More is not always better in cancer care: Partnership report

The relevance of patient care and the sustainability of the cancer system depend on the avoidance of unnecessary tests, treatments and interventions

TORONTO — A new report from the Canadian Partnership Against Cancer looking into whether Canadian patients receive appropriate cancer care shows Canadian cancer patients undergo an estimated 770,000 interventions each year that may be of low value or expose them to unnecessary harm.

“More is not always better when it comes to cancer care,” said Dr. Geoff Porter, a surgical oncologist and Expert Lead in Clinical Care at the Partnership. “Providing patients with high-value care means ensuring they receive tests and treatments that offer the greatest clinical benefit with the most efficient use of resources. This can help improve quality of care and the sustainability of the health-care system.”

Quality & Sustainability in Cancer Control: A System Performance Spotlight Report measures how current oncology practices compare to cancer-related recommendations established by Choosing Wisely Canada – a campaign that aims to help physicians and patients engage in conversations about potentially unnecessary tests, treatments and procedures.

The report establishes baseline data for Choosing Wisely Canada’s cancer-related recommendations. In addition, the report presents findings relating to health care-system sustainability, including the use of day surgery for mastectomies and how often cancer patients are admitted to intensive care at the end of life.

The report found that while many high-quality, sustainable cancer control practices are already in place, there are areas where practice is not keeping pace with the recommendations, including:

  • The use of longer courses of radiation for women aged 50 and older with early stage breast cancer, despite evidence that shorter courses have less toxicity and provide equivalent tumour control, cosmetic outcomes and survival.
  • The use of multiple fractions of palliative radiation to relieve pain in cancer patients, despite evidence that single fraction radiation offers equivalent pain relief.
  • A large proportion of men with low-risk prostate cancer still receiving treatments with potential side effects that could be avoided, rather than undergoing active surveillance.

“Patients and their caregivers expect to receive the best care the cancer system can offer,” said Marjorie Morrison, CEO of the Canadian Cancer Action Network, an umbrella organization of 113 patient-centred cancer groups. “A ‘less is more’ approach to care requires thorough discussions with patients and their caregivers about the benefits and potential side effects of interventions. To achieve this, there needs to be a clearer understanding of what is considered the right test or treatment at the appropriate time.”

“These recommendations concern ‘low value’ care, where physicians and patients should think carefully about whether they’re truly necessary and where, in some cases, they can do more harm than good, exposing patients to harmful radiation, false-positive test results and anxiety,” said Dr. Wendy Levinson of Choosing Wisely Canada. “We encourage the Canadian cancer community to put these recommendations into practice and help avoid the 770,000 instances of unnecessary care that take place each year by implementing their own Choosing Wisely project.”

Avoiding unnecessary screening could reduce false positive results, meaning fewer people would be subjected to unnecessary biopsies that show benign results. Beyond being beneficial to individual patients, prescribing shorter courses of radiation could also free up capacity for other patients awaiting treatment.

Ensuring better concordance with the recommendations may, most importantly, not only lead to better care. It may also provide opportunities to reinvest scarce health resources in other areas of the cancer system. A slight decrease in the use of the cancer control practices measured in this report could potentially result in 8,900 false positive results being avoided, 3,100 treatments and related side effects avoided and $23 million that could be redirected to other health-care services.

Analyzing pan-Canadian data on compliance with Choosing Wisely Canada recommendations helps provide policymakers in provinces and territories with the tools and information they need to make informed decisions to improve patient care, reduce unnecessary tests and treatments and improve the quality and sustainability of Canada’s cancer system.


Karen Palmer
Canadian Partnership Against Cancer
(647) 388-9647

About the System Performance Initiative

The Canadian Partnership Against Cancer’s System Performance Initiative produces annual reports that present performance indicators spanning the various dimensions of cancer control, such as prevention, screening, diagnosis, treatment, patient experience and research. In addition, the Partnership produces spotlight reports that provide a detailed look at dimensions of the cancer control continuum.

About the Canadian Partnership Against Cancer

The Canadian Partnership Against Cancer works with Canada’s cancer community to reduce the burden of cancer on Canadians. Grounded in and informed by the experiences of those affected by cancer, the organization works with partners to support multi-jurisdictional uptake of evidence that will help to optimize cancer control planning and drive improvements in quality of practice across Canada. Through sustained effort and a focus on the cancer continuum, the organization supports the work of the collective cancer community in achieving long-term population outcomes: reduced incidence of cancer, less likelihood of Canadians dying from cancer, and an enhanced quality of life of those affected by cancer.

About Choosing Wisely Canada

Choosing Wisely Canada is a campaign to help clinicians and patients engage in conversations about unnecessary tests and treatments and make smart and effective choices to ensure high-quality care. Canadian national specialty societies participating in the campaign, representing a broad spectrum of clinicians, have been asked to develop lists of “Five Things Clinicians and Patients Should Question.” These lists identify tests and treatments commonly used in each specialty, but are not supported by evidence, and/or could expose patients to unnecessary harm. Choosing Wisely Canada is organized by the Canadian Medical Association and the University of Toronto.