Volume 198 - Issue 11
Over 150 potentially low-value health care practices: an Australian study
Author: Graham Pitson
Med J Aust 2013; 198 (11): 597-598. || doi: 10.5694/mja13.10085
Published online: 17 June 2013
Published online: 17 June 2013
To the Editor: Elshaug and colleagues recently attempted to identify low-value health care practices.1 They further identified 13 services found by more than one of their search methods, implying that these services may be of particularly low value.
One such practice identified is “radiotherapy for patients with metastatic spinal cord disease”.1 However, this terminology is loose at best, and the following quotes from Elshaug et al’s own ...
To the Editor: Elshaug and colleagues recently attempted to identify low-value health care practices.1 They further identified 13 services found by more than one of their search methods, implying that these services may be of particularly low value.
One such practice identified is “radiotherapy for patients with metastatic spinal cord disease”.1 However, this terminology is loose at best, and the following quotes from Elshaug et al’s own sources do not offer ready support for the authors’ conclusion that this treatment may be of low value:
“Radiation therapy is a mainstay of treatment for spinal metastases, and continues to play an important role in pain relief, prevention of pathological fractures, and stabilization of neurological function”;2 and
“Offer fractionated radiotherapy as the definitive treatment of choice to patients with epidural tumour without neurological impairment, mechanical pain or spinal instability ”.3
Two of Elshaug et al’s references refer specifically to the treatment of metastatic spinal cord compression (MSCC),3,4 and it may be that this was what the authors really meant to review. Here, there is a valid question as to which patients may be better served by surgery — as suggested by the randomised study of surgery in highly selected patients.4 However, patient selection is key — “Selecting patients who will benefit from resection remains a challenging undertaking”2 — and surgery is not suitable for all — “Offer urgent radiotherapy . . . to all patients with MSCC who are not suitable for spinal surgery . . .”.3
In summary, radiotherapy for patients with metastatic spinal cord disease does not appear to be a low-value practice and is actually recommended by Elshaug et al’s own sources.
Competing interests
No relevant disclosures.
References
- Elshaug AG, Watt AM, Mundy L, Willis CD. Over 150 potentially low-value health care practices: an Australian study. Med J Aust 2012; 197: 556-560. CBBGFGCE
- Sciubba DM, Petteys RJ, Dekutoski MB, et al. Diagnosis and management of metastatic spine disease. A review. J Neurosurg Spine 2010; 13: 94-108. CBBHIHGI
- Metastatic spinal cord compression: diagnosis and management of patients at risk of or with metastatic spinal cord compression. Clinical guidelines CG75. London: National Institute for Health and Clinical Excellence, 2008. http://www.nice.org.uk/CG75 (accessed May 2013).
- Patchell RA, Tibbs PA, Regine WF, et al. Direct decompressive surgical resection in the treat-ment of spinal cord compression caused by metastatic cancer: a randomised trial. Lancet 2005; 366: 643-648. CHDGGDHE