“Choosing wisely” in oncology: The example of surveillance positron emission tomography-computed tomography (PET-CT) for patients with colorectal cancer (CRC) treated with curative intent.

Background: Healthcare overuse is a major challenge for healthcare systems. Professional guidelines, such as “Choosing Wisely”, have been put in place to mitigate specific areas of overuse. We examined whether the rate of unwarranted PET-CT in CRC patients treated with curative intent was successfully reduced following the adoption of “Choosing Wisely". Methods: We used the large Clalit Health Services dataset in Israel to identify patients with CRC who received adjuvant chemotherapy for localized disease between January 2017-December 2021. We then examined the number of PETCTs performed for each patient. Results: 1799 patients were included in our study (Table). We distinguished localized from metastatic cases based on specific drugs administered or not administered during the follow-up period (i.e. biologics). For the entire cohort, the median number of PETCTs performed per patient over the study period was 3. 364 (20.2%) patients underwent a single PETCT, 946 (52.6%) patients underwent ≥2 PETCTs, and 25 patients underwent ≥ 10 PETCTs. Assuming a single PETCT is considered “guideline concordant” during diagnosis and treatment of localized CRC, 52.6% (946/1799) of patients in our cohort underwent “guideline discordant” PETCT scans. Conclusions: Despite professional guidelines recommending against routine PETCT to monitor for recurrence following curative-intent treatment of CRC, there remains a large volume of “guideline-discordant” PETCTs in this space. Professional guidelines such as “Choosing Wisely” have largely failed to prevent this example of healthcare overuse.