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It is not recommended to deprescribe or interrupt opioid treatment in a patient with concurrent chronic pain and opioid dependence without considering the impact on morbidity and mortality of ...
Choosing Wisely Australia
Australasian Chapter of Addiction Medicine
Efforts to reduce opioid-related harm must be carefully balanced against considerations of potential harms that might result from abrupt discontinuation or rapid tapering of drug dosages. These include risks related to withdrawal symptoms and increased pain as well as to seeking other, at time more dangerous, sources of opioids. The adverse physical and psychological outcomes of abrupt reduction or discontinuation of long-time medication include uncontrolled pain, related loss of function and ...
ver más ... 2019It is not recommended to routinely offer pharmacological venous thromboembolism prophylaxis to ambulatory outpatients who are undergoing oncological treatment
Choosing Wisely Australia
Medical Oncology Group of Australia
Patients receiving oncological treatment are at higher risk of thromboembolic disease and hence may require anticoagulant treatment. While there is some evidence that some of these treatments significantly reduce the risk of venous thromboembolic (VTE) events, this benefit must be weighed against the risk of haemorrhagic complications. Pharmacological VTE prophylaxis should not, therefore, be routinely offered to ambulant oncology patients. Exceptions may apply to high-risk cases, such as ...
ver más ... 2019Testing for serum tumor markers is not recommended in patients with nonspecific symptoms except to evaluate or monitor a cancer known to produce these markers.
Choosing Wisely Australia
Medical Oncology Group of Australia
In patients with non-specific symptoms, testing for a panel of tumour markers to try and diagnose an underlying cancer is not supported by evidence given the low sensitivity and specificity of these tests. An exception is in cases of suspected, strong underlying predisposition of specific cancers, in which case testing may prove a useful adjunct or in specific contexts where biomarkers may be useful such as CA-125 for suspected ovarian cancer and the use of PSA to detect prostate cancer in men ...
ver más ... 2019Avoid 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 ...
Choosing Wisely Australia
Medical Oncology Group of Australia
Some biomarker and imaging tests are effective in staging cancers. For instance, flourodeoxyglucose (FDG) PETs are most effective at staging NSCLC (non-small-cell lung cancer), restaging HL (Hodgkin lymphoma), staging/restaging colorectal cancer, and detection of SPN (solitary pulmonary nodule). However, the clinical impacts of these tests for surveillance of asymptomatic patients are unclear, particularly in cases where early detection of recurrence is unlikely to improve clinical ...
ver más ... 2019Do not perform routine cancer screening, or surveillance for a new primary cancer, in the majority of patients with metastatic disease.
Choosing Wisely Australia
Medical Oncology Group of Australia
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 ...
ver más ... 2019