New Recommendations in Choosing Wisely® Campaign Released

Dec 16, 2013

For the second year, ASCO participated in the American Board of Internal Medicine (ABIM) Foundation’s Choosing Wisely® campaign, an initiative intended to encourage conversations between physicians and patients about medical tests or procedures for which widespread use is not supported by evidence. Professional medical societies were invited to identify commonly used tests, treatments, or other interventions of little or no benefit across their respective fields.

In 2012, the first year of the campaign,ASCO contributed a Top Five list ofsuch interventions in cancer care,developed educational materials forphysicians and patients, and incorporatedthe recommendations into thequality measures of the Quality OncologyPractice Initiative (QOPI®). In October2013, in advance of the QualityCare Symposium, the Society’s second set of Top Five recommendations wasreleased. The effort was led by ASCO’sValue in Cancer Care Task Force and published online ahead of print by theJournal of Clinical Oncology.

“ASCO is very pleased to participate inthe Choosing Wisely campaign and tooffer a new set of recommendationsthis year. The campaign’s goals alignvery well with ASCO’s goals to promoteand support the practice of evidence-basedmedicine, thereby improving theoverall quality of patient care whilehelping to bring down the cost of carethrough avoidance of unnecessarytests, treatments, and procedures,”said ASCO Chief Medical Officer RichardL. Schilsky, MD, FACP, FASCO.

ASCO and the ABIM Foundation hopethat this campaign will encourageproper use of diagnostic and treatmentmodalities; avoid overuse or misuse ofthese interventions; improve patientquality of life and outcomes; stimulatediscussions about these subjectsbetween physicians and patients; andlead to a culture of routine evaluationof cost, value, and benefit of interventionsin a critically burdened healthcare system.

“Our second set of recommendationsfocus on aligning treatment planningwith the overall goals of care, selectingan evidence-based treatmentapproach for each clinical situation,and avoiding unnecessary tests thatdo little to improve patient outcomesin certain clinical situations,” Dr.Schilsky said.

ASCO made the following new recommendationsfor the Choosing Wiselycampaign (see detailed explanations of eachrecommendation):

  1. Do not give patients starting on achemotherapy regimen that has alow or moderate risk of causing nauseaand vomiting anti-emetic drugsintended for use with a regimen thathas a high risk of causing nauseaand vomiting.
  2. Do not use combination chemotherapyinstead of single-agent chemotherapywhen treating an individualfor metastatic breast cancer, unlessthe patient needs a rapid responseto relieve tumor-related symptoms.
  3. Avoid using positron emissiontomography (PET) or PET-computedtomography (PET-CT) scanning aspart of routine follow-up care tomonitor for a cancer recurrence inasymptomatic patients who havefinished initial treatment to eliminatethe cancer unless there is high-levelevidence that such imaging willchange the outcome.
  4. Do not perform prostate-specificantigen (PSA) testing for prostatecancer screening in men with nosymptoms of the disease whenthey are expected to live less than10 years.
  5. Do not use a targeted therapyintended for use against a specificgenetic aberration unless a patient’stumor cells have a specific biomarkerthat predicts an effectiveresponse to the targeted therapy.

These recommendations are meantas evidence-based advisories and arenot intended to replace a medical professional’sindependent judgment oras a substitute for consultation witha medical professional.

Cancer.Net, ASCO’s patientinformation website, providesresources for each recommendation,as well as a podcast with Dr. Schilskyon what this Top Five list means forpatients (

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