The American College of Surgeons (ACS) and Commission on Cancer (CoC) on September 4 released separate lists of commonly ordered but not always necessary tests or procedures as part of the Choosing Wisely® campaign, an initiative of the American Board of Internal Medicine (ABIM) Foundation. The list from each of the 30 specialty society Choosing Wisely partners identifies five targeted, evidence-based recommendations for potentially unnecessary and sometimes harmful tests and procedures and that call for conversations between patients and physicians regarding essential care.
The American College of Surgeons’ list set forth the following five recommendations:
Don’t perform axillary lymph node dissection for clinical stages I and II breast cancer with clinically negative lymph nodes without attempting sentinel node biopsy.
Avoid the routine use of "whole-body" diagnostic computed tomography (CT) scanning in patients with minor or single system trauma.
Avoid colorectal cancer screening tests on asymptomatic patients with a life expectancy of less than ten years and no family or personal history of colorectal neoplasia.
Avoid admission or preoperative chest X-rays for ambulatory patients with unremarkable history and physical exam.
Don’t do computed tomography for the evaluation of suspected appendicitis in children until after ultrasound has been considered as an option.
"These recommendations will help to enhance the patient-surgeon relationship and heighten the quality of care surgical patients receive, which is one of our highest priorities," said David B. Hoyt, MD, FACS, ACS Executive Director.
The Commission on Cancer established the following five recommendations:
Don’t perform surgery to remove a breast lump for suspicious findings unless needle biopsy cannot be done.
Don’t initiate surveillance testing after cancer treatment without providing the patient a survivorship care plan.
Don’t use surgery as the initial treatment without considering presurgical (neoadjuvant) systemic and/or radiation for cancer types and stage where it is effective at improving local cancer control, quality of life, or survival.
Don’t perform major abdominal surgery or thoracic surgery without a pathway or standard protocol for post-operative pain control and pneumonia prevention.
Don’t initiate cancer treatment without defining the extent of the cancer (through clinical staging) and discussing with the patient the intent of treatment.
"This initiative will help provide cancer patients with a highly credible resource to obtain reliable information when discussing certain aspects of their care with their physicians," said David P. Winchester, MD, FACS, Medical Director, ACS Cancer Programs.