The American Society of Clinical Oncology has highlighted five categories of tests, procedures and treatments that are commonly used on terminally ill patients despite their clinical values not currently supported by available medical research. The list is part of the American Board of Internal Medicine’s (ABIM) annual Choosing Wisely Campaign.

“As physicians, we have a fundamental responsibility to provide high-quality, high-value cancer care for all of our patients,” said Dr. Lowell E. Schnipper, lead author of the article and chair of ASCO’s Value of Cancer Care Task Force.

“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. By providing evidence-based care, we not only help our patients live better with cancer, we also assure they are getting high-quality care that will deliver the greatest possible benefit for the cost.” Nearly 140 oncologists voted on the list’s items.

The Top Five List:

• Do not give patients starting on a chemotherapy regimen that has a low or moderate risk of causing nausea and vomiting anti-emetic drugs intended for use with a regimen that has a high risk of causing nausea and vomiting.

• Do not use combination chemotherapy (multiple drugs) instead of chemotherapy with one drug when treating an individual for metastatic breast cancer unless the patient needs a rapid response to relieve tumor-related symptoms.

• Avoid using PET or PET-CT scanning as part of routine follow-up care to monitor for a cancer recurrence in patients who have finished initial treatment to eliminate the cancer unless there is high-level evidence that such imaging will change the outcome.

• 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.

• Do not use a targeted therapy intended for use against a specific genetic aberration unless a patient’s tumor cells have a specific biomarker that predicts an effective response to the targeted therapy.

“The Top Five List is a start,” said LMM Co-Founder Dr. Mary F. Mulcahy, a clinical oncologist with Northwestern Memorial Hospital. “In addition to the rest of the Choosing Wisely campaign, it is bringing attention to some of the excessive expenditures in medical care. It begins to change the conversation around medical care to include the overuse or misuse of medical tests, and the harm/benefit of medical tests. This may very well lead to improved end of life care as patients will be more familiar with the limitations in medical care.”

According to the study researchers, the rising cost of health care continues to threaten the long-term vigor of the U.S. economy, and answers are needed. “Cancer care, although a relatively small fraction of total U.S. health care expenditures, is expected to increase from $125 billion in 2010 to $158 billion in 2020,” the study reads.

“Hopefully evaluations like this will continue and will result in less waste in medical care,” Mulcahy said.