FYI- Excessive tests? ASCO's 5 top don'ts

[Guest guest]

Another prominent medical group speaking out on common tests/procedues not

supported by available evidence. From Number 2 below, it appears that the

expensive array of tests reported to have been give to Warren Buffet (MRI,

CT, bone scan) would not have been deemed necessary IF his " Stage 1 " biopsy

results were T1c-T2a, Gleason sum 6 or less, PSA 10 or less (have yet to see

what the biopsy results actually were).

Nothing wrong with going the 'extra mile' to define his condition if those

tests were affordable, but, there is no scientific basis to expect those

tests to be positive for the low-risk biopy results defined above. So,

nobody should have the expectation that this array of expensive tests should

be the 'gold standard' following a biopsy diagnosed as low-risk prostate

cancer.

The Best to You and Yours!

Jon in Nevada

American Society of Clinical Oncology Choosing Wisely: Five Things

Physicians and Patients Should Question

The American Society of Clinical Oncology (ASCO) is a medical professional

oncology society committed to conquering cancer through research, education,

prevention, and delivery of high-quality patient care. ASCO recognizes the

importance of evidence-based cancer care and making wise choices in the

diagnosis and management of patients with cancer. After careful

consideration by experienced oncologists, ASCO highlights five categories of

tests, procedures and/or treatments whose common use and clinical value are

not supported by available evidence. These test and treatment options should

not be administered unless the physician and patient have carefully

considered if their use is appropriate in the individual case. As an

example, when a patient is enrolled in a clinical trial, these tests,

treatments, and procedures may be part of the trial protocol and therefore

deemed necessary for the patient's participation in the trial.

[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.

Studies show that cancer directed treatments are likely to be

ineffective for solid tumor patients who meet the above stated criteria.

Exceptions include patients with functional limitations due to other

conditions resulting in a low performance status or those with disease

characteristics (e.g., mutations) that suggest a high likelihood of response

to therapy.

Implementation of this approach should be accompanied with appropriate

palliative and supportive care.

[2] Don't perform PET, CT, and radionuclide bone scans in the staging of

early prostate cancer at low risk for metastasis.

Imaging with PET, CT, or radionuclide bone scans can be useful in the

staging of specific cancer types. However, these tests are often used in the

staging evaluation of low-risk cancers, despite a lack of evidence

suggesting they improve detection of metastatic disease or survival.

Evidence does not support the use of these scans for staging of newly

diagnosed low grade carcinoma of the prostate (Stage T1c/T2a,

prostate-specific antigen (PSA) <10 ng/ml, Gleason score less than or equal

to 6) with low risk of distant metastasis.

Unnecessary imaging can lead to harm through unnecessary invasive

procedures, over-treatment, unnecessary radiation exposure, and

misdiagnosis.

[3] Don't perform PET, CT, and radionuclide bone scans in the staging of

early breast cancer at low risk for metastasis.

Imaging with PET, CT, or radionuclide bone scans can be useful in the

staging of specific cancer types. However, these tests are often used in the

staging evaluation of low-risk cancers, despite a lack of evidence

suggesting they improve detection of metastatic disease or survival.

In breast cancer, for example, there is a lack of evidence demonstrating

a benefit for the use of PET, CT, or radionuclide bone scans in asymptomatic

individuals with newly identified ductal carcinoma in situ (DCIS), or

clinical stage I or II disease.

Unnecessary imaging can lead to harm through unnecessary invasive

procedures, over-treatment, unnecessary radiation exposure, and

misdiagnosis.

[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.

Surveillance testing with serum tumor markers or imaging has been shown

to have clinical value for certain cancers (e.g., colorectal). However for

breast cancer that has been treated with curative intent, several studies

have shown there is no benefit from routine imaging or serial measurement of

serum tumor markers in asymptomatic patients.

False-positive tests can lead to harm through unnecessary invasive

procedures, over-treatment, unnecessary radiation exposure, and

misdiagnosis.

[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.

ASCO guidelines recommend using white cell stimulating factors when the

risk of febrile neutropenia, secondary to a recommended chemotherapy

regimen, is approximately 20 percent and equally effective treatment

programs that do not require white cell stimulating factors are unavailable.

Exceptions should be made when using regimens that have a lower chance

of causing febrile neutropenia if it is determined that the patient is at

high risk for this complication (due to age, medical history, or disease

characteristics).

Source:

http://chicago2012.asco.org/MeetingProgram/TopFive.aspx?cmpid=rs_am_rh_em_t_all_\

04-25-12_amhtml & et_cid=29182741 & et_rid=463659544 & linkid=Educational+sessions

[Guest guest]

Nice to know that the American Society of Clinical Oncology has come out on record to say what Medical Oncologist Strum has been saying over and over for years. Now, let’s hope the AUA does the same. Chuck Always as close as the other end of your computer to help address any prostate cancer concerns. " What you leave behind is not what is engraved in stone monuments, but what is woven into the lives of others. " (Chuck) Maack - Prostate Cancer Advocate/Activist Email: maack1@... PCa Help: " Observations " http://www.theprostateadvocate.com From: ProstateCancerSupport [mailto:ProstateCancerSupport ] On Behalf Of ccnvw@...Sent: Tuesday, April 24, 2012 11:51 PMTo: ProstateCancerSupport; ww; newdx; PROSTATESubject: FYI- Excessive tests? ASCO's 5 top don'ts Another prominent medical group speaking out on common tests/procedues not supported by available evidence. From Number 2 below, it appears that the expensive array of tests reported to have been give to Warren Buffet (MRI, CT, bone scan) would not have been deemed necessary IF his " Stage 1 " biopsy results were T1c-T2a, Gleason sum 6 or less, PSA 10 or less (have yet to see what the biopsy results actually were).Nothing wrong with going the 'extra mile' to define his condition if those tests were affordable, but, there is no scientific basis to expect those tests to be positive for the low-risk biopy results defined above. So, nobody should have the expectation that this array of expensive tests should be the 'gold standard' following a biopsy diagnosed as low-risk prostate cancer.The Best to You and Yours!Jon in NevadaAmerican Society of Clinical Oncology Choosing Wisely: Five Things Physicians and Patients Should QuestionThe American Society of Clinical Oncology (ASCO) is a medical professional oncology society committed to conquering cancer through research, education, prevention, and delivery of high-quality patient care. ASCO recognizes the importance of evidence-based cancer care and making wise choices in the diagnosis and management of patients with cancer. After careful consideration by experienced oncologists, ASCO highlights five categories of tests, procedures and/or treatments whose common use and clinical value are not supported by available evidence. These test and treatment options should not be administered unless the physician and patient have carefully considered if their use is appropriate in the individual case. As an example, when a patient is enrolled in a clinical trial, these tests, treatments, and procedures may be part of the trial protocol and therefore deemed necessary for the patient's participation in the trial.[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.Studies show that cancer directed treatments are likely to be ineffective for solid tumor patients who meet the above stated criteria.Exceptions include patients with functional limitations due to other conditions resulting in a low performance status or those with disease characteristics (e.g., mutations) that suggest a high likelihood of response to therapy.Implementation of this approach should be accompanied with appropriate palliative and supportive care.[2] Don't perform PET, CT, and radionuclide bone scans in the staging of early prostate cancer at low risk for metastasis.Imaging with PET, CT, or radionuclide bone scans can be useful in the staging of specific cancer types. However, these tests are often used in the staging evaluation of low-risk cancers, despite a lack of evidence suggesting they improve detection of metastatic disease or survival.Evidence does not support the use of these scans for staging of newly diagnosed low grade carcinoma of the prostate (Stage T1c/T2a, prostate-specific antigen (PSA) <10 ng/ml, Gleason score less than or equal to 6) with low risk of distant metastasis.Unnecessary imaging can lead to harm through unnecessary invasive procedures, over-treatment, unnecessary radiation exposure, and misdiagnosis.[3] Don't perform PET, CT, and radionuclide bone scans in the staging of early breast cancer at low risk for metastasis.Imaging with PET, CT, or radionuclide bone scans can be useful in the staging of specific cancer types. However, these tests are often used in the staging evaluation of low-risk cancers, despite a lack of evidence suggesting they improve detection of metastatic disease or survival.In breast cancer, for example, there is a lack of evidence demonstrating a benefit for the use of PET, CT, or radionuclide bone scans in asymptomatic individuals with newly identified ductal carcinoma in situ (DCIS), or clinical stage I or II disease.Unnecessary imaging can lead to harm through unnecessary invasive procedures, over-treatment, unnecessary radiation exposure, and misdiagnosis.[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.Surveillance testing with serum tumor markers or imaging has been shown to have clinical value for certain cancers (e.g., colorectal). However for breast cancer that has been treated with curative intent, several studies have shown there is no benefit from routine imaging or serial measurement of serum tumor markers in asymptomatic patients.False-positive tests can lead to harm through unnecessary invasive procedures, over-treatment, unnecessary radiation exposure, and misdiagnosis.[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.ASCO guidelines recommend using white cell stimulating factors when the risk of febrile neutropenia, secondary to a recommended chemotherapy regimen, is approximately 20 percent and equally effective treatment programs that do not require white cell stimulating factors are unavailable.Exceptions should be made when using regimens that have a lower chance of causing febrile neutropenia if it is determined that the patient is at high risk for this complication (due to age, medical history, or disease characteristics).Source: http://chicago2012.asco.org/MeetingProgram/TopFive.aspx?cmpid=rs_am_rh_em_t_all_04-25-12_amhtml & et_cid=29182741 & et_rid=463659544 & linkid=Educational+sessions