Your oncologist stays up on the latest research in treatments, so you should be able to trust his or her recommendations. But doctors are people too, and sometimes they fall into familiar routines. Sometimes they want to try the newest drugs to see how well they work. Sometimes they let patients talk them into medicines or treatments that may be unnecessary.
This year the American Society for Clinical Oncology (ASCO), the professional group for oncologists, listed five overused cancer tests and treatments that their members should avoid. One of them is related to prostate cancer, but the other four may affect you or your loved one who is being treated for breast cancer. Of those four, I suspect patient behavior may affect the oncologist’s decisions.
The guidelines include:
Don’t give anti-nausea drugs to patients receiving chemotherapy drugs that have a low probability of causing nausea. This seems like a no-brainer. Why give an expensive drug for a problem that might not even happen? One of patients’ greatest fears when they start chemotherapy is that they may vomit. Oncologists probably like to be able to reassure patients that they can control this horrible side effect with one of the new anti-nausea medications.
As a patient, I found that I needed to start medication for nausea before I started vomiting, but research shows that many of the older, less expensive drugs work just as well to prevent and/or reduce nausea. If your doctor follows these guidelines, your bill at the drugstore will be lower. However, if the first drug your doctor gives you doesn’t conquer nausea, speak up. There may be a newer drug to try. Don’t push your doctor for the newest drug, but don’t hesitate to speak up if the first one he prescribes doesn’t work for you.
Do not use combination chemotherapy instead of single-drug chemotherapy for metastatic breast cancer. ASCO recommends giving drugs one at a time to improve a patient’s quality of life. Combination chemo should be considered if the tumor load must be reduced quickly because it is immediately life-threatening. Sometimes as patients, we ask for a treatment that a friend received or that we read about in a news release. Discussing treatment options with your doctor is a good idea. Just keep in mind that the decision-making process for choosing a drug can be complicated.
Do not use a targeted therapy drug unless the patient’s lab results show the biomarker that indicates the drug will be successful. I must confess I was floored to see this on the list of overused treatments. I assumed that doctors would not prescribe a targeted therapy like Herceptin unless the pathology report showed that the cells were Her2 positive. Apparently some oncologists decide to prescribe “off-label” in the hopes that a drug will help despite a lack of evidence. Could patient requests to try these drugs push the doctor into prescribing them? I don’t know, but again, discussing drug options with your doctor is a good idea. Insisting on trying a drug that helped your friend is not.
Avoid imaging tests for patients who have finished treatment and show no signs of recurrence. This is the area where patient fears probably have the biggest impact on the oncologist’s actions. After treatment ends, we want reassurance that the cancer is gone. Asking the doctor to order a PET or CT scan seems harmless. I know from reading hundreds of letters from cancer survivors that most of the time the oncologist explains that scans usually can’t “see” a cancer recurrence until it is actually causing symptoms. The imaging test confirms the doctor and patient’s suspicion that something is wrong, not vice versa. Usually, the doctor refuses to order the tests because she understands that over the next years of cancer survivorship, a patient doesn’t need exposure to unnecessary radiation and the stress of routine scans.
I have also seen members of on-line support groups encourage an anxious survivor to insist on pressing for routine tests to “reduce anxiety.” Sometimes the doctor gives in. I’m guessing that the patient pushes for more tests, and the doctor gives in most often when insurance covers the cost. Few of us have thousands of extra dollars to spend for tests that are essentially useless. Yet, when people with good insurance push for medically unnecessary tests, the cost of insurance for everyone goes up. You and your doctor may have a legitimate disagreement about whether you need a bone scan to see if the pain in your back is a cancer recurrence or a muscle strain. However, your doctor is following well-researched guidelines by not ordering an annual bone scan if you have no symptoms.
Medicine is still an art as well as a science. In an ideal patient-doctor relationship, you and your doctor discuss treatment options. You trust that your doctor will listen to your concerns and then use his or her training and experience to design the best plan for you. Dr. Lowell Schnipper, the chair of the task force that came up with the new guidelines, explains it this way, “As physicians, we have a fundamental responsibility to provide high-quality, high-value cancer care for all of our patients. That means eliminating screening and imaging tests where the risk of harm outweighs the benefits, and making sure that every choice of treatment reflects the best available evidence.”
Colwell, J. “ASCO Issues ‘Top 5’ List of Overused Cancer Tests and Treatments” October 29, 2013. Accessed December 31, 2013 http://www.cancernetwork.com/practice-policy/asco-issues-top-5-list-overused-cancer-tests-and-treatments
Published On: December 31, 2013