Doctors call for end to five cancer tests, treatments

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.

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.

"Our goal was to improve care and improve the value of the care we deliver," said Dr. Lowell Schnipper, a cancer physician at Beth Israel Deaconess Medical Center who led the task force assembled by the American Society of Clinical Oncology (ASCO). The 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.

"The American people have a much higher opinion of doctors than of government bureaucrats," said Kate Nix, a policy analyst at the free-market Heritage Foundation. Whether the ASCO recommendations to withhold some tests and treatments will be seen as rationing "depends on how they are used. Will they inhibit the ability of doctors and patients to make the best decision in each case?"

PATIENTS VS. FINANCIAL INTERESTS

Advocates for cancer patients applauded the recommendations.

"I think this is a great effort from ASCO," said Dr. Otis Brawley, chief medical officer of the American Cancer Society. "They are putting their patients ahead of their own financial interests," since in the existing fee-for-service health-care system physicians make money on every test and treatment they order.

Brawley does not see the effort as leading to health-care rationing. "This is the rational use of health-care, not rationing," he said.

Other advocates agreed. "I am shocked, surprised, and pleased," said Fran Visco, president of the National Breast Cancer Coalition and a breast-cancer survivor. "Shocked because ASCO has long been loath to say, 'do less.' Pleased because it appears that they are trying to follow the science, which is nice."