Choosing Wisely in oncology: are guidelines effective at preventing unnecessary diagnostics? The example of surveillance positron emission tomography for patients with localised colorectal cancer.

Objective: Healthcare overuse is a major challenge for healthcare systems and patients worldwide. Professional guidelines such as the 'Choosing Wisely' guidelines have attempted to reduce specific examples of overuse. We examined the use of surveillance positron emission tomography CT (PETCT) in patients with colorectal cancer (CRC) treated with curative intent.

Methods and analysis: We used the large Clalit Health Services dataset in Israel to identify patients with CRC who received adjuvant chemotherapy between January 2017 and December 2021. We examined the number of PETCTs performed for each patient.

Results: We included 1799 patients in our study cohort. We distinguished localised from metastatic cases based on specific drugs administered or not administered during the follow-up period (ie, biologics). For the entire cohort, the median number of PETCTs performed per patient over the study period was 3364 (20.2%) patients underwent a single PETCT, 946 (52.6%) patients underwent ≥2 PETCTs and 25 patients underwent ≥10 PETCTs. If none or a single PETCT is considered 'guideline-concordant' during diagnosis and treatment of localised CRC, 69% of 4231 PETCTs performed were 'guideline-discordant'.

Conclusion: Despite the 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, constituting healthcare overuse of an expensive diagnostic procedure.