Oncologists hold key to curbing ca... (ecommendations reinforce current ASCO an...)

Oncologists hold key to curbing cancer costs

Date:5/26/2011

ecommendations reinforce current ASCO and National Comprehensive Cancer Network (NCCN) evidence-based guidelines. Some of their proposals call for more frank discussions about end-of-life care between physicians and patients, and others urge increased scrutiny when using expensive treatments and surveillance tests. They argue that by establishing these guidelines, oncologists would be less likely to continue treatments in situations where the treatments no longer beneficial for the patient.

"It is important that we are compassionate and honest with our patients about when continuing chemotherapy causes more harm than good," says Hillner. "Two simple but critically important points: we should stop routinely giving chemotherapy to patients who are so weakened by the disease that they cannot walk unaided into the clinic. And when the cancer has grown through three successive regimens, it is time to switch teams and use hospice. Research has shown that for patients in these situations it is highly unlikely that continued chemotherapy will prolong life."

The authors suggest the following changes in oncologists' behavior:

Limit surveillance testing or imaging to situations in which a benefit has been shown.
Limit second-line and third-line treatment for metastatic cancer to sequential single-agent chemotherapy for most solid tumors.
Limit chemotherapy to patients with good outcomes, with an exception for highly responsive disease.
In metastatic solid cancers, replace the routine use of white-cell-stimulating factors with a reduction in the chemotherapy dose.
For patients who are not responding to three consecutive regimens, limit further chemotherapy to clinical trials.

The authors suggest the following changes in oncologists' attitudes and practice:

Recognize that the costs of care are driven by what we do and do not do.
Set more realistic expectations both for doctors and patients.
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Contact: John Wallace
wallacej@vcu.edu
804-628-1550
Virginia Commonwealth University
Source:Eurekalert

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