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Over 150 potentially low-value health care practices: an Australian study

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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),