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ASTRO Releases Its Second ‘Choosing Wisely’ List

DiGiulio, Sarah

doi: 10.1097/01.COT.0000455779.64927.57


SAN FRANCISCO—The American Society for Radiation Oncology has released its second list of five radiation oncology-specific treatments that are commonly ordered but may not always be appropriate.

Both lists are part of the American Board of Internal Medicine's national Choosing Wisely campaign. The new announcement was made here at ASTRO's Annual Meeting. ASTRO's original list was released at last year's Annual Meeting (OT 10/25/14 issue).

“We are a consumer-driven society of ‘more is more,’ but we need to bring the message back to what is necessary and what is appropriate for the individual patient,” Carol A. Hahn, MD, MS, Chair of ASTRO's Clinical Affairs and Quality Council, which spearheaded development of the list, said during a session at the meeting titled “Innovative Payment Models and The Future of Radiation Oncology—Impact on Quality, Payment Reform, and Patient Care” when the list was announced.

“We're starting to see some change in practice,” ASTRO President Bruce G. Haffty, MD, MS, noted during a news briefing. “We believe the Choosing Wisely campaign really does have an impact in terms of reserving resources in health care.”

The new list was developed by an ASTRO work group convened in January to narrow down a list of 28 draft concepts to nine potential items for the final list. The group included representatives from ASTRO's health policy, government relations, and clinical affairs and quality committees.



In an anonymous survey, ASTRO members then provided feedback rating the value and relevancy of each item, and the work group then submitted a list of eight items to the ASTRO Board of Directors, who chose the final five items on the list.

Hahn, Associate Professor of Radiation Oncology at Duke University Medical Center, noted in an interview after the session that the working group looked for items that were within radiation oncology's sphere of reimbursement: “We looked for items where radiation oncologists really owned the issue.”

The group also looked for items that were commonly done, she added. “Obviously if it's a very rare procedure, it's not going to have a lot of impact.”

The five new recommendations from ASTRO are:

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




The list is published online on the ASTRO website at, and will also be included on the Consumer Reports site in an overall patient brochure that contains all the Choosing Wisely recommendations to date from the 60-plus specialty organizations (

“We want to empower patients to go to their providers with this data in hand and be aware of these discussions,” Hahn said. “It's a stronger effort if patients become engaged as well as the membership, and will help us improve quality and promote care that's truly necessary—the right care for the right patient at the right time.”

ASTRO has also drafted a manuscript defining its process of developing its Choosing Wisely list, which was presented at a poster presentation at the meeting (Abstract 2966)—Hahn was the first author—and will also be published in an article later this year in Practical Radiation Oncology.

© 2014 by Lippincott Williams & Wilkins, Inc.
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