ASTRO's Choosing Wisely recommendations impact breast cancer practices

The Choosing Wisely campaign has resulted in the alteration of some breast cancer practices for the better, according to a study presented last week at the American Society for Radiation Oncology (ASTRO) annual meeting, Medscape Medical News reported.

Last fall, ASTRO made five Choosing Wisely recommendations, including one stating that oncologists should not initiate whole breast radiotherapy as part of breast conservation therapy in women over the age of 50 while in early stage breast cancer unless they consider shorter treatment schedules.

Shorter radiation therapy schedules for early-stage breast cancer--which also are less costly and more convenient for patients--are known as hypofractionation. In the study presented at ASTRO, the researchers, lead by Heather Curry, M.D., director of radiation oncology at eviti, Inc., an oncology decision-support company in Philadelphia, examined 1,636 radiation treatment requests for the management of breast cancer between June 2011 and June 2014. Of those, 869 were for breast conserving therapy and 322 were considered eligible for hypofractionation.

The researchers found that the rate of hypofractionation prescription increased from 9.67 percent of eligible patients to 21.30 percent after the Choosing Wisely recommendations were issued.

Though the study was small--just 322 patients from a private insurance database--Curry told Medscape that it "gives some 'real-time' insight into how current practice patterns have evolved since last year's Choosing Wisely."

Last week, ASTRO released a second list of five radiation oncology-specific Choosing Wisely recommendations, including:

  1. Don't recommend radiation following hysterectomy for endometrial cancer patients with low-risk disease
  2. Don't initiate non-curative radiation therapy without defining the goals of treatment with the patient and considering palliative care referral
  3. Don't routinely recommend follow-up mammograms more often than annually for women who have had radiotherapy following breast conserving surgery
  4. Don't routinely offer radiation therapy for patients who have resected non-small cell lung cancer, negative margins,N0-1 disease
  5. Don't routinely add adjuvant whole brain radiation therapy to stereotactic radiosurgery for limited brain metastases

To learn more:
- read the article in Medscape
- check out ASTRO's recommendations from Sept. 2013
- here's ASTRO's new Choosing Wisely recommendations