ASCO's "top 5"

KittyKitty

http://newsatjama.jama.com/2012/04/04/top-5-list-aims-to-reduce-unnecessary-cancer-care-and-cut-costs/

CuttIng "unnecessary" cancer costs.

leggo

Removed my post. Decided it didn't really apply to me.

Wabbit

I recently saw a similar article about heart disease ... the same Top 5 thing.

After reading both I'm not sure there is anything much here that is totally new.  Most oncologists already do not do any routine scans looking for mets in the absence of symptoms for example.

I did note the last sentence about the white blood counts which I've taken to mean the Neulasta shots.  Those shots have been very heavily marketed and it is entirely possible that a lot of people really don't need them.   I do know that when I was treated 6 years ago with AC I did not have them and my blood counts recovered very nicely on their own and I never got any kind of infection.  Actually I was on a 10 day course of antibiotics each cycle.  I assume that was the 'old way' of doing things but if it works just as well it is defintely cheaper for everybody.  I did have 3 weeks between treatments though.  It does seem to me reading the board now that they have become routine.  They are extremely expensive.  and have painful and unpleasant side effects so it might be a very good idea to wait and see if they are needed?

I had a PET scan and in hindsight I do think that was an unnecessary expense for someone like me with no node or vascular involvement.  At the time I was just doing what I was told but honestly it scared the crap out of me and cost me a significant co-pay also. 

The reason that so many of us feel it is vital to have Living Wills and such is because of the fact that medical science has developed the ability to keep people technically alive for much longer than there is any real 'life'.  Death can be delayed by being hooked up to machines that take over our physical functions but just because we 'can' it does not always mean we 'should' or that it is being done in the patient's best interest. 

We can argue about 'what' should be in new guidelines but I do think it is long past time that some of these issues are confronted and addressed.   

Wabbit

The other factor to keep in mind when reading the guidelines is that they are not talking about just breast cancer.  Breast cancer is a very 'treatable' cancer and there are many treatments that can put it in remission or keep it stable.  Many other cancers are not very treatable at this point in time.  So when they talk about not offering chemo that has no possibility of working they are not necessarily talking about breast cancer.

My friend with cancer so widespread that they could not even determine what was primary had several different chemo treatments.  They knew it was futile and had no chance of stopping his cancer.  Once he figured that out he stopped it.   I think that is more the type of situation they are talking about.  Doctors now seem to feel obligated to throw everything at you even if they know if won't work.   

otter

The article at the link just discusses the recommendations pertaining to cancer care (diagnostic procedures and treatments).  Eventually, most, if not all, of the physicians' specialty organizations will be developing similar guidelines for their areas of practice.

This is all a part of a movement by the ABIM Foundation (ABIM = American Board of Internal Medicine:  http://www.abim.org/) to improve medical care in the U.S.  The campaign is called "Choosing Wisely" (http://choosingwisely.org/). 

Here's a brief explanation of what the "Choosing Wisely" campaign involves (taken from http://choosingwisely.org/?page_id=8 ):

++++++++quote begins+++++++++++

"Choosing Wisely® aims to promote conversations between physicians and patients by helping patients choose care that is:
* Supported by evidence
* Not duplicative of other tests or procedures already received
* Free from harm
* Truly necessary

"In response to this challenge, national organizations representing medical specialists have been asked to "choose wisely" by identifying five tests or procedures commonly used in their field, whose necessity should be questioned and discussed. The resulting lists of "Five Things Physicians and Patients Should Question" will spark discussion about the need—or lack thereof—for many frequently ordered tests or treatments."

+++++++++++++++quote ends+++++++++++

Nine specialty organizations have already released their lists of "Five Things Physicians and Patients Should Question" (http://choosingwisely.org/?page_id=13).

I don't think cost-cutting is the main objective, although it probably is a factor.  After all, much of the criticism of our current healthcare system in the U.S. points to its high cost; and there have been several analyses that blame "over-utilization" of healthcare resources as a reason for the high expenditure of healthcare dollars.

I am not saying all, or any, of that is correct.  Being treated for invasive cancer does give us a whole new perspective on what's important and what's cost-effective, and even what's "medically necessary."

otter