American Society of Clinical Oncology (ASCO)

  1. Don’t use cancer-directed therapy for solid tumor patients with the following characteristics: low performance status (3 or 4), no benefit from prior evidence-based interventions, not eligible for a clinical trial, and no strong evidence supporting the clinical value of further anti-cancer treatment.
  2. Don’t perform PET, CT, and radionuclide bone scans in the staging of early prostate cancer at low risk for metastasis.
  3. Don’t perform PET, CT, and radionuclide bone scans in the staging of early breast cancer at low risk for metastasis.
  4. Don’t perform surveillance testing (biomarkers) or imaging (PET, CT, and radionuclide bone scans) for asymptomatic individuals who have been treated for breast cancer with curative intent.
  5. Don’t use white cell stimulating factors for primary prevention of febrile neutropenia for patients with less than 20 percent risk for this complication.

American Society of Nephrology (ASN)

  1. Don’t perform routine cancer screening for dialysis patients with limited life expectancies without signs or symptoms.
  2. Don’t administer erythropoiesis-stimulating agents (ESAs) to chronic kidney disease (CKD) patients with hemoglobin levels greater than or equal to 10 g/dL without symptoms of anemia.
  3. Avoid nonsteroidal anti-inflammatory drugs (NSAIDS) in individuals with hypertension or heart failure or CKD of all causes, including diabetes.
  4. Don’t place peripherally inserted central catheters (PICC) in stage III-V CKD patients without consulting nephrology.
  5. Don’t initiate chronic dialysis without ensuring a shared decision-making process between patients, their families, and their physicians.

American Society of Nuclear Cardiology (ASNC)

  1. Don’t perform stress cardiac imaging or coronary angiography in patients without cardiac symptoms unless high-risk markers are present.
  2. Don’t perform cardiac imaging for patients who are at low risk.
  3. Don’t perform radionuclide imaging as part of routine follow-up in asymptomatic patients.
  4. Don’t perform cardiac imaging as a pre-operative assessment in patients scheduled to undergo low-or intermediate-risk non-cardiac surgery.
  5. Use methods to reduce radiation exposure in cardiac imaging, whenever possible, including not performing such tests when limited benefits are likely.


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