New ASCO Choosing Wisely® List Details Five Cancer Tests and Treatments Routinely Performed Despite Lack of Evidence


Key Points

  • The new “Top Five” list advocates eliminating screening and imaging tests where the risk of harm outweighs the benefits and making sure that every choice of treatment reflects the best available evidence.
  • Recommendations are based on a comprehensive review of current high-level clinical evidence, conducted by the Value of Cancer Care Task Force.

The American Society of Clinical Oncology (ASCO) today announced its second “Top Five” list of opportunities to improve the quality and value of cancer care. Published in the Journal of Clinical Oncology (JCO), ASCO’s second Top Five list was released as part of the Choosing Wisely® campaign, sponsored by the ABIM Foundation, to encourage conversations between physicians and patients aimed at curbing the use of certain tests and procedures that are not supported by clinical research.

“As physicians, we have a fundamental responsibility to provide high-quality, high-value cancer care for all of our patients,” said Lowell E. Schnipper, MD, lead author of the JCO article and Chair of ASCO’s Value of Cancer Care Task Force. “That means eliminating screening and imaging tests where the risk of harm outweighs the benefits, and making sure that every choice of treatment reflects the best available evidence. By providing evidence-based care, we not only help our patients live better with cancer, we also assure they are getting high-quality care that will deliver the greatest possible benefit for the cost.”

ASCO’s New ‘Top Five’ Choosing Wisely List

The following list was developed by ASCO’s Value of Cancer Care Task Force, which solicited ideas from the full ASCO membership, regional oncology societies, and patient advocates. Each recommendation is based on a comprehensive review of current high-level clinical evidence (including published studies and guidelines from ASCO and other organizations), conducted by the Task Force.

  1. Do not give antinausea drugs (antiemetics) to patients starting on chemotherapy regimens that have low or moderate risk of causing nausea and vomiting
  2. Do not use combination chemotherapy instead of single-drug chemotherapy when treating an individual for metastatic breast cancer unless the patient needs urgent symptom relief.
  3. Avoid using advanced imaging technologies—such as positron-emission tomography (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.
  4. Do not perform prostate-specific antigen (PSA) testing for prostate cancer screening in men with no symptoms of the disease when they are expected to live less than 10 years. 
  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.

‘The Best Care for Patients Is the Best Approach for Society’

“All medical professionals should be accountable for both their patients’ well-being as well as their wise stewardship of health resources. High-value care not only benefits patients, but also reduces societal health-care costs which should be a concern for everyone,” said Clifford A. Hudis, MD, FACP, President of ASCO. “At ASCO, we want to ensure that oncology providers have the skills and tools needed to assess the benefits of tests and treatments and to discuss options with their patients. These goals are not in conflict: The best care for patients is the best approach for society.”

To help members assess care in their practices based on ASCO’s Top Five lists, measures based on the Top Five recommendations are offered as test measures in ASCO’s Quality Oncology Practice Initiative (QOPI®), a national program that helps practices assess and improve the quality of care they deliver through retrospective medical record abstraction and performance analysis. A team of clinicians and quality measurement experts are reviewing “Top Five” test performance based on more than 14,000 records (160 practices) and further refining the measures for future implementation.

For more information on ASCO’s Top Five list and the Choosing Wisely campaign, visit

The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.