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Our Hope for the "Top Five" List in Oncology

Michael Paul Link, MD

05 Apr 2012 3:13 PM

As oncologists, we are often expected to “do everything possible” to prolong our patients’ lives and ensure their peace of mind. This expectation arises from within ourselves, as committed caregivers, and from our patients and their families.

Much of the time, this expectation is right and necessary.  But in some cases, the evidence runs the other way, telling us that a “less is more” approach may be the best way to ensure our patients’ quality of life, or even their survival. While a given intervention may offer the theoretical possibility of patient benefit, the evidence may not be enough to outweigh the potential for harm.

Matching the needs of our patients to the best available science is at the core of the oncology profession. That’s why ASCO is proud to be part of the American Board of Internal Medicine Foundation’s Choosing Wisely® campaign.  As one of nine specialty societies participating in the campaign, ASCO has developed a “Top Five” list of tests and treatments that are commonly used in oncology, despite a lack of supporting evidence and the potential to cause unnecessary harm to patients.  It is our hope that the Top Five list for oncology will help spark new conversations about the benefits and potential harms of these interventions, so together, physicians and patients arrive at decisions that consistently yield high-quality—and high-value—care.

What is meant by the term “high-value” care?  In short, it is about maximizing the patient benefits that are achieved for every dollar spent.  It is a concept that encompasses the quality, effectiveness, and safety of the care we provide, and is sensitive to each patient’s individual needs.

The Top Five list for oncology underscores that evidence-based medicine is at the heart of high-value cancer care that serves patients’ needs.  Over the coming months, ASCO will be holding webcasts and providing additional resources to help our members implement these recommendations. Working together, we can ensure that every person with cancer receives the best possible care.

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Michael Paul Link, MD