Choosing Wisely Campaign

The American Society of Clinical Oncology (ASCO) is again participating in the American Board of Internal Medicine’s (ABIM) Choosing Wisely campaign designed to streamline healthcare delivery. The announcement stated that ASCO and the ABIM Foundation hope the campaign will encourage proper use of diagnostic and treatment modalities; avoid overuse or misuse of these interventions; improve patient quality of life and outcomes; stimulate discussions about these subjects between physicians and patients; and lead to a culture of routine evaluation of cost, value, and benefit of interventions in a critically burdened healthcare system.

The new recommendations, announced at the Genitourinary Cancers Symposium, are as follows:

• Do not give patients antiemetics when initiating a chemotherapy regimen with low or moderate potential for causing nausea/vomiting. These drugs are designed for chemotherapy regimens with a high risk of causing nausea/vomiting.
• Do not use combination chemotherapy (multiple drugs) for patients with metastatic breast cancer. These patients should receive single-agent therapy, with the exception of those who require a rapid response to relieve tumor-
  related symptoms.
• Avoid use of PET (positron emission tomography) or PET-CT (computed tomography) imaging for routine follow-up care to monitor for recurrence in patients treated with curative intent. PET and PET-CT are used to diagnose, stage, and monitor how well treatment is working. Using these tests to monitor for recurrence does not improve outcomes and therefore is not recommended unless there is high-level evidence that such imaging will change outcome.
• Do not perform PSA (prostate-specific antigen) testing for screening asymptomatic men for prostate cancer if they have
  <10-year life expectancy.
• Do not use a targeted therapy designed for use against a specific genetic abnormality unless a patient’s tumor cells have a specific biomarker that predicts an effective response to the targeted therapy.

Full details of these recommendations and the Choosing Wisely campaign can be accessed at www.asco.org/topfive.