Deimplementation of the Choosing Wisely Recommendations for Low-Value Breast Cancer Surgery: A Systematic Review
Overtreatment of early-stage breast cancer results in increased morbidity and cost without improving survival. Major surgical organizations participating in the Choosing Wisely campaign identified 4 breast cancer operations as low value: (1) axillary lymph node dissection for limited nodal disease i...
Uložené v:
| Vydané v: | JAMA surgery Ročník 155; číslo 8; s. 759 |
|---|---|
| Hlavní autori: | , , |
| Médium: | Journal Article |
| Jazyk: | English |
| Vydavateľské údaje: |
United States
01.08.2020
|
| Predmet: | |
| ISSN: | 2168-6262, 2168-6262 |
| On-line prístup: | Zistit podrobnosti o prístupe |
| Tagy: |
Pridať tag
Žiadne tagy, Buďte prvý, kto otaguje tento záznam!
|
| Abstract | Overtreatment of early-stage breast cancer results in increased morbidity and cost without improving survival. Major surgical organizations participating in the Choosing Wisely campaign identified 4 breast cancer operations as low value: (1) axillary lymph node dissection for limited nodal disease in patients receiving lumpectomy and radiation, (2) re-excision for close but negative lumpectomy margins for invasive cancer, (3) contralateral prophylactic mastectomy in patients at average risk with unilateral cancer, and (4) sentinel lymph node biopsy in women 70 years or older with hormone receptor-positive cancer.
To evaluate the extent to which these procedures have been deimplemented, determine the implications of decreased use, and recognize possible barriers and facilitators to deimplementation.
A systematic review of published literature on use trends in breast surgery was performed in accordance with PRISMA guidelines. The Ovid, Embase, Cumulative Index to Nursing and Allied Health Literature, and Cochrane databases were searched for original research with relevance to the Choosing Wisely recommendations of interest. Eligible studies were examined for data about use, and any patient-level, clinician-level, or system-level factors associated with use.
Concordant with recommendations, national rates of axillary lymph node dissection for patients with limited nodal disease have decreased by approximately 50% (from 44% in 2011 to 30% to 34% in 2012 and 25% to 28% in 2013), and national rates of lumpectomy margin re-excision have decreased by nearly 40% (from 16% to 34% before to 14% to 18% after publication of a consensus statement). Conversely, national rates of contralateral prophylactic mastectomy continue to rise each year, accounting for up to 30% of all mastectomies for breast cancer (range in all mastectomy cases: 2010-2012, 28%-30%; 1998, <2%), and rates of sentinel lymph node biopsy in women 70 years or older with low-risk breast cancer are persistently greater than 80% (range, 80%-88%). Factors associated with high rates of contralateral prophylactic mastectomy use are younger age, white race, increased socioeconomic status, and the availability of breast reconstruction; limited data exist on factors associated with high rates of sentinel lymph node biopsy in women 70 years or older. Successful deimplementation of axillary lymph node dissection and lumpectomy margin re-excision were associated with decreased costs and improved patient-centered outcomes.
This review demonstrates variable deimplementation of 4 low-value surgical procedures in patients with breast cancer. Addressing specific patient-level, clinician-level, and system-level barriers to deimplementation is necessary to encourage shared decision-making and reduce overtreatment. |
|---|---|
| AbstractList | Overtreatment of early-stage breast cancer results in increased morbidity and cost without improving survival. Major surgical organizations participating in the Choosing Wisely campaign identified 4 breast cancer operations as low value: (1) axillary lymph node dissection for limited nodal disease in patients receiving lumpectomy and radiation, (2) re-excision for close but negative lumpectomy margins for invasive cancer, (3) contralateral prophylactic mastectomy in patients at average risk with unilateral cancer, and (4) sentinel lymph node biopsy in women 70 years or older with hormone receptor-positive cancer.ImportanceOvertreatment of early-stage breast cancer results in increased morbidity and cost without improving survival. Major surgical organizations participating in the Choosing Wisely campaign identified 4 breast cancer operations as low value: (1) axillary lymph node dissection for limited nodal disease in patients receiving lumpectomy and radiation, (2) re-excision for close but negative lumpectomy margins for invasive cancer, (3) contralateral prophylactic mastectomy in patients at average risk with unilateral cancer, and (4) sentinel lymph node biopsy in women 70 years or older with hormone receptor-positive cancer.To evaluate the extent to which these procedures have been deimplemented, determine the implications of decreased use, and recognize possible barriers and facilitators to deimplementation.ObjectiveTo evaluate the extent to which these procedures have been deimplemented, determine the implications of decreased use, and recognize possible barriers and facilitators to deimplementation.A systematic review of published literature on use trends in breast surgery was performed in accordance with PRISMA guidelines. The Ovid, Embase, Cumulative Index to Nursing and Allied Health Literature, and Cochrane databases were searched for original research with relevance to the Choosing Wisely recommendations of interest. Eligible studies were examined for data about use, and any patient-level, clinician-level, or system-level factors associated with use.Evidence ReviewA systematic review of published literature on use trends in breast surgery was performed in accordance with PRISMA guidelines. The Ovid, Embase, Cumulative Index to Nursing and Allied Health Literature, and Cochrane databases were searched for original research with relevance to the Choosing Wisely recommendations of interest. Eligible studies were examined for data about use, and any patient-level, clinician-level, or system-level factors associated with use.Concordant with recommendations, national rates of axillary lymph node dissection for patients with limited nodal disease have decreased by approximately 50% (from 44% in 2011 to 30% to 34% in 2012 and 25% to 28% in 2013), and national rates of lumpectomy margin re-excision have decreased by nearly 40% (from 16% to 34% before to 14% to 18% after publication of a consensus statement). Conversely, national rates of contralateral prophylactic mastectomy continue to rise each year, accounting for up to 30% of all mastectomies for breast cancer (range in all mastectomy cases: 2010-2012, 28%-30%; 1998, <2%), and rates of sentinel lymph node biopsy in women 70 years or older with low-risk breast cancer are persistently greater than 80% (range, 80%-88%). Factors associated with high rates of contralateral prophylactic mastectomy use are younger age, white race, increased socioeconomic status, and the availability of breast reconstruction; limited data exist on factors associated with high rates of sentinel lymph node biopsy in women 70 years or older. Successful deimplementation of axillary lymph node dissection and lumpectomy margin re-excision were associated with decreased costs and improved patient-centered outcomes.FindingsConcordant with recommendations, national rates of axillary lymph node dissection for patients with limited nodal disease have decreased by approximately 50% (from 44% in 2011 to 30% to 34% in 2012 and 25% to 28% in 2013), and national rates of lumpectomy margin re-excision have decreased by nearly 40% (from 16% to 34% before to 14% to 18% after publication of a consensus statement). Conversely, national rates of contralateral prophylactic mastectomy continue to rise each year, accounting for up to 30% of all mastectomies for breast cancer (range in all mastectomy cases: 2010-2012, 28%-30%; 1998, <2%), and rates of sentinel lymph node biopsy in women 70 years or older with low-risk breast cancer are persistently greater than 80% (range, 80%-88%). Factors associated with high rates of contralateral prophylactic mastectomy use are younger age, white race, increased socioeconomic status, and the availability of breast reconstruction; limited data exist on factors associated with high rates of sentinel lymph node biopsy in women 70 years or older. Successful deimplementation of axillary lymph node dissection and lumpectomy margin re-excision were associated with decreased costs and improved patient-centered outcomes.This review demonstrates variable deimplementation of 4 low-value surgical procedures in patients with breast cancer. Addressing specific patient-level, clinician-level, and system-level barriers to deimplementation is necessary to encourage shared decision-making and reduce overtreatment.Conclusions and RelevanceThis review demonstrates variable deimplementation of 4 low-value surgical procedures in patients with breast cancer. Addressing specific patient-level, clinician-level, and system-level barriers to deimplementation is necessary to encourage shared decision-making and reduce overtreatment. Overtreatment of early-stage breast cancer results in increased morbidity and cost without improving survival. Major surgical organizations participating in the Choosing Wisely campaign identified 4 breast cancer operations as low value: (1) axillary lymph node dissection for limited nodal disease in patients receiving lumpectomy and radiation, (2) re-excision for close but negative lumpectomy margins for invasive cancer, (3) contralateral prophylactic mastectomy in patients at average risk with unilateral cancer, and (4) sentinel lymph node biopsy in women 70 years or older with hormone receptor-positive cancer. To evaluate the extent to which these procedures have been deimplemented, determine the implications of decreased use, and recognize possible barriers and facilitators to deimplementation. A systematic review of published literature on use trends in breast surgery was performed in accordance with PRISMA guidelines. The Ovid, Embase, Cumulative Index to Nursing and Allied Health Literature, and Cochrane databases were searched for original research with relevance to the Choosing Wisely recommendations of interest. Eligible studies were examined for data about use, and any patient-level, clinician-level, or system-level factors associated with use. Concordant with recommendations, national rates of axillary lymph node dissection for patients with limited nodal disease have decreased by approximately 50% (from 44% in 2011 to 30% to 34% in 2012 and 25% to 28% in 2013), and national rates of lumpectomy margin re-excision have decreased by nearly 40% (from 16% to 34% before to 14% to 18% after publication of a consensus statement). Conversely, national rates of contralateral prophylactic mastectomy continue to rise each year, accounting for up to 30% of all mastectomies for breast cancer (range in all mastectomy cases: 2010-2012, 28%-30%; 1998, <2%), and rates of sentinel lymph node biopsy in women 70 years or older with low-risk breast cancer are persistently greater than 80% (range, 80%-88%). Factors associated with high rates of contralateral prophylactic mastectomy use are younger age, white race, increased socioeconomic status, and the availability of breast reconstruction; limited data exist on factors associated with high rates of sentinel lymph node biopsy in women 70 years or older. Successful deimplementation of axillary lymph node dissection and lumpectomy margin re-excision were associated with decreased costs and improved patient-centered outcomes. This review demonstrates variable deimplementation of 4 low-value surgical procedures in patients with breast cancer. Addressing specific patient-level, clinician-level, and system-level barriers to deimplementation is necessary to encourage shared decision-making and reduce overtreatment. |
| Author | Wang, Ton Baskin, Alison S Dossett, Lesly A |
| Author_xml | – sequence: 1 givenname: Ton surname: Wang fullname: Wang, Ton organization: Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor – sequence: 2 givenname: Alison S surname: Baskin fullname: Baskin, Alison S organization: Department of Surgery, University of Michigan, Ann Arbor – sequence: 3 givenname: Lesly A surname: Dossett fullname: Dossett, Lesly A organization: Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor |
| BackLink | https://www.ncbi.nlm.nih.gov/pubmed/32492121$$D View this record in MEDLINE/PubMed |
| BookMark | eNpNkE1Lw0AQhhep2Fr7BzzIHr2kTiZpuuutxk8oCNaPY9jsTtqUJFuziSX_3qAVnMvM4XkfhveUDSpbEWPnPkx9AP9qq0rl2no9RUCYQoB4xEboR8KLMMLBv3vIJs5toR8BEAbyhA0DDCX66I_Y7pbycldQSVWjmtxW3Ga82RCPN9a6vFrzj9xR0fEX0rbsKfNDOZ7Zmi_t3ntXRUv8piblGh6rSlPNV_1fVHfXfMFXnWuo7DO6N3zltD9jx5kqHE0Oe8ze7u9e40dv-fzwFC-WngohajyTaUSUkQFfgVEmoJkITZbONQQyBVAiDaWkWYrZXM-E1CpAkCbNIl-GmQxwzC5_vbvafrbkmqTMnaaiUBXZ1iUYgozCSAjRoxcHtE1LMsmuzktVd8lfS_gNp19u4Q |
| CitedBy_id | crossref_primary_10_1245_s10434_024_15811_x crossref_primary_10_32604_oncologie_2022_027640 crossref_primary_10_1002_jso_26320 crossref_primary_10_1007_s40258_022_00771_8 crossref_primary_10_1245_s10434_022_13056_0 crossref_primary_10_1016_j_clbc_2023_03_011 crossref_primary_10_1245_s10434_024_16354_x crossref_primary_10_1136_bmjopen_2023_072762 crossref_primary_10_1016_j_suronc_2025_102191 crossref_primary_10_1245_s10434_021_09928_6 crossref_primary_10_1007_s10549_025_07789_1 crossref_primary_10_3322_caac_21731 crossref_primary_10_1016_j_surg_2021_12_025 crossref_primary_10_1016_j_jss_2021_05_006 crossref_primary_10_1200_EDBK_390450 crossref_primary_10_1016_j_asjsur_2023_09_053 crossref_primary_10_1097_NR9_0000000000000059 crossref_primary_10_1016_j_jss_2023_11_037 crossref_primary_10_1245_s10434_020_08823_w crossref_primary_10_1136_bmjopen_2022_062755 crossref_primary_10_1007_s10549_022_06646_9 crossref_primary_10_1245_s10434_021_10863_9 crossref_primary_10_1016_j_jss_2021_09_021 crossref_primary_10_1016_j_soc_2021_08_002 crossref_primary_10_1245_s10434_020_08924_6 crossref_primary_10_1186_s41021_023_00287_0 crossref_primary_10_3322_caac_70011 crossref_primary_10_1016_j_soc_2023_05_008 crossref_primary_10_1016_j_jss_2023_12_051 crossref_primary_10_1038_s41523_022_00383_4 crossref_primary_10_1001_jamanetworkopen_2020_17129 crossref_primary_10_1016_j_jss_2020_12_057 crossref_primary_10_1200_JCO_25_00099 crossref_primary_10_1016_j_amjsurg_2022_11_036 crossref_primary_10_1245_s10434_022_12626_6 crossref_primary_10_1016_j_jss_2021_10_005 crossref_primary_10_1016_j_surg_2022_09_016 crossref_primary_10_1186_s43058_021_00211_z crossref_primary_10_1097_PRS_0000000000007538 crossref_primary_10_1016_j_jss_2024_09_071 crossref_primary_10_1002_jso_26901 crossref_primary_10_1200_EDBK_320691 crossref_primary_10_1097_XCS_0000000000000002 crossref_primary_10_1245_s10434_024_16124_9 crossref_primary_10_1590_acb360608 crossref_primary_10_3322_caac_21754 crossref_primary_10_1245_s10434_023_14086_y crossref_primary_10_3389_fonc_2022_958116 crossref_primary_10_1038_s41523_022_00394_1 crossref_primary_10_1001_jamanetworkopen_2021_6322 crossref_primary_10_1245_s10434_025_17861_1 crossref_primary_10_1245_s10434_020_09009_0 crossref_primary_10_1038_s41416_021_01417_7 crossref_primary_10_1016_j_suc_2022_08_005 crossref_primary_10_1097_GOX_0000000000004344 crossref_primary_10_1002_jso_27088 crossref_primary_10_1097_AS9_0000000000000159 crossref_primary_10_1245_s10434_022_12003_3 crossref_primary_10_1186_s13012_022_01197_5 crossref_primary_10_1245_s10434_023_14156_1 crossref_primary_10_1245_s10434_023_13274_0 crossref_primary_10_1016_j_amjsurg_2024_115774 crossref_primary_10_1038_s41598_025_12896_6 crossref_primary_10_1245_s10434_020_08961_1 crossref_primary_10_1245_s10434_021_10807_3 crossref_primary_10_1245_s10434_021_10460_w |
| ContentType | Journal Article |
| DBID | CGR CUY CVF ECM EIF NPM 7X8 |
| DOI | 10.1001/jamasurg.2020.0322 |
| DatabaseName | Medline MEDLINE MEDLINE (Ovid) MEDLINE MEDLINE PubMed MEDLINE - Academic |
| DatabaseTitle | MEDLINE Medline Complete MEDLINE with Full Text PubMed MEDLINE (Ovid) MEDLINE - Academic |
| DatabaseTitleList | MEDLINE - Academic MEDLINE |
| Database_xml | – sequence: 1 dbid: NPM name: PubMed url: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed sourceTypes: Index Database – sequence: 2 dbid: 7X8 name: MEDLINE - Academic url: https://search.proquest.com/medline sourceTypes: Aggregation Database |
| DeliveryMethod | no_fulltext_linktorsrc |
| EISSN | 2168-6262 |
| ExternalDocumentID | 32492121 |
| Genre | Research Support, U.S. Gov't, P.H.S Systematic Review Journal Article Research Support, N.I.H., Extramural |
| GrantInformation_xml | – fundername: AHRQ HHS grantid: K08 HS026030 – fundername: NCI NIH HHS grantid: T32 CA009672 |
| GroupedDBID | 0R~ 4.4 53G AAWTL ABBLC ABJNI ACDNT ACGFS ADBBV AENEX AHMBA ALMA_UNASSIGNED_HOLDINGS AMJDE ANMPU BRYMA C45 CGR CUY CVF EBD EBS ECM EIF EMOBN EX3 GX1 H13 NPM OB2 OBH OHH OVD PQQKQ RAJ SV3 TEORI WOW 7X8 |
| ID | FETCH-LOGICAL-a406t-dfc22296d01a0dad3e584dfb7c039b00a8b499e5b2f7c589ca3209dbf6194f932 |
| IEDL.DBID | 7X8 |
| ISICitedReferencesCount | 78 |
| ISICitedReferencesURI | http://www.webofscience.com/api/gateway?GWVersion=2&SrcApp=Summon&SrcAuth=ProQuest&DestLinkType=CitingArticles&DestApp=WOS_CPL&KeyUT=000564292600018&url=https%3A%2F%2Fcvtisr.summon.serialssolutions.com%2F%23%21%2Fsearch%3Fho%3Df%26include.ft.matches%3Dt%26l%3Dnull%26q%3D |
| ISSN | 2168-6262 |
| IngestDate | Thu Oct 02 12:19:34 EDT 2025 Thu Jan 02 22:51:43 EST 2025 |
| IsPeerReviewed | true |
| IsScholarly | true |
| Issue | 8 |
| Language | English |
| LinkModel | DirectLink |
| MergedId | FETCHMERGED-LOGICAL-a406t-dfc22296d01a0dad3e584dfb7c039b00a8b499e5b2f7c589ca3209dbf6194f932 |
| Notes | ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23 ObjectType-Undefined-3 |
| PMID | 32492121 |
| PQID | 2409646888 |
| PQPubID | 23479 |
| ParticipantIDs | proquest_miscellaneous_2409646888 pubmed_primary_32492121 |
| PublicationCentury | 2000 |
| PublicationDate | 2020-08-01 20200801 |
| PublicationDateYYYYMMDD | 2020-08-01 |
| PublicationDate_xml | – month: 08 year: 2020 text: 2020-08-01 day: 01 |
| PublicationDecade | 2020 |
| PublicationPlace | United States |
| PublicationPlace_xml | – name: United States |
| PublicationTitle | JAMA surgery |
| PublicationTitleAlternate | JAMA Surg |
| PublicationYear | 2020 |
| References | 32986239 - CA Cancer J Clin. 2020 Nov;70(6):430-431 33146668 - JAMA Surg. 2021 Feb 1;156(2):199-200 |
| References_xml | – reference: 32986239 - CA Cancer J Clin. 2020 Nov;70(6):430-431 – reference: 33146668 - JAMA Surg. 2021 Feb 1;156(2):199-200 |
| SSID | ssj0000800439 |
| Score | 2.57049 |
| SecondaryResourceType | review_article |
| Snippet | Overtreatment of early-stage breast cancer results in increased morbidity and cost without improving survival. Major surgical organizations participating in... |
| SourceID | proquest pubmed |
| SourceType | Aggregation Database Index Database |
| StartPage | 759 |
| SubjectTerms | Breast Neoplasms - surgery Clinical Decision-Making Female Humans Mastectomy - statistics & numerical data Practice Guidelines as Topic Procedures and Techniques Utilization - statistics & numerical data Value-Based Health Insurance |
| Title | Deimplementation of the Choosing Wisely Recommendations for Low-Value Breast Cancer Surgery: A Systematic Review |
| URI | https://www.ncbi.nlm.nih.gov/pubmed/32492121 https://www.proquest.com/docview/2409646888 |
| Volume | 155 |
| WOSCitedRecordID | wos000564292600018&url=https%3A%2F%2Fcvtisr.summon.serialssolutions.com%2F%23%21%2Fsearch%3Fho%3Df%26include.ft.matches%3Dt%26l%3Dnull%26q%3D |
| hasFullText | |
| inHoldings | 1 |
| isFullTextHit | |
| isPrint | |
| link | http://cvtisr.summon.serialssolutions.com/2.0.0/link/0/eLvHCXMwpV3JTsMwELWAcuDCIrayyUhcDY6TJjEXVAoVh1JVKktvleMFKtGmNC2Iv2cmScsJCYlLTokUecaeN4vfI-TM1qxTSc0yqWTCAu0pJk2YsCjhmuswNsLkJK6tqN2Oez3ZKQtuWTlWOT8T84PapBpr5BcQeWQYhJCwXY3fGapGYXe1lNBYJhUfoAxuzKgXL2osiIaCXExMeGHMALuL8t7MnHgom01eIEkU_Jz7qJ_7G8rMo01z47__uUnWS5xJ64VjbJElO9om4xs7GM4HxtEiNHUUECBtvKYpFg3oM6ovfVFMSofwViG4lFFAtrSVfrIn9Taz9BoH2ae0gQ4zod3iYvUlrdPughaaFj2HHfLYvH1o3LFScoEpiOxTZpxGge_QcE9xo4xvAaAYl0Sa-8ieqOIEUiRbS4SLdC2WWvmCS5M4LIY4wIK7ZGWUjuw-oZ4fam4g6xXKBJ5UKpQiUtrEzoIH-EGVnM4XsA8ujX0KNbLpLOv_LGGV7BVW6I8L7o2-jwyHnvAO_vD1IVlD0xbjekek4mBD22Oyqj-mg2xykvsKPNud-29avcvN |
| linkProvider | ProQuest |
| openUrl | ctx_ver=Z39.88-2004&ctx_enc=info%3Aofi%2Fenc%3AUTF-8&rfr_id=info%3Asid%2Fsummon.serialssolutions.com&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.atitle=Deimplementation+of+the+Choosing+Wisely+Recommendations+for+Low-Value+Breast+Cancer+Surgery%3A+A+Systematic+Review&rft.jtitle=JAMA+surgery&rft.au=Wang%2C+Ton&rft.au=Baskin%2C+Alison+S&rft.au=Dossett%2C+Lesly+A&rft.date=2020-08-01&rft.issn=2168-6262&rft.eissn=2168-6262&rft.volume=155&rft.issue=8&rft.spage=759&rft_id=info:doi/10.1001%2Fjamasurg.2020.0322&rft.externalDBID=NO_FULL_TEXT |
| thumbnail_l | http://covers-cdn.summon.serialssolutions.com/index.aspx?isbn=/lc.gif&issn=2168-6262&client=summon |
| thumbnail_m | http://covers-cdn.summon.serialssolutions.com/index.aspx?isbn=/mc.gif&issn=2168-6262&client=summon |
| thumbnail_s | http://covers-cdn.summon.serialssolutions.com/index.aspx?isbn=/sc.gif&issn=2168-6262&client=summon |