Manasi Kapoor, Oncology Roundtable
As one of nine specialty societies participating in the American Board of Internal Medicine’s Choosing Wisely campaign, the American Society for Clinical Oncology (ASCO) has submitted a "Top Five" list for ensuring high-quality, low-cost care for cancer patients.
Given the rising cost of health care—especially in cancer care—this campaign is a step in the right direction for delivering greater value. In early April, ASCO published five opportunities to tackle overuse in oncology by reducing the number of tests and treatments that are not based on clinical evidence.
The concept of the “Top Five” list was first put forward by Howard Brody, MD, PhD, director of the Institute for the Medical Humanities and a family medicine professor at the University of Texas. In a 2010 commentary piece in the New England Journal of Medicine, Brody challenged various clinical specialties to look within their respective areas of expertise to identify five procedures or tests that are commonly performed despite the lack of clinical evidence.
ASCO’s “Top Five” recommendations for cancer care
The recommendations are as follows:
1. Avoid unnecessary anticancer therapy, including chemotherapy, in patients with advanced solid-tumor cancers who are unlikely to benefit, and instead focus on symptom relief and palliative care.
2-3. For early-stage breast cancer (2) and prostate cancer (3) that are at low risk of spreading, do not use advanced imaging technologies (positron emission tomography (PET), CT and radionuclide bone scans) for determining the cancer's spread.
4. For individuals who have completed curative treatment for breast cancer, and who have no symptoms of recurrence, advanced imaging tests (PET, CT and radionuclide bone scans) and routine blood tests for certain biomarkers (CEA, CA 15-3, CA 27-29) should not be used to screen for cancer recurrences.
5. Avoid administering white blood cell stimulating factors to patients who have a very low risk for febrile neutropenia (less than 20%).
ASCO plans to provide resources for their members with more information on the “Top Five” opportunities, as well implementation guidance. Look out for these tools and resources on their website in the near future.
Members of the Oncology Roundtable can view Redesigning Cancer Care Delivery for the Era of Accountability for more information on cancer care recommendations.