Table 1.

Choosing wisely in oncology: recommendations by societies

Society procedure	ASCO	ASH	ASTRO	SSO
Therapy	Overall, cancer-directed No therapy for solid tumour when: PS 3–4, no benefit from prior interventions, no eligibility for clinical trials, no strong evidence supporting the clinical value of further anticancer treatment. No combination chemotherapy when treating metastatic breast cancer, unless a rapid response to relieve tumour-related symptoms is needed. No targeted therapy unless tumour cells have a specific biomarker that predicts an effective response to the these agents. Supportive care No WBC-stimulating factors for primary prevention of febrile neutropaenia in patients with <20% risk for this complication. Antiemetics should be adapted to the likelihood of severe or persistent chemotherapy-induced nausea and vomiting.	Overall No routine use of inferior vena cava filters in patients with VTE. No plasma or prothrombin complex concentrates for non-emergent reversal of vitamin K antagonists (ie, outside of the setting of major bleeding, intracranial haemorrhage or anticipated emergent surgery). Supportive care If transfusion of RBCs is necessary, transfuse the minimum number of units to relieve symptoms or to return to a safe HB range (7–8 g/dL in stable, non-cardiac inpatients).	Overall No routine use of RXT hyperfractionated schedules (>10 fractions) for palliation of bone metastases. No RXT in non-curative setting without defining the goals of treatment and considering palliative care referral. No routine adjuvant whole brain RXT to stereotactic radiosurgery for limited brain metastases. Breast Consider shorter RXT schedules after conservative surgery in women aged ≥50 years with early stage invasive cancer. No routine use of IMRT to deliver whole RXT after conservative surgery. Prostate Consider active surveillance in low-risk prostate cancer. No routine use of proton beam therapy. Endometrial No RXT following hysterectomy in low-risk disease. NSCLC No routine RXT in R0, N0-1 resected disease.
Staging	Prostate No PET, CT and bone scans in the staging of early prostate cancer. Breast No PET, CT and bone scans in the staging of early breast cancer.			Colorectal cancer No routine PET-CT as staging for localised disease or as part of surveillance after surgery. Breast cancer No routine sentinel node biopsy in clinically node negative women aged ≥70 years with hormone receptor positive invasive cancer. Melanoma No routine imaging in patients localised with primary cutaneous melanoma, unless suspicion for metastatic disease.
Surveillance	Breast No surveillance biomarkers or imaging (PET, CT and bone scans) for asymptomatic curatively treated patients. No routine PET or PET-CT surveillance for cancer recurrence detection in asymptomatic patients who complete initial treatment, unless there is high level of evidence that such imaging will change the outcome.	Lymphoma Limit surveillance CT scans in asymptomatic patients after curative-intent treatment for aggressive lymphoma.	Breast No mammograms more often than annually after RXT following sparing surgery.	Colorectal cancer No routine blood tests other than carcinoembryonic antigen.
Screening	Prostate No PSA testing in asymptomatic men when they are expected to live <10 years.	Thrombophilia No test in patients with VTE occurring in the context of major transient risk factors (surgery, trauma or prolonged immobility).		Breast cancer No routine breast MRI in average risk women

ASCO, American Society for Clinical Oncology; ASH, American Society of Hamatology; ASTRO, American Society for Radiation Oncology; IMRT, intensity modulated radiotherapy; NSCLC, non-small cell lung cancer; PSA, prostate-specific antigen; PS, performance status; RBC, red blood cells; RXT, radiotherapy; SSO, Society of Surgical Oncology; VTE, venous thromboembolism; WBC, white blood cells.