Blood cancers

5 low value practices to avoid when treating cancer patients


Overuse of chemotherapy in patients with advanced cancer is one of five areas of low value practice highlighted  in a new ‘Choosing Wisely’ list of procedures to avoid.

Developed as part of the RACP’s Evolve series, the Medical Oncology Group of Australia (MOGA) recommends:

  1. Avoid cytotoxic chemotherapy in patients with advanced cancer who are unlikely to benefit from chemotherapy (ECOG performance status 3 or 4) and continue to focus on symptom relief and palliative care.
  2. Do not routinely offer pharmacological venous thromboembolism (VTE) prophylaxis to ambulatory outpatients who are undergoing oncological treatment.
  3. Do not perform routine cancer screening, or surveillance for a new primary cancer, in the majority of patients with metastatic disease.
  4. Avoid tests (biomarkers and imaging) for recurrent cancer in previously treated asymptomatic patients unless there is evidence early detection of recurrence can improve survival or quality of life. This includes avoiding surveillance testing (biomarkers) or imaging (PET, CT and radionuclide bone scans) for asymptomatic individuals who have been treated for breast cancer with curative intent.
  5. Do not perform serum tumour marker tests except to evaluate or monitor a cancer known to produce these markers.

The MOGA Top 5 low-value practices and interventions are also part of the NPS MedicineWise Choosing Wisely Australia initiative.

In a statement released by NPS MedicineWise, Professor Chris Karapetis, Head of Department of Medical Oncology at the Flinders Medical Centre, Adelaide, said the first recommendation should encourage oncologists to distinguish between curative chemotherapy and end-of-life palliative chemotherapy.

“Palliative chemotherapy that does not improve the quality of life of a patient with advanced and incurable cancer should be avoided wherever possible,” he said.

NPS MedicineWise CEO Adjunct Associate Professor Steve Morris said: “The overuse of chemotherapy in patients with advanced cancer can cause a considerable amount of additional distress to patients and their families due to the myriad of severe side effects associated with chemotherapy.”

“These new recommendations provide the latest evidence-based advice on tests and treatments for cancer patients and provide a guide for best practice in palliative care oncology,” he added

The full MOGA Evolve guidelines can be found here.

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