Choosing Wisely Africa: Ten Low-Value or Harmful Practices That Should Be Avoided in Cancer Care

Abstract

PURPOSE Choosing Wisely Africa (CWA) builds on Choosing Wisely (CW) in the United States, Canada, and India and aims to identify low-value, unnecessary, or harmful cancer practices that are frequently used on the African continent. The aim of this work was to use physicians and patient advocates to identify a short list of low-value practices that are frequently used in African low- and middle-income countries. METHODS The CWA Task Force was convened by the African Organization for Research and Training in Cancer and included representatives from surgical, medical, and radiation oncology, the private and public sectors, and patient advocacy groups. Consensus was built through a modified Delphi process, shortening a long list of practices to a short list, and then to a final list. A voting threshold of ≥ 60% was used to include an individual practice on the short list. A consensus was reached after a series of teleconferences and voting processes. RESULTS Of the 10 practices on the final list, one is a new suggestion and 9 are revisions or adaptations of practices from previous CW campaign lists. One item relates to palliative care, 8 concern treatment, and one relates to surveillance. CONCLUSION The CWA initiative has identified 10 low-value, common interventions in Africa’s cancer practice. The success of this campaign will be measured by how the recommendations are implemented across sub-Saharan Africa and whether this improves the delivery of high-quality cancer care.

Silver linings: a qualitative study of desirable changes to cancer care during the COVID-19 pandemic

“…This qualitative study sought to describe what lessons can be gained bi-directionally between different health systems during the pandemic. Cessation of low-value practices in cancer care has long been sought and the pandemic provided a window for implementation of the recommendations made by various groups [12][13][14][15].…”

Value-based radiotherapy: A new chapter of the ESTRO-HERO project

“…As higher costs do not guarantee improved outcomes [25], initiatives have sought to define high and low value cancer care. These include prioritisation exercises by multi-stakeholder groups defining low-value or unsafe care practices in particular country or continent contexts, such as the Choosing Wisely campaigns [26][27][28], or the development of value appraisal tools for new interventions. With respect to the latter, the ESMO Magnitude of Clinical Benefit Scale, the ASCO Value Framework and the NCCN Blocks are the dominant scales that have been used when considering the value of oncology interventions, specifically drug treatments [29][30][31].…”

Cancer Clinical Trials in Africa—An Untapped Opportunity: Recommendations From AORTIC 2019 Conference Special Interest Group in Clinical Trials

“… 6 , 11 Organizations such as AORTIC and ASCO are building bridges to conquer cancer and reduce disparities in patient outcome through educational programs and partnership with African countries. 12 In addition, regulatory agencies such as the US Food and Drug Administration have convened discussion meetings and issued position papers and guidance documents in an effort to address this disparity. 13 …”