“Stop” Says The American Society of Clinical Oncology – Stop the useless chemo, needless drugs, and unnecessary scans.
By Nurse Mark
The American Society of Clinical Oncology recently released new recommendations to it’s members, advising them to stop the unnecessary use of chemotherapy in patients with advanced cancers who are unlikely to benefit, to limit the use of granulocyte colony-stimulating factor drugs like Neupogen in patients undergoing chemotherapy, and to reduce the use of expensive scans and biomarker testing for the staging of early breast and prostate cancers and for detecting breast cancer recurrences.
While the actual ASCO report and recommendations are full of “weasel-words” and “yes-but’s” that allow doctors to find ways to continue to do all these things if they wish, this is an important step forward in the humane treatment of people with cancers.
In recommending that doctors stop chemotherapy in patients with advanced cancers the ASCO has recognized that, in many cases, when the disease is far advanced the treatment is worse than the disease and that for all the toxic side-effects of treatment, a patients life may only be extended by weeks or at most months – and that the “treatment” is likely to make that added time a miserable experience.
Instead, the ASCO recommends that patients be given “appropriate palliative and supportive care.” In other words, patients should be helped to enable them to enjoy whatever time they may have to live in comfort and dignity.
They also recommend limiting the use of hideously expensive and potentially dangerous drugs like Neupogen or Leukine (the two brand names available in the US) to those patients who are actually at high risk of developing a condition called febrile neutropenia from the use of toxic chemotherapy drugs – and the ASCO report acknowledges that there is a “clear overuse of these agents” and these drugs are often used inappropriately.
Finally, three of the ASCO’s “five recommendations” deal with the use (and over-use) of high-tech imaging, scanning, and diagnostic testing.
For example, they suggest that in patients with early-stage prostate cancer and early-stage breast cancer who have a low risk for metastasis, PET scans, CT scans, and radionuclide bones scans should not be used to determine whether the cancer has spread.
“These tests are often used in staging evaluation of low-risk cancers, despite a lack of evidence suggesting that they detect metastatic disease or survival,” the report says. “Unnecessary imaging can lead to harm through unnecessary invasive procedures, overtreatment, and misdiagnosis.”
Not to mention that they are obscenely expensive, often produce false results and cause unneeded anxiety for patients. Oh, and they expose people to huge doses of damaging ionizing radiation…
Speaking of obscenely expensive, a common theme throughout the ASCO report is an acknowledgement of the need to contain costs. The report goes on to conclude that the five things it discusses: “represents a series of practices in frequent use in common clinical scenarios that are not supported by strong evidence. Reconsidering their use, one patient at a time, is likely to improve the value of care that is provided, which in this case means the desired clinical outcome at the lowest cost to the patient and society.
So, in summary:
- No more “chemo ’til the last, dying breath.” Doctors are encouraged to know when to say “enough is enough” and to then concentrate their efforts toward helping their patients find and enjoy the very best possible quality of life – even though that life might be slightly shorter.
- No more “drug therapy because we can” just on the off-chance that it might prevent a problem. Doctors are being told to assess their patients, and commit drug therapy regimens on those patients actually at risk for the complications that the drugs are intended to treat.
- No more “willy-nilly” ordering of high-tech scans, imaging, tests, and other esoteric diagnostics. They most often don’t provide any significant information of value, the information that they do provide often does not affect the treatment choices anyway, and they frequently give false positives, resulting in patient anxiety and unnecessary treatment.
The ASCO “fact sheet” can be found here:
And the full report can be found here:
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