Choosing wisely in oncology: necessity and obstacles.

In the last decades, the survival of many patients with cancer improved thanks to modern diagnostic methods and progresses in therapy. Still for several tumours, especially when diagnosed at an advanced stage, the benefits of treatment in terms of increased survival or quality of life are at best modest when not marginal, and should be weighed against the potential discomfort caused by medical procedures. As in other specialties, in oncology as well the dialogue between doctor and patient should be encouraged about the potential overuse of diagnostic procedures or treatments.

Randomised comparison of complications from three different permanent central venous access systems.

Principles: We present a prospective randomised trial comparing complications from three different permanent central venous access systems (PCVAS).

Methods: The PCVAS trial groups were I, polyurethane ChemoSite (AutoSuture); II, polyurethane Port-a-Cath (Pharmacia-Upjohn); and III, silicone Port-a-Cath. The PCVAS were inserted under local anaesthesia by direct puncture of the subclavian vein, using the Seldinger technique.