Choosing Wisely® 2013: ASCO’s Second List Top Five Cancer-Related Tests, Procedures, and Treatments Many Do Not Need

Listen to the Cancer.Net Podcast: The Second Top Five List in Oncology – What This Means for Patients, with Dr. Richard Schilsky, adapted from this content.


Being diagnosed and treated for cancer is a complex process, often filled with many tests, procedures, and treatments that may not be familiar to you. Learning more about these tests and treatments can help you understand what to expect when having them, but how do you know which ones actually increase your chance of recovering from cancer and maintaining the best quality of life and which ones increase side effects without improving quality of life?

To help patients answer these questions, the American Society of Clinical Oncology (ASCO) joined with the American Board of Internal Medicine (ABIM) Foundation and other medical specialty societies in the Choosing Wisely® campaign. The campaign’s goals are to improve the value of each patient’s medical care, meaning that patients receive the tests, procedures, and treatments that are most likely to improve their lives without overburdening them with unnecessary costs. In 2012, ASCO released its first “Top Five” list of tests, procedures, and treatments that are misused or overused in oncology.

In 2013, a panel of experts from ASCO carefully reviewed the latest cancer research and created the second list of “Top Five” tests, procedures, and treatments that are often used in cancer care but have not been shown to increase the chance of recovery or quality of life for most patients. By avoiding these tests, procedures, and treatments, ASCO hopes that patients can continue to receive high-quality cancer care without unnecessary side effects and costs. This summary is designed to help patients talk with their doctors about the purpose and goals of specific cancer-related tests and procedures, to determine which options are right for them.

Topic #1: Medications to Prevent Vomiting Intended for Chemotherapy with Low Risk of Causing Nausea or Vomiting

Chemotherapy (the use of drugs to kill cancer cells) can cause nausea and vomiting, although not all types of chemotherapy cause nausea and vomiting and not all patients who receive chemotherapy will have these side effects. Also, some of the drugs used for chemotherapy are more likely to cause nausea and vomiting than other drugs. ASCO’s recommendations for preventing vomiting provide a list of the types of chemotherapy that are more or less likely to cause nausea and vomiting.

Topic #2: Chemotherapy with Multiple Drugs Instead of with One Drug for Breast Cancer that Has Spread

Metastatic breast cancer is when the disease has spread beyond the breast and lymph nodes near the breast to other parts of the body. Treatment options for people with metastatic breast cancer often include chemotherapy. Chemotherapy is the use of drugs to kill cancer cells, usually by stopping the cancer cells’ ability to grow and spread. Chemotherapy can be given one drug at a time or in combinations of drugs at the same time. Certain types of targeted therapy called monoclonal antibodies, which can include trastuzumab (Herceptin) and pertuzumab (Perjeta), are often used with chemotherapy.

Topic #3: Follow-up PET or PET-CT Scans to Watch for a Cancer Recurrence

Many different types of tests are used to help diagnose cancer, determine the cancer’s stage, monitor how well treatment is working, and watch for a cancer recurrence (return of the cancer). Imaging tests (or scans) are ways to create pictures of the organs and tissues inside the body. Different types of scans are often used at different points in a person’s cancer diagnosis, treatment, and recovery.

Topic #4: PSA Testing for Prostate Cancer in Men with No Symptoms of the Disease

Prostate Specific Antigen (PSA) is a type of protein released by prostate tissue that is found in higher levels in a man’s blood when there is abnormal activity in the prostate, including prostate cancer or a condition called benign prostate hyperplasia (BPH), which is not cancer but a noncancerous growth of normal prostate cells that occurs with age. Ever since higher levels of PSA have been linked to a higher likelihood of having prostate cancer, there has been hope that PSA testing could be a simple way to find prostate cancer earlier.

Topic #5: Do Not Use Therapy Targeted Against Spec. Gene Mutation When Patient’s Tumor Does Not Have Gene Mutation

As part of the cancer diagnosis process, your doctor may recommend running laboratory tests on a piece (or sample) of the tumor to identify specific genes, proteins, and other factors unique to the cancer. Results of these tests will help decide whether your treatment options include a type of drug treatment called targeted therapy. Targeted therapy targets the cancer’s specific genes, proteins, or the tissue environment that contributes to cancer growth and survival. This type of treatment blocks the growth and spread of cancer cells while limiting damage to normal cells.