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Clinical Impact of ASCO Choosing Wisely Guidelines on Staging Imaging for Early-Stage Breast Cancers: A Time Series Analysis Using SEER-Medicare Data.

Publication ,  Journal Article
Baltz, AP; Siegel, ER; Kamal, AH; Siegel, R; Kozlik, MM; Crist, STS; Makhoul, I; ASCO Quality Publications Task Force,
Published in: JCO Oncol Pract
February 2023

PURPOSE: American Society for Clinical Oncology released the Choosing Wisely list in 2012, highlighting low-value procedures that lack evidence, advising against the use of positron emission tomography, computerized tomography, and radionuclide bone scans for the staging of early-stage breast cancer at low risk for metastasis. The objective of the study was to assess the impact of the American Society of Clinical Oncology Choosing Wisely guidelines on inappropriate staging imaging among early-stage breast cancers. METHODS: The Surveillance, Epidemiology, and End Results Program-Medicare data set was used to identify 50,004 women age 66 years and older with new incident diagnosis of early-stage breast cancer (stage 0 through stage 2a; T < 4, N = 0, and M = 0). The primary outcome was the incidence of patients with inappropriate imaging following an early-stage breast cancer diagnosis. The primary outcome was identified within 6 months of the first diagnosis. An interrupted time series analysis using negative binomial regression was performed for outpatient claims for these diagnostic studies versus the two interruptions of guidelines release and guidelines reinforcement. Mean images per patient, percent change for the study period, and rate of change per year were calculated. RESULTS: Imaging rates fell by a modest 2.32% following guidelines release in April 2012 (point estimate = -2.32%; 95% CI, -6.34% to 1.88%). By contrast, imaging rates fell by a four-fold larger amount (point estimate = -9.36%; 95% CI, -13.20% to -5.35%) following guidelines published reminders in journals (or reinforcement) in October 2013. Mean imaging studies per patient (95% CI) declined from 1.80 (1.76 to 1.84) in January 2012 to 1.50 (1.48 to 1.53) by January 2015, representing a 16% decline in imaging overuse in 2015 compared with 3 years earlier. The rate of change (95% CI) in images per patient was initially small at -0.47% (-4.27% to 3.33%) per year between April 2012 and October 2013, but almost eight times faster at -3.70% (-5.81% to -1.60%) per year after October 2013. CONCLUSION: This analysis demonstrates a substantial decrease in the prevalence of imaging overuse in early-stage breast cancers correlating with the 2013 reinforcement of American Society of Clinical Oncology's 2012 Choosing Wisely guidelines. The creation and dissemination of such resources serves as a powerful tool to improve clinical practice, cost-effectiveness, and patient safety from secondary malignancies, anxiety, and overdiagnosis.

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Published In

JCO Oncol Pract

DOI

EISSN

2688-1535

Publication Date

February 2023

Volume

19

Issue

2

Start / End Page

e274 / e285

Location

United States

Related Subject Headings

  • United States
  • Tomography, X-Ray Computed
  • Time Factors
  • Positron-Emission Tomography
  • Medicare
  • Humans
  • Female
  • Breast Neoplasms
  • Aged
  • 3211 Oncology and carcinogenesis
 

Citation

APA
Chicago
ICMJE
MLA
NLM
Baltz, A. P., Siegel, E. R., Kamal, A. H., Siegel, R., Kozlik, M. M., Crist, S. T. S., … ASCO Quality Publications Task Force, . (2023). Clinical Impact of ASCO Choosing Wisely Guidelines on Staging Imaging for Early-Stage Breast Cancers: A Time Series Analysis Using SEER-Medicare Data. JCO Oncol Pract, 19(2), e274–e285. https://doi.org/10.1200/OP.22.00500
Baltz, Alan P., Eric R. Siegel, Arif H. Kamal, Robert Siegel, Mary May Kozlik, Stéphanie T. S. Crist, Issam Makhoul, and Issam ASCO Quality Publications Task Force. “Clinical Impact of ASCO Choosing Wisely Guidelines on Staging Imaging for Early-Stage Breast Cancers: A Time Series Analysis Using SEER-Medicare Data.JCO Oncol Pract 19, no. 2 (February 2023): e274–85. https://doi.org/10.1200/OP.22.00500.
Baltz AP, Siegel ER, Kamal AH, Siegel R, Kozlik MM, Crist STS, et al. Clinical Impact of ASCO Choosing Wisely Guidelines on Staging Imaging for Early-Stage Breast Cancers: A Time Series Analysis Using SEER-Medicare Data. JCO Oncol Pract. 2023 Feb;19(2):e274–85.
Baltz, Alan P., et al. “Clinical Impact of ASCO Choosing Wisely Guidelines on Staging Imaging for Early-Stage Breast Cancers: A Time Series Analysis Using SEER-Medicare Data.JCO Oncol Pract, vol. 19, no. 2, Feb. 2023, pp. e274–85. Pubmed, doi:10.1200/OP.22.00500.
Baltz AP, Siegel ER, Kamal AH, Siegel R, Kozlik MM, Crist STS, Makhoul I, ASCO Quality Publications Task Force. Clinical Impact of ASCO Choosing Wisely Guidelines on Staging Imaging for Early-Stage Breast Cancers: A Time Series Analysis Using SEER-Medicare Data. JCO Oncol Pract. 2023 Feb;19(2):e274–e285.

Published In

JCO Oncol Pract

DOI

EISSN

2688-1535

Publication Date

February 2023

Volume

19

Issue

2

Start / End Page

e274 / e285

Location

United States

Related Subject Headings

  • United States
  • Tomography, X-Ray Computed
  • Time Factors
  • Positron-Emission Tomography
  • Medicare
  • Humans
  • Female
  • Breast Neoplasms
  • Aged
  • 3211 Oncology and carcinogenesis