting should not be given to patients beginning a chemotherapy regimen with a low to moderate risk of nausea or vomiting. These drugs are designed for those on a chemotherapy program that has a high likelihood because they are expensive and have other side effects.

“When using chemotherapy that is less likely to cause nausea and vomiting, there are other effective drugs available at lower cost,” wrote ASCO.

Secondly, combination chemotherapy should not be used instead of chemo with one drug when treating a patient with metastatic breast cancer unless the individual needs a rapid response to alleviate tumor-related symptoms. While chemotherapy with multiple drugs may impede the tumor growth for a longer time than treatment with a single agent, use of combination chemo hasn’t increased overall survival. More frequent and severe side effects could actually worsen a patient’s quality of life.

PET or PET-CT scanning should not be included in routine follow-up care monitoring for cancer recurrence in patients who have finished initial treatment unless there’s high-level evidence that the imaging will change the outcome. False positive tests can result in unnecessary and invasive procedures, overtreatment, unnecessary radiation exposure, and incorrect diagnoses.

Additionally, PSA testing for prostate cancer screening in men with no symptoms of the disease should not be performed if they are expected to live less than ten years. Men who receive PSA screening have not been shown to live longer than men who do not receive PSA screening.

“Men with medical conditions that limit their life expectancy to less than 10 years are unlikely to benefit from PSA screening as their probability of dying from the underlying medical problem is greater than the chance of dying from asymptomatic prostate cancer,” wrote ASCO.

Number five on the list of oncology guidelines states that targeted therapy intended for use against a genetic aberration should not be used unless a patient’s tumor cells have a specific biomarker that predicts an effective response to the targeted therapy.

“Like all anti-cancer therapies, there are risks to using targeted agents when there is no evidence to support their use because of the potential for serious side effects or reduced efficacy compared with other treatment options,” stated ASCO.

The procedures on ASCO’s list should not be pursued unless the physician and patient have considered if they are appropriate in the particular case, according to the organization.