Advance-CTR Pilot Projects Program (2020)
"Are We 'Choosing Wisely' and Improving Value in Cancer Care?"
The US expenditures for cancer care are substantially increasing and are expected to cross $175 billion in 2020. The Choosing Wisely campaign was launched with the aim to encourage appropriate use of healthcare resources. The American Society of Clinical Oncology (ASCO) identified several cancer tests, procedures, and medications that were determined as low-value care. Very limited information is available about the use of ASCO-defined low-value healthcare services in the real-world population, especially the older patients with cancer, for are at increased risk of receiving low-value services. There is a crucial yet unmet need to determine the extent of use of low-value healthcare services in patients with breast cancer or prostate cancer, to examine any changes in the rates of use of these services post-campaign, and also to identify the significant predictors of use of low-value healthcare services that may be indicative of inefficient or wasteful use of healthcare resources. It is hypothesized that the use of ASCO-defined low-value healthcare services will be prevalent in elderly cancer patients. The proposed research will evaluate this hypothesis in two specific aims. In Aim 1, proportion of elderly patients with breast cancer or prostate cancer who received ASCO-defined low-value healthcare services pre- and post-campaign will be determined. Also trends in use of these services from 2007 to 2015 will be examined. In addition, we will also assess changes in rates of use of low-value healthcare services pre- and post-campaign. In Aim 2, variation in use of low-value healthcare services post-campaign and its significant predictors will be identified after adjusting for patient demographic, socioeconomic, geographic, clinical and healthcare access-related factors. The National Cancer Institute's Surveillance Epidemiology and End Results cancer registry data will be linked to the Medicare claims data to identify elderly patients diagnosed with incident breast cancer or prostate cancer during 2007-2015. By determining the extent of use of low-value healthcare services in patients with breast cancer or prostate cancer, we will be able to identify opportunities for improving value-based care in this vulnerable population. By understanding the changes in the rates of ASCO-defined recommended care, we will be able to determine the effect of the campaign on the use of low-value cancer care and be also able to identify the patient subgroups who are more likely to receive low-value care.