A recent analysis found that ASCO's Choosing Wisely initiative are an effective strategy to enhance value-based care among patients with early-stage prostate cancer, according to findings presented during the 2022 National Comprehensive Cancer Network Annual Conference (Abstract HSR22-174). The recommendation to not use staging imaging in this patient population coincided with a significant decline in the use of unnecessary staging imaging procedures post-Choosing Wisely implementation, according to study author Ami Vyas, PhD, MS, MBA, Assistant Professor of Pharmacy Practice at the University of Rhode Island.
"In 2012, the American Board of Internal Medicine launched the Choosing Wisely initiative with the purpose of identifying low value health care services, and hence reduce health care costs," Vyas noted. "In April 2012, the American Society of Clinical Oncology identified recommendations for cancer care with the aim to enhance the value of cancer care and reduce the use of low-value services."
One of those recommendations was not to use imaging procedures for the staging in early-stage prostate cancer patients who are at low risk of developing metastasis. To better understand the impact of this recommendation, Vyas and colleagues conducted a retrospective observational cohort study to assess the impact of the Choosing Wisely initiative on the use of staging imaging in older patients with early-stage prostate cancer.
Methods & Findings
The researchers used the SEER-Medicare linked database. Between 2007 and 2016, they identified 55,705 men aged 66 or older at the first primary diagnosis of less than T1c/T2a or T2 not-otherwise-specified incident prostate cancer, with a Gleason score of 6 or less or PSA level of 10 ng/ml or less.
"For the staging imaging procedures, we examined PET scans, CT scans, and radionuclide bone scans that were identified from the Medicare claims," said Vyas, during her presentation. "The proportion of patients with at least one claim for any of these staging imaging procedures in the 3 months prior to and 3 months following prostate cancer diagnosis were identified for the pre-Choosing Wisely period and the post-Choosing Wisely time period."
The researchers also included several covariates in their analysis, according to Vyas. These included patient demographic and socioeconomic characteristics, as well as clinical characteristics and comorbidities. Additionally, they also controlled for external health care environmental factors in their analysis.
"We performed an interrupted time series analysis and segmented regression to assess if the Choosing Wisely initiative reduced staging imaging of procedures in our study cohort," noted Vyas. They conducted a sensitivity analysis by identifying at least one claim of staging imaging procedure expanding to 6 months following cancer diagnosis.
The analysis revealed that half of older men enrolled in Medicare (50.4%) received staging imaging prior to the initiation of the Choosing Wisely recommendations. This dropped to 43.7 percent following the launch of the initiative. "There was an approximately 7 percent decline in the use of staging imaging procedures in men with early-stage prostate cancer between the pre- and post-Choosing Wisely era," Vyas emphasized.
From the interrupted time series analysis, the researchers found that there was a significant 0.18 percent point per quarter reduction in the rate of staging imaging use pre-Choosing Wisely, according to the study authors. "There was a continued decline of 1.02 percent point per quarter immediately post-Choosing Wisely implementation," they reported. "There was a significant 0.31 percent point per quarter decrease in the rate of staging imaging use due to the Choosing Wisely program."
Additionally, sensitivity analyses showed that 55.0 percent of men received staging imaging pre-Choosing Wisely. Following the implementation of the program, that percentage fell to 48.1 percent. "Interrupted time series analysis showed a significant 0.25 percent point per quarter decline in the rate of staging imaging use resulting from Choosing Wisely program," Vyas noted.
"The ASCO's Choosing Wisely initiative coincided with a decline in the use of unnecessary staging imaging procedures in older men with early-stage prostate cancer," she concluded. "While the ASCO's Choosing Wisely initiative appeared to be associated with a decline in the use of unnecessary medical procedures in men with prostate cancer, the decline was slow, thereby highlighting opportunities to target interventions to address this unnecessary use of health care."
Catlin Nalley is a contributing writer.