Five items breast cancer patients need to discuss with their doctors ...

The American Society of Clinical Oncology p(ASCO) published an article in the Journal of Clinical Oncology titled, The Top Five List: Practices and interventions that are costly, widely used, and not supported by high-level clinical evidence. This list details expensive procedures that may not be suitable as routine methods for treating breast and other cancers. Breast cancer patients in Little Rock, Arkansas, should be aware of these recommendations and be ready to discuss them with their physicians.

Metastatic breast cancer and chemotherapy

Chemotherapy should not be used in metastatic breast cancer patients if the patient has had three or more rounds of unsuccessful chemotherapy. The dangers of the toxicity of chemotherapy outweigh any potential benefits after three separate rounds of chemo. Patients with advanced metastatic breast cancer that is unresponsive to treatment should spend time and money looking into end-of-life solutions.

PET, CT and radionuclide bone scans in the staging of early, low risk breast cancer

The article states that expensive imaging such as PET, CT and radionuclide bone scans do not give any better diagnosis or benefits than liver serum tests for early, low risk breast cancers such as ductal carcinoma in situ. This is especially true because the average cost of one of these tests can exceed $2,500 with insurance only paying a part of the cost, leaving the patient to bare the burden of the difference.

Surveillance testing and imaging in asymptomatic patients

For patients who are being treated with curative intent, surveillance testing (biomarkers) and imaging (PET, CT and radionuclide bone scans) show no value when the patient is asymptomatic. When no symptoms exist, the article states that it is possible to do harm through extensive testing. The harm presents itself as unnecessary exposure to radionuclide compounds, radiation, and undo stress and worry on the patient.

White cell stimulating factors

Drugs such as Neupogen and Neulasta are frequently over-used. These drugs help to stimulate the body's production of white blood cells while the patient is undergoing certain chemotherapy treatments. Chemotherapy drugs such as Cytoxin, can cause febrile neutropenia-- a serious medical condition where the white blood cell count is so low it leaves the immune system unable to combat even minor infections. Both drugs are commonly given after chemotherapy treatments even when there is no indication that the patients white blood cell count will reach dangerously low levels. Prior to prescribing white cell stimulating factors, blood tests should be used to determine if they are necessary. The cost of a single injection of Neulasta can exceed $9,000.

MRI in post-treatment surveillance of breast cancer

Many physicians routinely use MRI as a postoperative follow-up with breast cancer patients. The article concludes that this is not necessary and it can lead to further invasive testing which carries a risk of death.

Little Rock, Arkansas is not a wealthy area. Many residents receive public assistance, which includes Medicaid. Cancer treatment is expensive. When the costs of expensive testing is not completely covered by insurance, Medicaid or Medicare, the patient is left paying the balance. By discussing the need for testing and high-cost therapies with your physician and evaluating alternatives, patients can reduce their financial risk while still receiving proper medical care.?

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