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Karim S, Doll CM, Dingley B, Merchant SJ, de Moraes FY, Booth CM. The Choosing Wisely Oncology Canada Cancer List: An Update. J Cancer Policy 2023; 37:100431. [PMID: 37391095 DOI: 10.1016/j.jcpo.2023.100431] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Accepted: 06/22/2023] [Indexed: 07/02/2023]
Abstract
BACKGROUND Choosing Wisely (CW) Canada is a national campaign to identify unnecessary or harmful services that are frequently used in Canada. The original CW Oncology Canada Cancer list was developed in 2014. A CW Oncology Canada working group was established to review new evidence and guidelines and to update the current CW Oncology Canada Cancer List. METHODS Between January and March 2022, we conducted a survey of members of the Canadian Association of Medical Oncology (CAMO), Canadian Association of Radiation Oncology (CARO) and the Canadian Society of Surgical Oncology (CSSO). We took the feedback from the survey, including potential new recommendations as well as those that were thought to be no longer relevant and up to date, and conducted a literature review with the assistance of the Canadian Agency for Drugs and Technology in Health (CADTH). The final updated list of recommendations was made by the CW Oncology Canada working group based on a consensus process. RESULTS We reviewed two potential recommendations to add and two potential recommendations to remove from the existing CW Oncology Canada Cancer List. The recommendation "Do not prescribe whole brain radiation over stereotactic radiosurgery for patient with limited brain metastases (≤4 lesions)" was supported by several evidence-based guidelines with the strength of recommendations ranging from strong to moderate and the quality of evidence ranging from level 1 to level 3. After reviewing the evidence, the working group felt that the other potential recommendation to add and the two potential recommendations to remove did not have sufficient strength and quality of evidence at this time to be added or removed from the list. CONCLUSION The updated Choosing Wisely Oncology Canada Cancer List consists of 11 items that oncologists should question in the treatment of patients with cancer. This list can be used to design specific interventions to reduce low value care.
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Affiliation(s)
- Safiya Karim
- Department of Oncology, University of Calgary, Calgary, AB, Canada.
| | - Corinne M Doll
- Department of Oncology, University of Calgary, Calgary, AB, Canada
| | | | - Shaila J Merchant
- Department of Oncology, Queen's University, Kingston, ON, Canada; Division of Cancer Care and Epidemiology, Queen's University Cancer Research Institute, Kingston, ON, Canada
| | - Fabio Ynoe de Moraes
- Department of Oncology, Queen's University, Kingston, ON, Canada; Division of Cancer Care and Epidemiology, Queen's University Cancer Research Institute, Kingston, ON, Canada
| | - Christopher M Booth
- Department of Oncology, Queen's University, Kingston, ON, Canada; Division of Cancer Care and Epidemiology, Queen's University Cancer Research Institute, Kingston, ON, Canada
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Karim S, Doll CM, Dingley B, Merchant S, de Moraes FY, Booth CM. Are the Choosing Wisely Canada Cancer recommendations relevant and up to date with the current evidence? J Cancer Policy 2023; 35:100406. [PMID: 36693524 DOI: 10.1016/j.jcpo.2023.100406] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Revised: 01/18/2023] [Accepted: 01/19/2023] [Indexed: 01/22/2023]
Abstract
INTRODUCTION The Choosing Wisely (CW) Canada campaign was launched in 2012 to identify low-value, unnecessary and/or harmful services that are frequently used. The CW Canada Cancer list was developed in 2014 by a task force convened by the Canadian Partnership Against Cancer. The list outlines ten harmful or low-value practices that oncologists should avoid. We conducted a study of oncologists to understand the familiarity with the current recommendations and whether these continue to be relevant and up to date. METHODS An electronic survey was developed by the members of the CW Oncology Working Group and distributed to practicing oncologists. The survey consisted of questions on 1) the familiarity of the existing CW Canada Cancer list 2) the relevance of the current list to current evidence and 3) any recommendation(s) that could be added or removed from the existing list. Descriptive statistics were used to analyze responses and narrative analysis was used to identify themes in open-ended questions. RESULTS Between January 14 and May 3, 2022, 151 survey responses were received (overall response rate of 20 %) from 68 medical oncologists (45 % of study cohort, response rate 32 %), 54 radiation oncologists (36 % of study cohort, response rate 14 %) and 29 surgical oncologists (19 % of study cohort, response rate 18 %). Seventy-nine percent (120/151) of respondents were familiar with the current list and 65 % (78/119) said they implemented the recommendations "always" or "most of the time". Eight recommendations had > 80 % agreement that they were relevant and up to date with current evidence. There was interest in adding a new recommendation to avoid whole brain radiation and consider stereotactic radiosurgery (SRS) in patients with ≤ 4 brain metastases. CONCLUSIONS There is excellent familiarity with the CW Canada Cancer list amongst the survey respondents and most recommendations continue to be relevant and up to date with current evidence. There is an opportunity to educate physicians about the intent of the campaign and to add a new recommendation on the use of SRS for patients with a limited number of brain metastases. There is also an opportunity to identify barriers at the patient, provider and institution level that are hindering adoption of the CW Canada Cancer list POLICY SUMMARY: This survey will impact implementation and publication of an updated CW Canada Cancer list.
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Affiliation(s)
- Safiya Karim
- Department of Oncology, University of Calgary, Calgary, AB, Canada.
| | - Corinne M Doll
- Department of Oncology, University of Calgary, Calgary, AB, Canada
| | | | - Shaila Merchant
- Department of Oncology, Queen's University, Kingston, ON, Canada; Division of Cancer Care and Epidemiology, Queen's University Cancer Research Institute, Kingston, ON, Canada
| | - Fabio Ynoe de Moraes
- Department of Oncology, Queen's University, Kingston, ON, Canada; Division of Cancer Care and Epidemiology, Queen's University Cancer Research Institute, Kingston, ON, Canada
| | - Christopher M Booth
- Department of Oncology, Queen's University, Kingston, ON, Canada; Division of Cancer Care and Epidemiology, Queen's University Cancer Research Institute, Kingston, ON, Canada
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de Vasconcelos Silva ACP, Araujo BM, Spiegel T, da Cunha Reis A. May value-based healthcare practices contribute to comprehensive care for cancer patients? A systematic literature review. J Cancer Policy 2022; 34:100350. [DOI: 10.1016/j.jcpo.2022.100350] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Revised: 07/28/2022] [Accepted: 07/30/2022] [Indexed: 12/30/2022]
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Rubagumya F, Mitera G, Ka S, Manirakiza A, Decuir P, Msadabwe SC, Adani Ifè S, Nwachukwu E, Ohene Oti N, Borges H, Mutebi M, Abuidris D, Vanderpuye V, Booth CM, Hammad N. Choosing Wisely Africa: Ten Low-Value or Harmful Practices That Should Be Avoided in Cancer Care. JCO Glob Oncol 2021; 6:1192-1199. [PMID: 32735489 PMCID: PMC7392774 DOI: 10.1200/go.20.00255] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
PURPOSE Choosing Wisely Africa (CWA) builds on Choosing Wisely (CW) in the United States, Canada, and India and aims to identify low-value, unnecessary, or harmful cancer practices that are frequently used on the African continent. The aim of this work was to use physicians and patient advocates to identify a short list of low-value practices that are frequently used in African low- and middle-income countries. METHODS The CWA Task Force was convened by the African Organization for Research and Training in Cancer and included representatives from surgical, medical, and radiation oncology, the private and public sectors, and patient advocacy groups. Consensus was built through a modified Delphi process, shortening a long list of practices to a short list, and then to a final list. A voting threshold of ≥ 60% was used to include an individual practice on the short list. A consensus was reached after a series of teleconferences and voting processes. RESULTS Of the 10 practices on the final list, one is a new suggestion and 9 are revisions or adaptations of practices from previous CW campaign lists. One item relates to palliative care, 8 concern treatment, and one relates to surveillance. CONCLUSION The CWA initiative has identified 10 low-value, common interventions in Africa’s cancer practice. The success of this campaign will be measured by how the recommendations are implemented across sub-Saharan Africa and whether this improves the delivery of high-quality cancer care.
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Affiliation(s)
- Fidel Rubagumya
- Rwanda Military Hospital, Kigali, Rwanda.,University of Global Health Equity, Burera, Rwanda
| | | | - Sidy Ka
- Joliot Curie Cancer Institute, Dakar, Senegal
| | | | | | | | | | | | | | | | | | - Dafalla Abuidris
- National Cancer Institute, University of Geriza, Wad Madani, Sudan
| | | | - Christopher M Booth
- Kingston Health Science Center, Queen's University, Kingston, Ontario, Canada
| | - Nazik Hammad
- Kingston Health Science Center, Queen's University, Kingston, Ontario, Canada
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Shah H, Surujballi J, Awan AA, Hutton B, Arnaout A, Shorr R, Vandermeer L, Alzahrani MJ, Clemons M. A scoping review characterizing "Choosing Wisely®" recommendations for breast cancer management. Breast Cancer Res Treat 2020; 185:533-547. [PMID: 33156490 DOI: 10.1007/s10549-020-06009-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Accepted: 10/29/2020] [Indexed: 11/29/2022]
Abstract
PURPOSE Choosing Wisely (CW)® was created by the American Board of Internal Medicine (ABIM) to promote patient-physician conversations about unnecessary medical interventions. Similarly, other countries created their own panels of experts called "CW® campaigns" which review recommendations submitted by that country's oncology societies. We performed a scoping review to consolidate CW® recommendations from different groups with respect to breast cancer care. METHODS A systematic search of Medline and Embase was designed by an information specialist for publications presenting CW® recommendations for breast cancer care practices from 2011-2020. We also reviewed the websites of all CW® campaigns and reference sections of each CW® recommendation. Two reviewers independently screened studies for inclusion and performed data extraction. Findings were summarized narratively. RESULTS Review of ABIM CW® recommendations showed 19 breast cancer-related recommendations pertaining to; screening (n = 4), radiological staging (n = 2), treatment (n = 10), surveillance (n = 2), and miscellaneous (genetic testing; n = 1). Of 22 countries with CW® campaigns, 10 published recommendations for breast cancer. Over half (57%) of recommendations were supported by more than one country. No recommendations were refuted between campaigns. Two campaigns developed 3 novel recommendations on new topics, including chemotherapy in ductal carcinoma in situ (Italy) and comparison of screening imaging modalities (Portugal). CONCLUSIONS CW® recommendations focus on reducing overutilization of investigations and treatments. There was a high rate of consensus between different CW® campaigns. As health care systems globally move attention to reduce low-value care, further studies are required to address adherence to these current recommendations and develop new recommendations.
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Affiliation(s)
- Hely Shah
- Department of Medicine, The Ottawa Hospital, Ottawa, ON, Canada
| | - Julian Surujballi
- Division of Medical Oncology, The Ottawa Hospital Cancer Centre, 501 Smyth Road, Ottawa, ON, Canada
| | - Arif Ali Awan
- Division of Medical Oncology, The Ottawa Hospital Cancer Centre, 501 Smyth Road, Ottawa, ON, Canada
| | - Brian Hutton
- The University of Ottawa, School of Epidemiology and Public Health, and Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Angel Arnaout
- Department of Surgery, The Ottawa Hospital, Ottawa, ON, Canada
| | | | | | - Mashari Jemaan Alzahrani
- Division of Medical Oncology, The Ottawa Hospital Cancer Centre, 501 Smyth Road, Ottawa, ON, Canada
| | - Mark Clemons
- Department of Medicine, The Ottawa Hospital, Ottawa, ON, Canada. .,Division of Medical Oncology, The Ottawa Hospital Cancer Centre, 501 Smyth Road, Ottawa, ON, Canada. .,The University of Ottawa, School of Epidemiology and Public Health, and Ottawa Hospital Research Institute, Ottawa, ON, Canada.
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Ratosa I, Chirilă ME, Steinacher M, Kozma E, Vojtíšek R, Franco P, Poortmans P. Hypofractionated radiation therapy for breast cancer: Preferences amongst radiation oncologists in Europe - Results from an international survey. Radiother Oncol 2020; 155:17-26. [PMID: 33065187 DOI: 10.1016/j.radonc.2020.10.008] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Revised: 09/24/2020] [Accepted: 10/05/2020] [Indexed: 12/11/2022]
Abstract
BACKGROUND AND PURPOSE We aimed to assess the prescription preference about hypofractionated radiation therapy (HFRT) for breast cancer (BC) patients amongst radiation oncologists (ROs) practicing in Europe and to identify restraints on HFRT utilisation. MATERIALS AND METHODS An online survey was circulated amongst ROs in Europe through personal, RO and BC societies' networks, from October 2019 to March 2020. The statistical analyses included descriptive statistics, chi-squared testing, and logistic regression analysis. RESULTS We received 412 responses from 44 countries. HFRT was chosen as the preferred schedule for whole breast irradiation (WBI) by 54.7% and for WBI with regional nodes irradiation (RNI) by 28.7% of the responding ROs. In the case of postmastectomy RT with or without reconstruction, HFRT was preferred by 21.1% and 29.6%, respectively. Overall, 69.2% of the responding ROs selected at least one factor influencing the decision to utilise HFRT, the most frequent of which included age (51.4%), RNI (46.9%), internal mammary lymph nodes irradiation (39.7%), BC stage (33.5%) and implant-based breast reconstruction (31.6%). ROs working in academic centres (odds ratio, (OR), 1.7; 95% confidence interval, (CI); 1.1-2.6, p = 0.019), practicing in Western Europe (OR, 4.2; 95%CI; 2.7-6.6, p < 0.0005) and/or dedicating >50% of clinical time to BC patients (OR, 2.5; 95%CI; 1.5-4.2, p = 0.001) more likely preferred HFRT. CONCLUSION Although HFRT is recognised as a new standard, its implementation in routine RT clinical practice across Europe varies for numerous reasons. Better dissemination of evidence-based recommendations is advised to improve the level of awareness about this clinical indication.
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Affiliation(s)
- Ivica Ratosa
- Division of Radiation Oncology, Institute of Oncology Ljubljana, Slovenia; Faculty of Medicine, University of Ljubljana, Slovenia.
| | | | | | - Elvisa Kozma
- Oncology Service, University Hospital, Tirana, Albania
| | - Radovan Vojtíšek
- Department of Oncology and Radiotherapy, University Hospital in Pilsen, Czech Republic
| | | | - Philip Poortmans
- Iridium Kankernetwerk, Wilrijk-Antwerp, Belgium; University of Antwerp, Faculty of Medicine and Health Sciences, Wilrijk-Antwerp, Belgium
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Kim JY, Lee KE, Kim K, Lee MA, Yoon WS, Han DS, Ahn SG, Kang JH. Choosing Wisely: The Korean Perspective and Launch of the 'Right Decision in Cancer Care' Initiative. Cancer Res Treat 2020; 52:655-660. [PMID: 32599973 PMCID: PMC7373865 DOI: 10.4143/crt.2020.221] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2020] [Accepted: 05/28/2020] [Indexed: 12/31/2022] Open
Abstract
Government healthcare expenditure is rising in Korea, and the costs incurred by patients in Korea exceed those incurred by patients in other Organization for Economic Co-operation and Development countries. Despite the increasing health expenditure, patient demand for services is increasing as well, so it is now becoming recognized that cancer care needs to be balanced. The most important measure in cancer care optimization is to provide high-quality care while keeping costs sustainable. The Korean Cancer Association considers the current situation of cancer therapy in Korea the foremost issue, which has led to the implementation of the nationwide ‘Right Decisions in Cancer Care’ initiative. This initiative is based on the concepts of medical professionalism in that it should be led by physicians working in the field of oncology, that education should be offered to patients and clinicians, and that it should influence healthcare policy. In this article, we introduce the nationwide ‘Right Decision in Cancer Care’ initiative and highlight the five initial items on its agenda. The agenda is open to expansion and update as the medical environment evolves and additional clinical evidence becomes available.
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Affiliation(s)
- Joo-Young Kim
- Department of Radiation Oncology, Research Institute and Hospital, National Cancer Center, Goyang, Korea
| | - Kyoung Eun Lee
- Division of Hematology-Oncology, Department of Internal Medicine, Ewha Womans University School of Medicine, Seoul, Korea
| | - Kyubo Kim
- Department of Radiation Oncology, Ewha Womans University School of Medicine, Seoul, Korea
| | - Myung Ah Lee
- Division of Hematology-Oncology, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Won Sup Yoon
- Department of Radiation Oncology, Korea University Ansan Hospital, Ansan, Korea
| | - Dong Seok Han
- Department of Surgery, Seoul National University Boramae Hospital, Seoul, Korea
| | - Sung Gwe Ahn
- Department of Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Jung-Hun Kang
- Division of Hematology-Oncology, Department of Internal Medicine, Gyeongsang National University College of Medicine, Jinju, Korea
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Lupichuk S, Tilley D, Surgeoner B, King K, Joy AA. Unwarranted imaging for distant metastases in patients with newly diagnosed ductal carcinoma in situ and stage I and II breast cancer. Can J Surg 2020; 63:E100-E109. [PMID: 32109016 DOI: 10.1503/cjs.003519] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
Background In 2012, the American Society of Clinical Oncology (ASCO) released a Choosing Wisely Top Five list that included a recommendation against ordering advanced imaging tests to screen for metastases among asymptomatic patients with early breast cancer. Our provincial breast cancer staging guideline was subsequently updated. We report on the use of unwarranted bone scanning (BS), computed tomography (CT), nonbreast magnetic resonance imaging (MRI) and positron emission tomography (PET) among women diagnosed with stage 0–II breast cancer in Alberta in 2011–2015. Methods The cohort was retrospectively ascertained from the Alberta Cancer Registry. We used additional provincial data sources to obtain information about diagnostic imaging tests completed from biopsy to surgical date plus 4 months. The reason for each BS, CT, MRI and PET was abstracted. We calculated the frequency of advanced imaging tests completed for routine metastatic screening. Results Of 10 142 patients included, 2887 (28.5%) had at least 1 advanced imaging test completed for routine metastatic screening. Of these 2887 patients, 438 (15.2%) had a follow-up BS, CT, MRI or PET, and 28 patients (1.0%) had a nonbreast imageguided biopsy. Use of routine advanced imaging tests did not change clearly over time. Conclusion Our results demonstrate persistent use of advanced imaging tests for routine metastatic screening among patients with stage 0–II breast cancer despite the release of the ASCO Choosing Wisely recommendations and the update of our provincial breast cancer staging guideline. Investigation of strategies for guideline translation to improve upon value-based care of patients with early breast cancer is warranted.
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Affiliation(s)
- Sasha Lupichuk
- From the Tom Baker Cancer Centre, Calgary, Alta. (Lupichuk); CancerControl Alberta, Alberta Health Services, Calgary, Alta. (Tilley, Surgeoner); and the Cross Cancer Institute, Edmonton, Alta. (King, Joy)
| | - Derek Tilley
- From the Tom Baker Cancer Centre, Calgary, Alta. (Lupichuk); CancerControl Alberta, Alberta Health Services, Calgary, Alta. (Tilley, Surgeoner); and the Cross Cancer Institute, Edmonton, Alta. (King, Joy)
| | - Brae Surgeoner
- From the Tom Baker Cancer Centre, Calgary, Alta. (Lupichuk); CancerControl Alberta, Alberta Health Services, Calgary, Alta. (Tilley, Surgeoner); and the Cross Cancer Institute, Edmonton, Alta. (King, Joy)
| | - Karen King
- From the Tom Baker Cancer Centre, Calgary, Alta. (Lupichuk); CancerControl Alberta, Alberta Health Services, Calgary, Alta. (Tilley, Surgeoner); and the Cross Cancer Institute, Edmonton, Alta. (King, Joy)
| | - Anil Abraham Joy
- From the Tom Baker Cancer Centre, Calgary, Alta. (Lupichuk); CancerControl Alberta, Alberta Health Services, Calgary, Alta. (Tilley, Surgeoner); and the Cross Cancer Institute, Edmonton, Alta. (King, Joy)
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Di Lalla V, Fortin B, Pembroke C, Freeman C, Yassa M, Hijal T. Are radiation oncologists following guidelines? An audit of practice in patients with uncomplicated bone metastases. Tech Innov Patient Support Radiat Oncol 2019; 9:13-17. [PMID: 32095590 PMCID: PMC7033799 DOI: 10.1016/j.tipsro.2018.12.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2018] [Revised: 12/12/2018] [Accepted: 12/22/2018] [Indexed: 12/18/2022] Open
Abstract
At our center single fraction radiotherapy is used in accordance with guidelines. Patient age, performance status and tumor histology influence treatment choice. We added a quality indicator to our performance dashboard to improve adherence. This strategy can be used in other complex practices and improve quality of care.
Background Best-practice guidelines recommend single-fraction (SFRT) instead of multi-fraction radiation therapy (MFRT) for uncomplicated symptomatic bone metastases. SFRT is comparable to MFRT in relieving pain, convenient for patients, and cost-effective. Patterns of practice in Canada reveal that SFRT is underused, with significant variability across the country. We audited SFRT use and studied factors that may influence treatment decisions at a large academic tertiary care center in Quebec, Canada. Methods Patients who received radiotherapy for uncomplicated bone metastases between February 2014 and March 2015 were reviewed. Age, gender, primary histology, site of metastases and performance status were identified as potential factors affecting fractionation. These were explored by Fisher's test on univariate analysis and logistic regression for multivariate analysis. Retreatment rates were analyzed with cumulative incidence and compared with Gray's test. Results 254 radiotherapy courses were administered to 165 patients, 85.4% of which were delivered using a single fraction of 8 Gy. Patients age less than 70 years and those with breast histology were more likely to receive MFRT (p = 0.04; p = 0.0046). Performance status (ECOG) was a significant predictor of fractionation because of high correlations between young age, breast histology, and ECOG status (p = 0.03). Follow-up was too short in 40% of patients to derive definitive conclusions on retreatment. Conclusions In accordance with current guidelines, our audit confirms that use of SFRT in patients with uncomplicated bone metastases at our center is high. We identified that patient age, primary histology, and performance status influenced fractionation. Incorporation of this quality indicator into our performance dashboard will allow assessment of retreatment differences and other criteria that may also influence treatment choice.
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Affiliation(s)
| | | | | | | | - Michael Yassa
- Hôpital Maisonneuve-Rosemont, Montreal, Quebec, Canada
| | - Tarek Hijal
- McGill University Health Centre, Montreal, Quebec, Canada
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Saletti P, Sanna P, Gabutti L, Ghielmini M. Choosing wisely in oncology: necessity and obstacles. ESMO Open 2018; 3:e000382. [PMID: 30018817 PMCID: PMC6045771 DOI: 10.1136/esmoopen-2018-000382] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2018] [Revised: 05/25/2018] [Accepted: 05/26/2018] [Indexed: 12/25/2022] Open
Abstract
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. Several oncological societies produced recommendations similar to those proposed by other medical disciplines adhering to the Choosing Wisely (CW) campaign. In this review, we describe what was reported in the medical literature concerning adequacy of screening, diagnostic, treatment and follow-up procedures and the potential impact on them of the CW. We only marginally touch on the more complex topic of treatment appropriateness, for which several evaluation methods have been developed (including the European Society for Medical Oncology-magnitude of clinical benefit scale). Finally, we review the possible obstacles for the development of CW in the oncological setting and focus on the strategies which could allow CW to evolve in the cancer field, so as to enhance the therapeutic relationship between medical professionals and patients and promote more appropriate management.
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Affiliation(s)
- Piercarlo Saletti
- Medical Oncology Clinic, Oncology Institute of Southern Switzerland, Bellinzona, Switzerland.
| | - Piero Sanna
- Palliative and Supportive Care Clinic, Oncology Institute of Southern Switzerland, Bellinzona, Switzerland
| | - Luca Gabutti
- Internal Medicine Department, Ente Ospedaliero Cantonale (EOC), Choosing Wisely EOC, Bellinzona, Switzerland
| | - Michele Ghielmini
- Medical Oncology Clinic, Oncology Institute of Southern Switzerland, Bellinzona, Switzerland
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