ASCO Issues ‘Top 5’ List of Overused Cancer Tests and Treatments

The American Society of Clinical Oncology (ASCO) today issued its second “Top 5” list of tests and treatments that are routinely used by oncologists despite a lack of evidence that they are cost effective or beneficial to patients.

The list-part of the “Choosing Wisely” campaign sponsored by the American Board of Internal Medicine-is aimed at encouraging oncologists to consider other options for high-cost or unproven tests and therapies. For example, expensive anti-emetics may be justified for patients taking highly emetogenic chemotherapy, but patients at lower risk for nausea and vomiting typically do just as well with older, less costly drugs, according to the recommendations published in the Journal of Clinical Oncology (JCO).

“As physicians, we have a fundamental responsibility to provide high-quality, high-value cancer care for all of our patients,” said Lowell E. Schnipper, MD, lead author of the JCO article and chair of ASCO’s Value of Cancer Care task force. “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 following “Top 5” recommendations are meant as “evidence-based advisories” for oncologists and patients to consider when creating individualized treatment plans, according to the JCO authors.

1.Do not give anti-nausea drugs (anti-emetics) to patients starting on chemotherapy regimens that have a low or moderate risk of causing nausea and vomiting. Reserve these expensive drugs for patients taking chemotherapy that has a high potential to produce severe and/or persistent nausea and vomiting.

2.Do not use combination chemotherapy instead of single-drug chemotherapy when treating an individual for metastatic breast cancer unless the patient needs urgent symptom relief. Give chemotherapy drugs one at a time in sequence, which may improve a patient’s quality of life without compromising overall survival. Consider combination therapy in situations where the cancer burden must be reduced quickly because it is causing significant symptoms or is immediately life threatening.

3.Avoid using advanced imaging technologies (PET, CT, and radionuclide bone scans) to monitor for a cancer recurrence in patients who have finished initial treatment and have no signs or symptoms of cancer. Using PET or PET-CT to monitor for cancer recurrence in asymptomatic patients who have completed treatment and have no signs of disease has not been shown to improve outcomes or survival and can often lead to false positive results.

4.Do not perform PSA testing for prostate cancer screening in men with no symptoms of the disease when they are expected to live less than 10 years. Studies have shown that PSA screening in this population does not reduce the risk of dying from prostate cancer or from any cause. Such testing could lead to unnecessary harm, including complications from unnecessary biopsy or treatment for cancers that may be slow growing and not ultimately life threatening.

5.Do not use a targeted therapy intended for use against a specific genetic abnormality unless a patient’s tumor cells have a specific biomarker that predicts a favorable response to the targeted therapy. 
 Targeted therapy drugs are far more expensive than other therapeutic options, and many carry the risk of significant adverse effects. The authors note that exceptions may be made in cases where high-level evidence supports use of the targeted therapy despite absence of a predictive biomarker.