ASCO's Top 5 Don'ts in Oncology Treatment

The American Society of Clinical Oncology's list of the top 5 common oncology treatments or procedures that “lack sufficient evidence for widespread use” should be considered when discussing the rising cost of cancer care.

Last week, in a letter to The New York Times, 2 oncologists from Memorial Sloan-Kettering Cancer Center explained why they would not prescribe or use cancer drugs that had prohibitively high price tags.

They provided Zaltrap (ziv-aflibercept) as an example, saying the drug had no advantage over competitors like Avastin (bevacizumab) for the treatment of metastatic colorectal cancer. “When choosing treatments for a patient, we have to consider the financial strains they may cause alongside the benefits they might deliver,” Drs. Bach and Saltz noted.

In a follow-up letter to the editor, Sandra M. Swain, MD, president of the American Society of Clinical Oncology (ASCO), supported the assertion that cancer care costs have become unsustainable. She stressed that physicians need to offer patients “meaningful benefits,” and part of this journey towards evidence-based cancer care includes highlighting the procedures, tests, and treatments that are not the most beneficial to patients. Dr. Swain and her colleagues from ASCO, along with participants from other medical societies, drafted a “top 5” list of common tests and treatments that are expensive, overused, and not supported by widespread clinical evidence.

The list is part of the Choosing Wisely campaign, an initiative of the ABIM Foundation that seeks to help patients choose care that is 1) supported by evidence, 2) not duplicative of other tests or procedures already received, 3) free from harm, and 4) truly necessary.

Several items in the list refer to the use of certain specialty pharmaceuticals and may be of interest to specialty pharmacists. For example, the use of granulocyte colony-stimulating factors to treat febrile neutropenia is discussed, as well as the use of surveillance testing by way of biomarkers. Some of the procedures on the list may be required as part of a clinical trial protocol, authors of the ASCO document noted, so their use should be carefully and thoughtfully considered.

Below is an abbreviated list of the top 5 oncology treatments or procedures ASCO suggests health care providers and patients should reconsider:

• 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, ineligible for a clinical trial, and no strong evidence supporting the clinical value of further anticancer treatment.
• Don’t perform positron emission tomography (PET), computed tomography (CT), and radionuclide bone scans in the staging of early prostate cancer at low risk for metastasis.
• Don’t perform PET, CT, and radionuclide bone scans in the staging of early breast cancer at low risk for metastasis.
• 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.
• Don’t use white cell stimulating factors for primary prevention of febrile neutropenia for patients with less than 20% risk for this complication.

For an in-depth explanation of the list items, or to learn more about the Choosing Wisely campaign, see the original document from ASCO.