Impact of choosing wisely on imaging in men with newly diagnosed prostate cancer

ElsevierVolume 41, Issue 1, January 2023, Pages 48.e19-48.e26Urologic Oncology: Seminars and Original InvestigationsAuthor links open overlay panelHighlights•

Staging imaging trends in new prostate cancer patients were studied

Over time, imaging utilization in low-risk patients decreased

Initiatives had a modest impact on decrease in bone scan use in low-risk patients

Imaging utilization moved towards higher-value care

Guideline-discordant imaging persists at high levels

AbstractIntroduction

Encouraging the appropriate use of staging imaging in patients with newly diagnosed prostate cancer remains a challenge. Assessing the effects of national efforts may help guide future initiatives in curtailing low-value care. The purpose of this study was to determine the impact of the Choosing Wisely campaign on imaging utilization among men with prostate cancer.

Methods

Surveillance, Epidemiology, and End Results – Medicare data were used to complete a longitudinal population-based study of men diagnosed with prostate cancer from 2007 to 2015. An interrupted time series analysis evaluated the impact of the Choosing Wisely campaign on trends of imaging utilization.

Results

From 2007 to 2015 imaging utilization in low-risk patients decreased, with computed tomography (CT) usage declining from 45.0% to 34.4% (P<0.001) and nuclear medicine bone scan (NMBS) from 27.8% to 11.7% (P<0.001). Choosing Wisely likely contributed to an absolute reduction of 2.9% (P=0.03) in utilization of NMBS in the low-risk population. Imaging usage for all modalities increased in the high-risk population, but with 32.8% continuing to not receive guideline-supported imaging.

Conclusions

In 2012, the Choosing Wisely campaign sought to decrease inappropriate staging imaging for men with low-risk prostate cancer and encourage stewardship of medical resources. Overall decreases in staging imaging trends suggest a move towards higher value care. However, this study found that the Choosing Wisely recommendations had a modest impact on utilization of NMBS, but not CT or PET scans. These results may help inform future efforts to promote guideline concordant imaging.

Keywords

Healthcare utilization

Staging imaging

Choosing Wisely

Prostate cancer

Guidelines

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