“Choosing Wisely”: The American Society for Radiation Oncology’s Top 5 List

Abstract

Purpose/Objective(s)To highlight five interventions that patients should question, as part of the Choosing Wisely campaign. This initiative, led by the American Board of Internal Medicine Foundation, fosters conversations between physicians and patients about treatments and tests that may be overused, unnecessary, or potentially harmful.Materials/MethodsPotential items were initially compiled using an online survey. They were then evaluated and refined by a workgroup representing the American Society of Radiation Oncology (ASTRO) Clinical Affairs and Quality, Health Policy, and Government Relations councils. Literature reviews were carried out to support the recommendation, narrative and references for each item. The final list of five items was selected by the ASTRO Board of Directors.ResultsASTRO’s five recommendations for the Choosing Wisely campaign are: (1) Don’t initiate whole breast radiation therapy as a part of breast conservation therapy in women age ≥50 with early stage invasive breast cancer without considering shorter treatment schedules. (2) Do not initiate management of low-risk prostate cancer without discussing active surveillance. (3) Do not routinely use extended fractionation schemes (>10 fractions) for palliation of bone metastases. (4) Don’t routinely recommend proton beam therapy for prostate cancer outside of a prospective clinical trial or registry. (5) Don't routinely use intensity modulated radiation therapy (IMRT) to deliver whole breast radiation therapy as part of breast conservation therapy.ConclusionsThe ASTRO list for the Choosing Wisely campaign highlights radiation oncology interventions that physicians should discuss with their patients before treatment is initiated. These five items provide opportunities for offering higher quality care. Purpose/Objective(s)To highlight five interventions that patients should question, as part of the Choosing Wisely campaign. This initiative, led by the American Board of Internal Medicine Foundation, fosters conversations between physicians and patients about treatments and tests that may be overused, unnecessary, or potentially harmful. To highlight five interventions that patients should question, as part of the Choosing Wisely campaign. This initiative, led by the American Board of Internal Medicine Foundation, fosters conversations between physicians and patients about treatments and tests that may be overused, unnecessary, or potentially harmful. Materials/MethodsPotential items were initially compiled using an online survey. They were then evaluated and refined by a workgroup representing the American Society of Radiation Oncology (ASTRO) Clinical Affairs and Quality, Health Policy, and Government Relations councils. Literature reviews were carried out to support the recommendation, narrative and references for each item. The final list of five items was selected by the ASTRO Board of Directors. Potential items were initially compiled using an online survey. They were then evaluated and refined by a workgroup representing the American Society of Radiation Oncology (ASTRO) Clinical Affairs and Quality, Health Policy, and Government Relations councils. Literature reviews were carried out to support the recommendation, narrative and references for each item. The final list of five items was selected by the ASTRO Board of Directors. ResultsASTRO’s five recommendations for the Choosing Wisely campaign are: (1) Don’t initiate whole breast radiation therapy as a part of breast conservation therapy in women age ≥50 with early stage invasive breast cancer without considering shorter treatment schedules. (2) Do not initiate management of low-risk prostate cancer without discussing active surveillance. (3) Do not routinely use extended fractionation schemes (>10 fractions) for palliation of bone metastases. (4) Don’t routinely recommend proton beam therapy for prostate cancer outside of a prospective clinical trial or registry. (5) Don't routinely use intensity modulated radiation therapy (IMRT) to deliver whole breast radiation therapy as part of breast conservation therapy. ASTRO’s five recommendations for the Choosing Wisely campaign are: (1) Don’t initiate whole breast radiation therapy as a part of breast conservation therapy in women age ≥50 with early stage invasive breast cancer without considering shorter treatment schedules. (2) Do not initiate management of low-risk prostate cancer without discussing active surveillance. (3) Do not routinely use extended fractionation schemes (>10 fractions) for palliation of bone metastases. (4) Don’t routinely recommend proton beam therapy for prostate cancer outside of a prospective clinical trial or registry. (5) Don't routinely use intensity modulated radiation therapy (IMRT) to deliver whole breast radiation therapy as part of breast conservation therapy. ConclusionsThe ASTRO list for the Choosing Wisely campaign highlights radiation oncology interventions that physicians should discuss with their patients before treatment is initiated. These five items provide opportunities for offering higher quality care. The ASTRO list for the Choosing Wisely campaign highlights radiation oncology interventions that physicians should discuss with their patients before treatment is initiated. These five items provide opportunities for offering higher quality care.