Top-Quality Oncologists Exercise Discretion When Selecting Supportive Care Therapies for Cancer Patients

By Casey Patterson
July 18, 2018

Grand Rounds is committed to partnering with employers to connect their employees with the highest quality physicians. In evolving our physician quality algorithm, our Data Science team is continually evaluating physicians’ clinical practice patterns, and the results paint a stark portrait of medicine today.

SUPPORTIVE CARE THERAPIES FOR CANCER PATIENTS: Not all oncologists are created equal.

One in five cancer patients undergoes chemotherapy treatment in the U.S. each year.1 Many patients dread chemotherapy due to its well-known side effects: nausea and vomiting. In one 1982 study, researchers found that up to 20% of patients postponed or even refused curative chemotherapy treatment due to fear of nausea and vomiting.2

Since then, more effective drugs for combatting these side effects, known as antiemetics, have come to market. Although truly life-saving for many patients, some antiemetics come with a high price tag and may not be appropriate for a given patient based on their treatment plan. Each patient’s cancer journey is unique. In some cases these supportive therapies can cause a patient more harm than good, taking a major pass at their wallet without clinical benefit.

The American Society of Clinical Oncology (ASCO) and the National Comprehensive Cancer Network (NCCN) publish guidelines on the appropriate administration of specific classes of antiemetics by type of chemotherapy treatment. Unnecessary antiemetic prescribing has been seen in as many as 24% of patients,3 and is one of the top ten sources of overuse identified by ASCO’s Choosing Wisely guidelines.4 In fact, some chemotherapy agents have such a low risk of chemotherapy-induced nausea and vomiting (CINV) that antiemetic therapy is not recommended.

Based on our analysis of patients receiving chemotherapy treatment with minimal CINV risk, we’ve found that top-decile oncologists are 18% less likely to use the most expensive antiemetic drugs compared to bottom-decile oncologists. With nearly $2 billion spent on antiemetic drug therapies in the U.S. each year, more appropriate use of these therapies could save hundreds of millions of dollars in annual health care spending.5

While treating and comforting cancer patients can be as much an art as it is a science, published guidelines can help oncologists care for their patients without causing an unnecessary financial burden. It’s clear from our analyses that higher quality oncologists are keeping these guidelines in mind when treating their patients, thereby avoiding administering medications that are unlikely to have a clinical benefit. Connecting employees to higher quality oncologists can spare the impact of unnecessary treatment costs on both employers and employees alike.

Read additional analyses in the Grand Rounds Data Insights series here.


  1. “Cancer Patients Receiving Chemotherapy: Opportunities for Better Management,” Milliman, Inc.,
  2. “Anticipatory vomiting in women receiving cyclophosphamide, methotrexate, and 5-FU (CMF) adjuvant chemotherapy for breast carcinoma,” Cancer Treatment Reports (1982),
  3. “Changes in Antiemetic Overuse in Response to Choosing Wisely Recommendations,” JAMA Oncology (2017),
  4. “Five More Things Physicans and Patients Should Question,” Choosing Wisely, ASCO,
  5. Estimate based on 2018 projected WW sales here and assumption that U.S. accounts for 50% of spend

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Casey Patterson

Casey Patterson

Casey is a member of the Data Products team at Grand Rounds. She is passionate about unlocking the potential of secondary health data sources to better inform the delivery of patient care and development of health technology. Prior to joining Grand Rounds, Casey supported academic research teams in tackling a broad range of health care challenges using administrative claims and electronic health record data.