Commission on Cancer identifed “Top 5” tests, treatments to question

It is with an eye toward improved patient care and better outcomes that various medical specialties have willingly undertaken the self-censure of weeding out the potentially unnecessary tests, treatments and procedures in their fields of medicine.

Through the ABIM foundation’s Choosing Wisely initiative, organizations from several medical specialties have been composing lists of medical tests, procedures and therapies that practitioners and patients may be wise to question.

Because time is of the essence in cancer diagnosis and treatment, it is particularly important to not waste it with testing and/or treatment that may not be necessary or beneficial. To this end, the Commission on Cancer (CoC) lists the following tests/treatments to question.

1. Surgery to remove a suspicious breast lump if needle biopsy is possible.

According to the CoC, verification of a breast cancer diagnosis prior to surgery decreases the number of surgeries needed for treatment, yields better cosmetic results and prevents mastectomy resulting from multiple surgeries. Read more

2. Surveillance testing after cancer treatment without a patient survivorship care plan.

The CoC maintains that testing for patients in remission after cancer treatment does not generally improve surveillance for recurrence and frequently leads to further inappropriate testing, along with patient anxiety, expense, and sometimes morbidity. Instead, the CoC suggests outlining a survivorship care plan with the patient, in order to establish a timeline for any necessary surveillance and support. Read more

3. Surgery as first line therapy without considering neoadjuvant radiation.

In several types of cancer, the CoC reports that presurgical chemotherapy, hormone treatments and/or radiation followed by surgery provides better outcomes than surgery as the initial treatment modality. Currently, there is no data to suggest that delaying surgery in favor of presurgical treatment causes cancer to spread or compromises survival, CoC stated. Read more

4. Major abdominal or thoracic surgery without a plan for postop pain control and pneumonia prophylaxis.

When it is necessary for a patient to undergo major abdominal or thoracic surgery, it is essential to have a plan for pain relief and prevention of pneumonia, CoC advised. Planning for these scenarios preoperatively can reduce complications and length of hospital stay. Read more

5. Starting cancer treatment without understanding the clinical stage or the goals of therapy.

It is incumbent upon the physician to identify and document the extent of the cancer through clinical staging prior to beginning treatment, the CoC noted. Physicians should also have an open discussion with patients about the goal of treatment (curative vs. palliative, or a combination of the two), ensuring that they understand the possible outcomes and side effects of these treatments. Read more