Are we Choosing Wisely® in radiation oncology practice - findings from an Australian population-based study.

Abstract

Objective: To evaluate the adoption of the Royal Australian and New Zealand College of Radiologists Choosing Wisely (CW) radiation oncology recommendations before and after the release of the recommendations METHODS: / Material: The Victorian Radiotherapy Minimum Data Set (VRMDS) captures details of radiotherapy delivered in the state of Victoria, Australia. This study comprised the following three groups of patients relevant to three of the five CW recommendations: women diagnosed with early-stage breast cancer at age 50 or above who had breast radiotherapy (excluding nodal irradiation), cancer patients who had palliative bone radiotherapy (excluding those with primary bone malignancies), and cancer patients who had stereotactic radiotherapy to the brain (excluding those with primary malignancies of central nervous system). The outcomes of interest were: use of hypofractionated breast radiotherapy (<25 fractions), use of long-course palliative bone radiotherapy (>10 fractions), and use of adjuvant whole brain radiotherapy (WBRT) within 1 month of stereotactic radiotherapy. The Cochrane-Armitage test was used to evaluate changes in practice over time. Of the 8,204 patients who had breast radiotherapy, there was an increase in hypofractionation use from 42% in 2013 to 82% in 2017 (P<0.001). The progressive increase in hypofractionation use was observed across institutions. Of the 15,634 courses of palliative bone radiotherapy delivered, only 1,279 (8%) were > 10 fractions, and this decreased from 10% in 2013 to 5% in 2017 (P<0.001). Of the 1,049 patients who received stereotactic radiotherapy for brain metastases, only 2% had adjuvant WBRT, and this decreased from 4% in 2013 to 0.7% in 2017 (P=0.02). There has been a significant change in radiation oncology practice in Australia between 2013 and 2017, in line with the CW recommendations. However, some of the recommendations need to be revised to reflect the rapidly evolving evidence in radiation oncology.