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The ‘Top 5’ List of Overused Cancer Tests and Treatments according to ASCO

The ‘Top 5’ List of Overused Cancer Tests and Treatments according to ASCO

In late October, the American Society of Clinical Oncology (ASCO) issued a “Top 5” list of tests and treatments that are routinely used by oncologists despite a lack of evidence that they are cost effective or beneficial to patients.

Three are particularly relevant to SLL/CLL patients undergoing treatment:

1. Do not give anti-nausea drugs (anti-emetics) to patients starting on chemotherapy regimens that have a low or moderate risk of causing nausea and vomiting.

3. Avoid using advanced imaging technologies (PET, CT, and radionuclide bone scans) to monitor for a cancer recurrence in patients who have finished initial treatment and have no signs or symptoms of cancer.

5. Do not use a targeted therapy intended for use against a specific genetic abnormality unless a patient’s tumor cells have a specific biomarker that predicts a favorable response to the targeted therapy.

Full article:

Personally I have no issue with these sensible suggestions, but I do have some comments.

1. Controlling any nausea resulting from chemotherapy treatment can make a huge difference to how well you get through the treatment, so make sure you keep a diary of your nausea so you do get anti-emetics if you ned them:

3. When it comes to the right amount and right type of imaging, you do really need to be in the care of a specialist experienced in CLL treatment.

5. I wish! We know that some standard CLL treatments just don't work well for some relatively common genetic abnormalities in CLL cells, yet those tests are not available in many countries and only available via specialist centres in the USA.


2 Replies

Thanks for this, Neil. Interesting. But I was very concerned at the recommendation NOT to give anti-nausea drugs if there was only a low/moderate risk of nausea from a particular treatment. However, the small print in the article (which they don't make clear in their summing up), seems to say that it is just the more expensive anti-emetics which are not recommended, because "patients at lower risk for nausea and vomiting typically do just as well with older, less costly drugs".

So, they're not actually saying "don't give any anti-nausea drugs", but just "use the cheaper ones". That was a bit reassuring but not entirely so. And to anyone just reading the summarised list of "Top 5" overused tests etc, the distinction between cheap and expensive anti-emetics is not made clear. I'd be interested to know which are the cheaper and which more expensive ones, and which are most commonly used in CLL treatments.



I had 3 anti-nausea meds during treatment, Ondansetron, Prochorperazine and Dimenhydrinate.

The trick to using these I found is to use them BEFORE you need then, keep ahead of the nausea.

The chemoimmunotherapy treatment nausea was extremely mild, however, radiotherapy caused extreme nausea for 10 days... :-(

Like everything in CLL it varies from patient to patient.


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