International Journal of Radiation Oncology*Biology*Physics
The ProfessionAre We Choosing Wisely in Radiation Oncology Practice–Findings From an Australian Population-Based Study
Introduction
In 2010, Howard Brody challenged medical specialty societies in the United States to create a list of the “top 5” low-value medical tests or treatments that were overused or misused.1 The American Board of Internal Medicine responded by introducing the Choosing Wisely (CW) campaign to engage clinicians and patients in conversation about unnecessary non–evidence-based tests and treatments. The American Society for Radiation Oncology (ASTRO) first embraced the CW campaign by introducing 5 recommendations on evidence-based radiation oncology practice in 2010,2 followed by another 5 recommendations the following year.3 Several international radiation oncology societies, such as the UK Royal College of Radiologists4 and the Canadian Association of Radiation Oncology,5 have followed suit, with tailored CW recommendations to meet the unique needs and healthcare systems of the respective countries.
The Royal Australian and New Zealand College of Radiologists Faculty of Radiation Oncology has also taken on this challenge, having developed 5 radiation oncology–specific CW recommendations in 2016 (Table 1).6 These recommendations are largely an adaptation of the ASTRO recommendations. The aim of this study is to assess the adoption of the CW recommendations evaluable using a population-based administrative dataset over time.
Section snippets
Data source
The Victoria Radiotherapy Minimum Data Set (VRMDS) is one of the administrative databases maintained by the Victoria Department of Health and Human Service. The VRMDS captures all episodes of radiation therapy delivered across all radiation therapy services in the state of Victoria, Australia.
Study population
This study included patients with cancer who received radiation therapy between 2013 (before the CW campaign) and 2017 (after release of the CW recommendations) as captured in the VRMDS. Group 1 included
Results
Of the 8204 patients who had breast radiation therapy (Group 1), 5356 (65%) had hypofractionation. There was an increase in uptake of hypofractionation from 42% in 2013 to 82% in 2017 (P < .001) (Table 2). Although patients treated in private (58%) and regional centers (56%) were less likely to have hypofractionation compared with patients treated in public (71%) and metropolitan (68%) institutions, respectively (P < .001) (Table 3), the progressive increase in uptake of hypofractionation was
Discussion
This is the first population-based study in Australia to evaluate adoption of the CW recommendations since the release of the Royal Australian and New Zealand College of Radiologists radiation oncology CW recommendations in 2016. For all 3 evaluable recommendations, we observed a change in practice in line with the CW recommendations.
To ensure maximal impact of the CW campaign, its recommendations need to focus on noncontroversial evidence-based practice and where there is reliable local data
Conclusions
This population-based study in Victoria, Australia, has shown increasing adoption of evidence-based practice in radiation oncology, in line with the CW recommendations, though it is not possible to confirm whether the CW campaign itself directly influenced the change in practice. Some of the CW recommendations may also need to be revised to reflect rapidly evolving evidence in the field of radiation oncology.
Acknowledgment
We acknowledge the assistance of the Victorian Department of Health and Human Services Center for Victorian Data Linkage (CVDL) in providing access to the data.
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Disclosures: none.