Choosing wisely in cancer control across Canada—a set of baseline indicators

Value-based care, which balances high-quality care with the most efficient use of resources, has been considered the next frontier in cancer care and a means to maintain health system sustainability. Created to promote value-based care, Choosing Wisely Canada—modelled after Choosing Wisely in the United States—is a national clinician-driven campaign to identify unnecessary or harmful services that are frequently used in Canada. As part of the campaign, national medical societies have developed recommendations for tests and treatments that clinicians and patients should question. Here, we present baseline indicator findings about current practice patterns associated with 7 cancer-related recommendations from Choosing Wisely Canada and about the effects of those practices on patients and the health care system.Indicator findings point to substantial variations in cancer system performance between Canadian jurisdictions, most notably for breast cancer screening practices, treatment practices for men with low-risk localized prostate cancer, and radiation therapy practices for early-stage breast cancer and bone metastases. Extrapolating indicator findings to the entire country, it was estimated that 740,000 breast and cervical cancer screening tests were performed outside of the recommended age ranges, and within 1 year of diagnosis, 17,000 patients received treatments that could be low-value. A 15% reduction in the use of the 7 screening and treatment practices examined could lead to multiple benefits for patients and the health care system: 9000 false-positive results and 3000 treatments and related side effects could be avoided, and 4500 hours of linear accelerator capacity could be freed up each year.Interjurisdictional performance variations suggest potential differences in clinical practice patterns in the planning and delivery of cancer control services, and in some cases, in disease management outcomes. Although the cancer screening and treatment practices described might be unnecessary for some patients, it is important to realize that they could, in fact, be necessary for other patients. Further research into appropriate rates of use could help to determine how much cancer care represents overuse of practices that are not supported by evidence or underuse of practices that are supported by evidence.

Download Full-text

Breast Cancer in Latin America: A Map of the Disease in the Region

American Society of Clinical Oncology Educational Book ◽

10.1200/edbk_201315 ◽

2018 ◽

pp. 451-456 ◽

Cited By ~ 7

Author(s):

Eduardo Cazap

Keyword(s):

Breast Cancer ◽

Health Care ◽

Latin America ◽

Urban Areas ◽

Access To Health Care ◽

Cancer Control ◽

Public Health Problem ◽

The United States ◽

High Morbidity ◽

Patient Organizations

In the next few decades, breast cancer will become a leading global public health problem as it increases disproportionately in low- and middle-income countries. Disparities are clear when comparisons are made with rates in Europe and the United States, but they also exist between the countries of the region or even within the same country in Latin America. Large cities or urban areas have better access and resource availability than small towns or remote zones. This article presents the status of the disease across 12 years with data obtained through three studies performed in 2006, 2010, and 2013 and based on surveys, reviews of literature, patient organizations, and public databases. The first study provided a general picture of breast cancer control in the region (Latin America); the second compared expert perceptions with medical care standards; and the third was a review of literature and public databases together with surveys of breast cancer experts and patient organizations. We conclude that breast cancer is the most frequent cancer and kills more women than any other cancer; we also suggest that aging is the principal risk factor, which will drive the incidence to epidemic levels as a result of demographic transition in Latin America. The economic burden also is large and can be clearly observed: in countries that today allocate insufficient resources, women go undiagnosed or uncared for or receive treatment with suboptimal therapies, all of which results in high morbidity and the associated societal costs. The vast inequities in access to health care in countries translates into unequal results in outcomes. National cancer control plans are the fundamental building block to an organized governance, financing, and delivery of health care for breast cancer.

Download Full-text

Food security status and breast cancer screening among women in the United States: Evidence from Health and Retirement Study and Health Care and Nutrition Study

10.21203/rs.3.rs-176608/v1 ◽

2021 ◽

Author(s):

Asos Mahmood ◽

Satish Kedia ◽

Patrick Dillon ◽

Hyunmin kim ◽

Hassan Arshad ◽

...

Keyword(s):

Breast Cancer ◽

Health Care ◽

Cancer Screening ◽

Food Insecurity ◽

Breast Cancer Screening ◽

The United States ◽

The Past ◽

Cancer Screenings ◽

Nutrition Study ◽

Retirement Study

Abstract Purpose: To assesses the impact of food insecurity on biennial breast cancer screenings (i.e., mammography or breast x-ray) among older women in the United States (US).Methods: Data from the 2014 and 2016 waves of the Health and Retirement Study and the 2013 Health Care and Nutrition Study were used. The analyses were limited to a nationally representative sample of 2,861 women between 50 to 74 years of age, residing in the US. We employed a propensity score weighting method to balance observed confounders between food-secure and food-insecure women and fitted a binary logistic regression to investigate population-level estimates for the association between food security and breast cancer screening.Results: Food insecurity was significantly associated with failure to obtain a mammogram or breast x-ray within the past two years. Food-insecure women had 54% lower odds of reporting breast cancer screening in the past two years (OR=0.46; 95% CI: 0.30-0.70, P-value <.001) as compared to food-secure women. Additional factors associated with a higher likelihood of receiving breast cancer screenings included greater educational attainment, higher household income, regular access to health care/advice, not smoking, and not being physically disabled or experiencing depressive symptoms.Conclusion: Results demonstrate a socioeconomic gradient existing in regard to the utilization of regular breast cancer screenings among women. Those who tend to have lower education, lower-income and lack of reliable healthcare access are more likely to be food insecure. Thus, more likely to face the financial, logistical, or environmental barriers in obtaining screening services that accompany food insecurity.

Download Full-text

Assessing the use of low value oncology care following the release of Choosing Wisely guidelines.

Journal of Clinical Oncology ◽

10.1200/jco.2021.39.15_suppl.e18861 ◽

2021 ◽

Vol 39 (15_suppl) ◽

pp. e18861-e18861

Author(s):

Alexander Gunn ◽

Melissa Sarver ◽

Samantha J Kaplan ◽

Yousuf Zafar ◽

Rachel Adams Greenup

Keyword(s):

Cancer Screening ◽

Guideline Adherence ◽

Cancer Care ◽

Systemic Treatment ◽

The United States ◽

Choosing Wisely ◽

Surveillance Imaging ◽

Patient Reported ◽

Oncology Care ◽

The Impact

e18861 Background: Low -value care contributes to the high costs of cancer treatment. Almost a decade has passed since the American Society of Clinical Oncology (ASCO) Choosing Wisely campaign identified costly diagnostic testing, radiographic imaging, and therapies that are routinely utilized in cancer care despite lacking evidence of benefit. We sought to evaluate the impact of ASCO Choosing Wisely guidelines and to identify barriers to and facilitators of guideline adherence. Methods: A systematic review of published literature from 2012-2021 was performed in accordance with PRISMA guidelines on the trend in use of low value oncology care. All ten of ASCO Choosing Wisely Guidelines were selected for inclusion; these included recommendations focused on cancer screening, staging and surveillance imaging, and systemic treatment and support. The following databases were searched for original research based in the United States: PubMed, CINAHL, Embase, Web of Science, Scopus, and ASCO Meeting abstracts. Eligible studies were examined for information on design, population, and study outcomes, which included guideline adherence and facilitators and barriers to implementation. All citations were independently dual-screened in a blinded fashion by authors (AG, MS). Results: 35 independent studies were identified from 3,590 unique citations and included n = 1,130,216 patients. Data sources captured large claims database analyses (13 studies, n = 1,069,289), institutional studies (14 studies, n = 53,358), patient-reported surveys (2 studies, n = 915), and interventional studies (6 studies, n = 6654). Adherence to ASCO Choosing Wisely guidelines ranged from 13% to 100% overall. Use of low value oncology care varied depending on the area of recommendation, such as cancer screening (44% to 77%), staging and surveillance imaging (30% to 100%), and systemic treatment and support (13% to 100%). Adherence was facilitated by: (a) physician awareness of and education around the recommendations; (b) patient engagement; (c) embedded EHR best practice alerts; (d) guideline alignment with insurance payer requirements; and (e) integrated healthcare systems. Barriers to guideline incorporation included perceived patient anxiety and concerns about patient satisfaction; illness-specific practices; and time needed for patient-provider conversations regarding low value care. Conclusions: Adherence to the ASCO Choosing Wisely guidelines is variable across the cancer care continuum. Health system and policy-level interventions are needed to further reduce the overuse of low value care in oncology.

Download Full-text

Breast Cancer Screening and the COVID-19 Pandemic

Journal of Breast Imaging ◽

10.1093/jbi/wbaa106 ◽

2020 ◽

Author(s):

Dana H Smetherman

Keyword(s):

Breast Cancer ◽

Health Care ◽

Cancer Screening ◽

Breast Cancer Screening ◽

Clinical Care ◽

The United States ◽

Screening Mammography ◽

Imaging Studies ◽

National Organizations ◽

Screening Mammograms

Abstract The novel SARS-CoV2 (COVID-19) pandemic has had a major impact on breast radiology practices. Initially, nonessential imaging studies, including screening mammography, were curtailed and even temporarily halted when lockdowns were instituted in many parts of the United States. As a result, imaging volumes plummeted while health care institutions worked to ensure safety measures were in place to protect patients and personnel. As COVID-19 infection levels started to stabilize in some areas, breast radiology practices sought guidance from national organizations, such as the Centers for Disease Control and Prevention, the Centers for Medicare and Medicaid Services, and radiology specialty societies, to develop strategies for patients to safely return for screening mammograms and other outpatient imaging studies. Postponement of breast cancer screening has led to delays in cancer diagnosis and treatment that could negatively affect patient outcomes for years to come. In order to continue to provide necessary imaging services, breast radiologists will need to face and overcome ongoing practical challenges related to the pandemic, such as negative financial impacts on practices and patients, the need for modifications in delivery of imaging services and trainee education, and differences in the health care system as a whole, including the shift to telehealth for clinical care. Nonetheless, despite the disruption the COVID-19 pandemic has caused, the need for breast radiology procedures, including breast cancer screening, remains strong.

Download Full-text

Oncosmart: A Private Initiative to Improve Breast Cancer Care in Costa Rica

Journal of Global Oncology ◽

10.1200/jgo.18.10560 ◽

2018 ◽

Vol 4 (Supplement 3) ◽

pp. 48s-48s

Author(s):

Andres Wiernik ◽

Loretta Fernandez ◽

Leonardo Lami ◽

Greivin Vindas ◽

Marissa Durman ◽

...

Keyword(s):

Breast Cancer ◽

Health Care ◽

Cancer Screening ◽

Costa Rica ◽

Health Care System ◽

Cancer Care ◽

Breast Cancer Care ◽

Private Initiative ◽

Advisory Role ◽

Care System

Purpose Founded in 2010, Hospital Metropolitano is the fastest growing health care system in Costa Rica with a network of two hospitals, 27 clinics, and more than 90,000 patients enrolled in its health plan, Medismart. Given the challenges faced by the national public health care system in providing cancer care, the Oncosmart program was launched in November 2016 with the goal of providing population-based cancer screening, diagnostics, cancer treatment, and survivorship care. The program has no restrictions on preexisting conditions and has a monthly membership cost of $14 USD per patient. Here, we summarize our breast cancer program results during the first 16 months of implementation. Methods We performed a retrospective analysis that evaluated data from our radiology department, cancer center, and survivorship program. We determined the number of patients with breast cancer who were diagnosed and/or received care in our health care system from November 2016 to March 2018. Results During this period analyzed, 5,687 mammograms were performed at our health care system and 215 patients were reported to have a Breast Imaging Reporting and Data System 4 to 5 requiring a breast biopsy. Of these, 24% were diagnosed with breast cancer, 36% had a nonmalignant breast condition, and 41% were false positives. Among patients with newly diagnosed breast cancer, 11% had noninvasive breast cancer and 89% had invasive disease. Twenty-seven percent of all breast cancer diagnosis occurred in women younger than age 50 years and two patients were diagnosed with a BRCA1/2 mutation. All biopsies performed at our program were reported within 30 days from abnormal imaging. During this period, we performed 53 breast cancer surgeries and provided chemotherapy and/or endocrine therapy to 32 patients, and among all patients who followed-up in the survivorship clinic, 22 followed-up for breast cancer survivorship. Conclusion Oncosmart is a low-cost and effective private initiative that improves access to breast cancer screening and breast cancer care in the middle-income country of Costa Rica. On the basis of national statistics, after 16 months of implementation, approximately 4% to 5% of all patients with breast cancer in the country are diagnosed within our program. AUTHORS' DISCLOSURES OF POTENTIAL CONFLICTS OF INTEREST The following represents disclosure information provided by authors of this manuscript. All relationships are considered compensated. Relationships are self-held unless noted. I = Immediate Family Member, Inst = My Institution. Relationships may not relate to the subject matter of this manuscript. For more information about ASCO's conflict of interest policy, please refer to www.asco.org/rwc or ascopubs.org/jco/site/ifc . Andres Wiernik Consulting or Advisory Role: Grupo Montecristo Leonardo Lami Employment: Roche, Genetech (I) Travel, Accommodations, Expenses: Roche/Genetech (I) Marissa Durman Consulting or Advisory Role: Grupo Montecristo

Download Full-text

Overview of Current Approaches to Aural Rehabilitation for Adults With Cochlear Implants

Perspectives of the ASHA Special Interest Groups ◽

10.1044/2020_persp-20-00078 ◽

2020 ◽

Vol 5 (5) ◽

pp. 1175-1187

Author(s):

Rachel Glade ◽

Erin Taylor ◽

Deborah S. Culbertson ◽

Christin Ray

Keyword(s):

Health Care ◽

Clinical Practice ◽

Cochlear Implants ◽

Practice Patterns ◽

The United States ◽

Care Providers ◽

Aural Rehabilitation ◽

Starting Point ◽

Clinical Models ◽

Hearing Health

Purpose This clinical focus article provides an overview of clinical models currently being used for the provision of comprehensive aural rehabilitation (AR) for adults with cochlear implants (CIs) in the Unites States. Method Clinical AR models utilized by hearing health care providers from nine clinics across the United States were discussed with regard to interprofessional AR practice patterns in the adult CI population. The clinical models were presented in the context of existing knowledge and gaps in the literature. Future directions were proposed for optimizing the provision of AR for the adult CI patient population. Findings/Conclusions There is a general agreement that AR is an integral part of hearing health care for adults with CIs. While the provision of AR is feasible in different clinical practice settings, service delivery models are variable across hearing health care professionals and settings. AR may include interprofessional collaboration among surgeons, audiologists, and speech-language pathologists with varying roles based on the characteristics of a particular setting. Despite various existing barriers, the clinical practice patterns identified here provide a starting point toward a more standard approach to comprehensive AR for adults with CIs.

Download Full-text

Knowledge, Attitude And Practice Towards Breast Cancer Screening Among Female Out-Patients Aged 18-65 Years Seeking Health Care Services At Jaramogi Oginga Odinga Teaching And Referral Hospital, Kisum

International Journal of Scientific and Research Publications (IJSRP) ◽

10.29322/ijsrp.9.05.2019.p8959 ◽

2019 ◽

Vol 9 (5) ◽

pp. p8959

Author(s):

Rosemary A. Okomo ◽

Jane Owenga ◽

Daniel Onguru

Keyword(s):

Breast Cancer ◽

Health Care ◽

Cancer Screening ◽

Breast Cancer Screening ◽

Health Care Services ◽

Referral Hospital ◽

Care Services ◽

Attitude And Practice ◽

Knowledge Attitude And Practice

Download Full-text

Evaluation of Patterns in Access to Breast Cancer Care and Breast Cancer Presentation in a Safety Net Patient Population

The American Surgeon ◽

10.1177/0003134820966288 ◽

2021 ◽

pp. 000313482096628

Author(s):

Erica Choe ◽

Hayoung Park ◽

Ma’at Hembrick ◽

Christine Dauphine ◽

Junko Ozao-Choy

Keyword(s):

Breast Cancer ◽

Cancer Screening ◽

Breast Cancer Screening ◽

Cancer Care ◽

Patient Population ◽

Safety Net ◽

Minority Women ◽

Breast Cancer Care ◽

Safety Net Hospital ◽

Screening Mammograms

Background While prior studies have shown the apparent health disparities in breast cancer diagnosis and treatment, there is a gap in knowledge with respect to access to breast cancer care among minority women. Methods We performed a retrospective analysis of patients with newly diagnosed breast cancer from 2014 to 2016 to evaluate how patients presented and accessed cancer care services in our urban safety net hospital. Patient demographics, cancer stage, history of breast cancer screening, and process of referral to cancer care were collected and analyzed. Results Of the 202 patients identified, 61 (30%) patients were younger than the age of 50 and 75 (63%) were of racial minority background. Only 39% of patients with a new breast cancer were diagnosed on screening mammogram. Women younger than the age of 50 ( P < .001) and minority women ( P < .001) were significantly less likely to have had any prior screening mammograms. Furthermore, in patients who met the screening guideline age, more than half did not have prior screening mammograms. Discussion Future research should explore how to improve breast cancer screening rates within our county patient population and the potential need for revision of screening guidelines for minority patients.

Download Full-text