San Diego, CA—Unnecessary treatment, imaging, and testing all came into focus in the American Society of Clinical Oncology (ASCO)’s 2013 choices for the Choosing Wisely campaign to eliminate the overuse and misuse of medical care resources.
At the 2013 ASCO Quality Care Symposium, Lowell E. Schnipper, MD, Medical Director, Beth Israel Deaconess Medical Center Cancer Center, Boston, Chair of ASCO’s Cost of Cancer Care Task Force, cited inappropriate use of antiemetics, combination chemotherapy for metastatic breast cancer, routine follow-up imaging with positron-emission tomography (PET) or PET–computed tomography (CT), prostate-specific antigen (PSA) testing, and targeted therapies.
2012 Top 5 List ASCO released its first “Top Five” list in 2012 and received considerable positive feedback from the oncology community, said the task force. “The exercise we went through to identify the top five items was viewed by our professional colleagues in ASCO as very, very helpful to them, because [the recommendations] all were quite evidence-based,” said Dr Schnipper. “They provided substantial support in difficult conversations the doctors might have been having with their patients as they were negotiating management plans with them.”
Initiated by the American Board of Internal Medicine Foundation, the Choosing Wisely campaign has provided a vehicle for leading medical organizations to identify and publicize practices that are widely used but have no supporting evidence and likely add nothing to aid clinical care. The 2012 inappropriate practices included:
2013 Top 5 List Dr Schnipper reviewed the 2013 Top Five and discussed the rationale for the choices:
These Top Five are not intended as “legislated dicta. They are evidence-based suggestions that are presented as a foundation for discussion between the doctor and the patient,” Dr Schnipper concluded. “Of course, there will be individual circumstances in which patients and their doctors may decide in ways that would not be consistent with the guidelines….What we are trying to do is make recommendations that adhere to evidence and encourage our colleagues to do so.”
The list was published simultaneously online (Schnipper LE, et al. J Clin Oncol. Epub 2013 October 29).