Presentation (CTI)

OBJECTIVES: The American Society of Clinical Oncology launched Choosing Wisely (CW) recommendations in early 2012 with the aim to enhance the value of cancer care. One of the CW recommendations is to not use staging imaging procedures in early-stage prostate cancer (PC) patients at low risk of developing metastasis. We examined the impact of CW on staging imaging in Veteran patients diagnosed with early-stage PC.
METHODS: Using the Veterans Affairs Healthcare database, we conducted a retrospective cohort study for adult men diagnosed with T1c/T2a incident PC with a Gleason score of ≤6 and prostate-specific antigen level of <10 ng/ml during 2008-2022 (N=31,012). We identified the proportion of patients who received at least one staging imaging procedure, including Positron Emission Tomography, Computerized Tomography, and radionuclide bone scans in three months before and three months after cancer diagnosis. We then conducted an interrupted time-series (ITS) analysis and segmented regression to evaluate the impact of CW on the rate of staging imaging use.
RESULTS: About one-third of patients (32%) received staging imaging pre-CW compared to 24.1% post-CW. There was a significant 0.21% point per quarter reduction in the staging imaging use between January 2008 and March 2012 (p<0.0001), and also a significant level change immediately post-CW. Between April 2012 and September 2013, there was a transitory non-significant additional decline in the rate of staging imaging use post-CW compared to pre-CW (p=0.1134). However, between October 2013 and December 2015, there was a slight increase in the rate of staging imaging use by 0.17% points per quarter (p<0.0001).
CONCLUSIONS: The ASCO’s CW recommendation resulted in a non-significant and short-term decline in the use of staging imaging post-CW. Our study findings demonstratethat ASCO’s CW campaign may have inadequate effectiveness in reducing the use of low-value care in Veteran patients with PC.