Do not perform routine cancer screening, or surveillance for a new primary cancer, in the majority of patients with metastatic disease.
For patients with metastatic cancer (particularly but not restricted to those with life expectancy of less than five years), screening for new primary cancers is of little value and may even cause harm.
Reductions in mortality due to earlier detection and management of cancer due to various forms of screening (e.g. breast, colorectal, and prostate) typically take approximately ten years to accrue. Also, patients who have suspected cancers detected after screening may need to undergo further tests (such as prostate biopsies) and treatments. Patients with metastatic disease are more susceptible to complications arising from such tests and treatments given that they are already in frail health.
- Ilic D, Neuberger MM, Djulbegovic M, Dahm P. Screening for prostate cancer. Cochrane Database Syst Rev. 2013;(1):CD004720.
- Lee SJ, Boscardin WJ, Stijacic-Cenzer I, et al. Time lag to benefit after screening for breast and colorectal cancer: Meta-analysis of survival data from the United States, Sweden, United Kingdom, and Denmark. BMJ. 2013; 346:e8441.
- Loeb S, Carter HB, Berndt SI, et al. Complications after prostate biopsy: data from SEER-Medicare. J Urol. 2011;186(5):1830–4.
- Tang V, Boscardin WJ, Stijacic-Cenzer I, Lee SJ. Time to benefit for colorectal cancer screening: survival meta-analysis of flexible sigmoidoscopy trials. BMJ;350:h1662.
- van Hees F, Zauber AG, Klabunde CN, et al. The appropriateness of more intensive colonoscopy screening than recommended in Medicare beneficiaries: a modelling study. JAMA Internal Medicine. 174(10):1568–76.
An Evolve working group of MOGA members was established and compiled an initial list of 79 potentially low-value tests, treatments, and other clinical practices in medical oncology, drawing on the results of a desktop review and clinical experience. Anonymised email feedback on the list was collated and analysed and the initial list was reduced to 64 items. These were divided into seven categories, ranging from ‘Diagnosis and staging’ to ‘Therapy’. An online survey allowed members of the working group to anonymously choose the top six or the top three from each category (depending on the number in the category). From this, a list of the top-28 items was then presented to the MOGA Executive Committee. Following anonymised email feedback, this list was further reduced to 24 items. Each member of the Committee was invited to nominate their top-12 of these. Responses were consolidated and a list of 11 items compiled, which served as the basis of a final online survey, to which the entire MOGA membership was invited to respond. Respondents assigned a score of 1 to 5 for each item based on their level of agreement with each. Scores for each item were averaged and the top-5 list produced.
- 1 Avoid cytotoxic chemotherapy in patients with advanced cancer who are unlikely to benefit from chemotherapy (ECOG performance status 3 or 4) and continue to focus on symptom relief and palliative care.
- 2 Do not perform routine cancer screening, or surveillance for a new primary cancer, in the majority of patients with metastatic disease.
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; including avoiding surveillance testing (biomarkers) or imaging (PET, CT and radionuclide bone scans) for asymptomatic individuals who have been treated for breast cancer with curative intent.
- 4 Do not perform serum tumour marker tests except to evaluate or monitor a cancer known to produce these markers.
- 5 Do not routinely offer pharmacological venous thromboembolism (VTE) prophylaxis to ambulatory outpatients who are undergoing oncological treatment.