ASCO: Cases for withholding chemo or unnecessary imaging

[Gfunk6]

Interesting news reports out today regarding new recommendations from a consensus panel of medical oncologists on behalf of ASCO.

patients who have been successfully treated for breast cancer and have no symptoms of cancer not undergo CT, PET, other imaging, or bone scans to check for a recurrence or spread of the disease, known as metastasis.

ASCO recommends against routine use of four other procedures: chemotherapy for patients with advanced cancers who are unlikely to benefit; advanced imaging technologies such as CT and PET or bone scans to determine the precise stage of both early breast and prostate cancers at low risk for metastasis; and drugs to stimulate white blood cell production in patients receiving chemotherapy if they have a risk of febrile neutropenia, an often-fatal condition marked by fever and abnormally low numbers of certain white blood cells.

I really have to give ASCO credit for these bold and far-seeing recommendations. These tests/interventions have not proven to be beneficial through any good evidence-based approach.

For every patient story we hear about, "I had Stage I breast cancer and a PET/CT showed bone mets!," there are dozens of stories of patients being harmed by biopsying benign lesions which we don't hear about in the media.

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[medgator]

Definitely glad to hear about the recs for use of PET/CT in upfront low-risk prostate and early Breast CA. PET/CT has definitely been abused in the community for those indications (although medicare is pretty strict about PET/CT for upfront prostate CA staging).

 

[Gfunk6]

When people see news like this, they like to spin it to suit their own political agenda. In that vein, I found this comment from a reader to be particularly relevant:

We all decry the ever-increasing cost of healthcare – and everyone has their bogeyman (just read through thee posts). Obamacare, greedy insurance companies, greedy drug companies, greedy doctors, etc. But the fact is that we spend nearly a quarter of our increasingly scarce healthcare dollars on people in their last year of life. Nobody wants "rationing" (Death Panels!) – we all want the best medical care that (somebody else's) money can provide. But therein lies the REAL problem: As long as YOU are willing to spend someone else's money differently from how you'd spend your own, we will never control healthcare costs.

Would YOU opt for that expensive MRI scan to rule out a break, when your doc says it is most probably just a sprain – if it cost YOU $2000? Would you opt for the $100,000 cancer treatment that has a 5% chance of extending your life for another six months – if YOU (or your surviving heirs) had to pay the tab? Answer "no" to these kinds of questions and you too are surely part of the problem. And part of the ultimate problem in American (indeed, world) societies: Everybody wants more goods and services than they are willing to pay for.

 

[medgator]

When people see news like this, they like to spin it to suit their own political agenda. In that vein, I found this comment from a reader to be particularly relevant:

Which reminds me of a relevant piece written from a physician's perspective

How Doctors Die
It’s Not Like the Rest of Us, But It Should Be