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ASCO Digs Deeper into Low-Value Practices with a Second ‘Choosing Wisely’ List

Butcher, Lola

doi: 10.1097/01.COT.0000438507.81242.05

The American Society of Clinical Oncology released its second “Top Five” list of common tests and treatments that are not supported by clinical research. The list ( and published in the Journal of Clinical Oncology (, is part of the ABIM Foundation's “Choosing Wisely” campaign ( that encourages physicians and patients to think carefully before proceeding with certain tests and procedures that should not be routine.



ASCO's new list:

1. Do not give anti-nausea drugs to patients starting on chemotherapy regiments that have low or moderate risk of causing 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.

3. Avoid using positron emission tomography (PET), 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.

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.

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.

The list was developed by ASCO's Value of Cancer Care Task Force, chaired by Lowell E. Schnipper, MD, which solicited ideas from ASCO members, regional oncology societies, and patient advocates. The task force conducted a comprehensive review of clinical evidence for each of the tests and treatments before making its recommendations.

In a news release announcing the new list, Schnipper said physicians have a fundamental responsibility to provide high-value care for all patients: “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,” he said.

“By providing evidence-based care, we not only help our patients live better with cancer, but also ensure they are getting high-quality care that will deliver the greatest possible benefit for the cost.”

© 2013 by Lippincott Williams & Wilkins, Inc.
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