Regarding adjuvant medical therapy, omission of endocrine therapy is an option for patients with very low-risk tumors.
The latter is also sometimes called therapy omission, i.e. the omission of drug treatment that is clinically indicated and likely to be beneficial for the patient.
During 1989 2002, 25.2% of the patients aged ⩾75 years received 'inappropriate' breast-conserving therapy (omission of radiotherapy, ALND or both).
The indicators on hazardous drug treatment represent drug disease interactions, whereas those on rational drug treatment can be used to indicate therapy omissions.
The Swedish indicators not only comprised indicators on drug disease interactions but also therapy omissions, both included among the diagnosis-specific indicators.
The most recent update [ 31] shows improvements, but still lacks some aspects of quality of drug use, such as DDIs, drug duplications and underprescribing (therapy omissions).
The criteria are divided into 65 criteria for potentially inappropriate prescriptions (STOPP) and 22 criteria for therapy omissions (START), each organised by physiological systems.
Among the currently available criteria/indicators, the Swedish ones would be most comparable to the STOPP and START criteria [ 35], which cover aspects on both IDU and therapy omissions, as well as DDIs and drug duplication.
They comprise several aspects of quality of drug prescribing, including inappropriate drugs, indication of drug use, drug dosage, polypharmacy, drug duplications, DDIs, drug use in decreased renal function, drug symptom/disease interactions and therapy omissions.
These criteria are largely based on medical conditions, covering both drug disease interactions and therapy omissions, and include aspects on drug dosing, renal function, DDIs and monitoring of drug effects [ 36].
However, since etoposide is considered a critical component of therapy, its omission in a young patient with a potentially curable malignancy was thought inappropriate.
