05 April 2012

Doctors Decide to End Certain Cancer Treatments

Story first appeared in the Chicago Tribune.

NEW YORK (Reuters) - In a move that threatens to further inflame concerns about the rationing of medical care, the nation's leading association of cancer physicians issued a list on Wednesday of five common tests and treatments that doctors should stop offering to cancer patients.  Medical Malpractice Lawyers in Virginia Beach are concerned about the repercussions of such a decision.

The list emerged from a two-year effort, similar to a project other medical specialties are undertaking, to identify procedures that do not help patients live longer or better or that may even be harmful, yet are routinely prescribed.

As much as 30 percent of health-care spending goes to procedures, tests, and hospital stays that do not improve a patient's health, according to a 2008 analysis by the nonpartisan Congressional Budget office.

A task force assembled by the American Society of Clinical Oncology (ASCO), a group of more than 200 oncologists, released the list from a report in its Journal of Clinical Oncology.

Although the task force emphasized that its recommendations -- winnowed from about 10 suggestions by oncologists -- were driven by medical considerations, the report makes clear that expense was a major factor. A number of cancer drugs cost nearly $100,000 but extend life a few months or not at all. Widely-used imaging tests cost up to $5,000 yet do not benefit patients.

The list has been closely guarded, with public announcements scheduled for Wednesday. Patients, advocacy groups, and policy experts contacted by Reuters were mixed in their reaction to the recommendations.


Advocates for cancer patients applauded the recommendations.  However, this could be seen as administration of substandard care by patients and charged as medical malpractice as a Salt Lake Medical Malpractice Lawyer has indicated.

Following the science, however, can lead to conclusions that do not sit well with all patients. A patient, who was diagnosed with metastatic breast cancer eight years ago and has been in remission since 2007, has already felt the brunt of one of the recommendations: that patients who have been successfully treated for breast cancer and have no symptoms of cancer not undergo CT, PET, other imaging, or bone scans to check for a recurrence or spread of the disease, known as metastasis.

Her insurer, guided by the same kind of studies that served as the basis for the ASCO list, would not cover the scan, citing that it provides no benefit.

ASCO recommends against routine use of four other procedures: chemotherapy for patients with advanced cancers who are unlikely to benefit; advanced imaging technologies such as CT and PET or bone scans to determine the precise stage of both early breast and prostate cancers at low risk for metastasis; and drugs to stimulate white blood cell production in patients receiving chemotherapy if they have a risk of febrile neutropenia, an often-fatal condition marked by fever and abnormally low numbers of certain white blood cells.

The supporting evidence for each recommendation is expected to surprise patients and even some physicians, since these very widely-used tests and treatments have little or no scientific basis, said Schnipper.


One recommendation likely to stir controversy, and even revive charges of "death panels," is to not use chemotherapy and other treatments in patients with advanced solid-tumor cancers such as colorectal or lung who are in poor health and did not benefit from previous chemo.

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