Choosing Wisely: The American Society for Radiation Oncology’s Top 5 list

Hahn, Carol A.; Kavanagh, Brian D.; Bhatnagar, Ajay; Jacobson, Geraldine M.; Lutz, S; Patton, Caroline; Potters, Louis; Steinberg, Michael

doi:10.1016/j.prro.2014.06.003

Cited by 107 publications

(43 citation statements)

References 33 publications

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“…We used recommendations from the Choosing Wisely campaign proposed by the American Society of Clinical Oncology (ASCO) and the American Society for Radiation Oncology (ASTRO). Services included: imaging for staging of early prostate or breast cancer at low risk for metastasis; surveillance imaging for asymptomatic individuals treated for low-risk breast cancer, 10,13–18 intensity-modulated radiation therapy (IMRT) for whole breast radiotherapy, 19,20 and extended fractionation schemes (>10 fractions) for palliation of bone metastases 20,21 (Table 1). …”

Section: Methodsmentioning

confidence: 99%

Physician-Driven Variation in Nonrecommended Services Among Older Adults Diagnosed With Cancer

et al. 2016

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Section: Methodsmentioning

confidence: 99%

Physician-Driven Variation in Nonrecommended Services Among Older Adults Diagnosed With Cancer

et al. 2016

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“…Defining guideline concordance Criteria for guideline concordance were derived from ASCO and ASTRO CW recommendations from 2012 and 2013. [4][5][6] For each guideline, the CCN database was used to identify patients who were eligible for each CW guideline measure between January 1, 2012 and December 31, 2015. Table 1 lists the specific criteria used to define the population and concordance with each measure.…”

Section: Study Design and Data Sourcementioning

confidence: 99%

“…Both ASCO and the American Society for Therapeutic Radiology and Oncology (ASTRO) have recommended against specific, yet commonly performed, practices. [4][5][6] The extent of adoption is different for each recommendation, but early evidence is emerging that concordance with these recommendations is overall suboptimal and that opportunities exist for improvement. 7 Certain patient and provider factors may contribute to the observed variability in concordance with specific CW recommendations.…”

Section: Introductionmentioning

confidence: 99%

Choosing Wisely: Opportunities for Improving Value in Cancer Care Delivery?

Rocque

Williams

Jackson

et al. 2017

JOP

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QUESTION ASKED: What is the concordance with ASCO and the American Society for Therapeutic Radiology and Oncology Choosing Wisely (CW) measures and the cost associated with nonconcordance?SUMMARY ANSWER: Baseline concordance with selected CW measures ranged from 39% to 94%, with marked variability by cancer center. Nonconcordance was associated with higher total Medicare costs for every measure. WHAT WE DID:We conducted a retrospective analysis of Medicare claims data from 2012 to 2015 to examine concordance between care received and nine CW (six ASCO and three American Society for Therapeutic Radiology and Oncology) recommendations, as well as the associated implications for cost of care.WHAT WE FOUND: Concordance varied by CW recommendation, ranging from 39% to 94% across the University of Alabama at Birmingham Health System Cancer Community Network. Significant variability was noted in concordance across centers for all CW recommendations, with as much as an 89% difference in concordance rates between cancer centers. Nonconcordance was associated with higher costs for every measure. If concordance were to increase to 95% for all measures, we would estimate a $19 million difference in total cost of care per quarter. CONFOUNDING FACTORS:Claims-based analysis is limited by the inability to discriminate whether lack of concordance is the result of appropriate clinical indications or clinical trial participation. REAL-LIFE IMPLICATIONS:These results demonstrate ample room for reduction of low-value care and corresponding costs associated with the CW recommendations. Because variability in concordance was driven primarily by cancer centers, rather than by patient factors, continued provider and patient education about these low-value services is needed to improve the value of cancer care.

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“…The Choosing Wisely campaign is also calling attention to “Top Five” tests and procedures in over 40 specialties that are expensive and commonly performed but lack clinical evidence (American Board of Internal Medicine [ABIM] Foundation ; Hahn et al. ; Schnipper et al. ).…”

mentioning

confidence: 99%

The Role of Patient Factors, Cancer Characteristics, and Treatment Patterns in the Cost of Care for Medicare Beneficiaries with Breast Cancer

Herrin

Soulos

et al. 2015

Health Services Research

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Objective. To characterize Medicare expenditures on initial breast cancer care and examine variation in expenditures across hospital referral regions (HRRs). Data Source. We identified 29,110 women with localized breast cancer diagnosed in [2005][2006][2007][2008] and matched controls from the Surveillance, Epidemiology, and End Results-Medicare linked database. Study Design. Using hierarchical generalized linear models, we estimated per patient Medicare expenditure on initial breast cancer care across HRRs and assessed the contribution of patient, cancer, and treatment factors to regional variation via incremental models. Principal Findings. Mean Medicare expenditure for initial breast cancer care was $19,255 per patient. The average expenditures varied from $15,053 in the lowestspending HRR quintile to $23,480 in the highest-spending HRR quintile. Patient sociodemographic, comorbidity, and tumor characteristics explained only 1.8 percent of the difference in expenditures between the lowest-and highest-spending quintiles, while use of specific treatment modalities explained 14.5 percent of the difference. Medicare spending on radiation therapy differed the most across the quintiles, with the use of intensity modulated radiation therapy increasing from 1.7 percent in the lowestspending quintile to 11.6 percent in the highest-spending quintile. Conclusions. Medicare expenditures on initial breast cancer care vary substantially across regions. Treatment factors are major contributors to the variation.

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Choosing Wisely: The American Society for Radiation Oncology’s Top 5 list

Abstract: The ASTRO list for the Choosing Wisely campaign highlights radiation oncology interventions that should be discussed between physicians and patients before treatment is initiated. These 5 items provide opportunities to offer higher quality and less costly care.

Cited by 107 publications

References 33 publications

Physician-Driven Variation in Nonrecommended Services Among Older Adults Diagnosed With Cancer

Physician-Driven Variation in Nonrecommended Services Among Older Adults Diagnosed With Cancer

Choosing Wisely: Opportunities for Improving Value in Cancer Care Delivery?

The Role of Patient Factors, Cancer Characteristics, and Treatment Patterns in the Cost of Care for Medicare Beneficiaries with Breast Cancer

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