primary care, study of the week

Choose, But Choose Wisely, Part 5

Moving on…

The list from the American Society of Clinical Oncology.

1.  Don’t use cancer-directed therapy for solid tumor patients with the following characteristics: low performance status (3 or 4), no benefit from prior evidence-based interventions, not eligible for a clinical trial, and no strong evidence supporting the clinical value of further anti- cancer treatment.
 This one is sure to be controversial.  Basically, it says that chemotherapy should not be used if there is not good evidence that it will work or if a patient has a low performance status.  When someone has cancer, especially if they are relatively young, there is often a push to “try everything.”  This recommendation says not to do that- don’t throw chemotherapy at people just in case it might work.  This will be a tough one for people to buy in to.


2.  Don’t perform PET, CT, and radionuclide bone scans in the staging of early prostate cancer at low risk for metastasis. 
If someone has been diagnosed with an early stage prostate cancer, there is no need for any extensive imaging.  Just treat the cancer.


3.  Don’t perform PET, CT, and radionuclide bone scans in the staging of early breast dance at low risk for metastasis. 
Similar to above.  Please check out this excellent blog post by a cancer surgeon for more information.


4.  Don’t perform surveillance testing (biomarkers) or imaging (PET, CT, and radionuclide bone scans) for asymptomatic individuals who have been treated for breast cancer with curative intent.
 Again, please see this post.


5. Don’t use white cell stimulating factors for primary prevention of febrile neutropenia for patients with less than 20 percent risk for this complication. 
There are certain medications that can be given that stimulate the production of white blood cells.  This can counteract the loss of white blood cells from chemotherapy.  However, these medications themselves carry risks and some very unpleasant side effects.  This recommendation is that these medications not be used unless the patient is at risk of complications from low white blood cells.

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