Experts warn against overuse of chemotherapy in patients with advanced cancer

16 May 2019

Specialists have today released new medical advice warning against the overuse of chemotherapy in patients with advanced cancer, urging doctors to instead prioritise symptom relief and palliative care.

The advice is one of the five recommendations on low value practices in oncology released by the Medical Oncology Group of Australia (MOGA) as part of the Royal Australasian College of Physicians (RACP) Evolve initiative, and the NPS MedicineWise Choosing Wisely Australia initiative.

Professor Chris Karapetis, Head of Department of Medical Oncology at the Flinders Medical Centre, said that “sadly, for some patients living with advanced cancer, chemotherapy is no longer effective, and symptom relief and palliative care should become the primary models of care.”

“Specialists can make an informed decision on the effectiveness of chemotherapy in a patient by utilising the Eastern Cooperative Oncology Group (ECOG) performance status which predicts poor survival, reduced response and worsened toxicity from chemotherapy.

“While chemotherapy remains one of the most effective treatments for patients with cancer, it is important for specialists to distinguish between curative chemotherapy and end-of-life palliative chemotherapy.

“Palliative chemotherapy that does not improve the quality of life of a patient with advanced and incurable cancer should be avoided wherever possible.”

NPS MedicineWise CEO Adj A/Prof Steve Morris said: ““The overuse of chemotherapy in patients with advanced cancer can cause a considerable amount of additional distress to patients and their families due to the myriad of severe side effects associated with chemotherapy.

“These new recommendations provide the latest evidence-based advice on tests and treatments for cancer patients and provide a guide for best practice in palliative care oncology.

“The core focus of the Choosing Wisely movement is to encourage health professionals and patients to have candid conversations about available and appropriate health management options, with the long-term goal of ensuring less people undergo healthcare they don’t need.”

The other four recommendations on low value practices in oncology are:

  1. Do not perform routine cancer screening, or surveillance for a new primary cancer, in the majority of patients with metastatic disease
  2. Avoid tests (biomarkers and imaging) for recurrent cancer in previously treated asymptomatic patients unless there is evidence that early detection of recurrence can improve survival or quality of life
  3. Do not perform serum tumour marker tests except to evaluate or monitor a cancer known to produce these markers
  4. Do not routinely offer pharmacological venous thromboembolism (VTE) prophylaxis to ambulatory outpatients who are undergoing oncological treatment

Recommendations can be accessed here.

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