Main Session
Sep
29
PQA 06 - Radiation and Cancer Biology, Health Care Access and Engagement
3066 - Choosing Wisely Bangladesh: Top Ten Practices that Should be Avoided in Cancer Care
Presenter(s)
Nowshin Hossain, MD - Ahsania Mission Cancer and General Hospital, Dhaka, Dhaka
N. T. Hossain1, M. S. S. Huq2, A. Kamal Uddin3, A. M. M. S. Alam1, A. Hossain4, A. Paul Chowdhury1, J. Ferdause1, S. Sultana5, M. A. Sumon6, T. Islam6, S. S. Soni7, and M. Karim8; 1Ahsania Mission Cancer and General Hospital, Dhaka, Bangladesh, 2Department of Radiation Oncology, UPMC Hillman Cancer Center, Pittsburgh, PA, 3Labaid Cancer Hospital And Super Speciality Centre, Dhaka, Bangladesh, 4National Institute of Cancer Research and Hospital, Dhaka, Bangladesh, 5Delta Hospital Ltd, Dhaka, Bangladesh, 6Kurmitola General Hospital, Dhaka, Bangladesh, 7All India Institute of Medical Sciences, India, India, 8Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh
Purpose/Objective(s):
Choosing Wisely Bangladesh (CWB), launched in 2024, is based on global Choosing Wisely initiatives and aims to identify and reduce low-value and costly cancer interventions in Bangladesh, a country with limited healthcare resources. With increasing cancer cases and insufficient resources, including chemotherapy centers and radiotherapy machines, the campaign seeks to prioritize cancer treatments for those with the most urgent needs. The initiative aims to collaborate across oncology specialties, policymakers, and patient advocacy groups to ensure efficient and effective cancer care. This is the fourth Choosing Wisely campaign in Low and Middle income countries (LMICs).Materials/Methods:
CWB was initiated by representatives from oncology specialties, patient advocacy, and expert advisors. The process began with identifying low-value practices in diagnosis, treatment, surveillance, and radiotherapy access. A list of 35 practices was initially created, then refined through expert voting. Voting thresholds were set at 60% for practice inclusion, considering frequency, cost-benefit ratio, and evidence. Final practices were selected through multiple teleconference discussions. The voting process ensured consensus among diverse stakeholders, representing both public and private sectors in cancer care.Results:
The final list comprises 10 low-value practices, including three new practices specific and relevant in the context of Bangladesh and seven modified practices adapted from previous campaigns in the U.S., Canada, and India. These practices cover diagnosis and treatment (4 practices), palliative care (1 practice), imaging (2 practices), and radiotherapy (3 practices). The list aims to reduce unnecessary tests and treatments, with a particular focus on addressing radiotherapy delays. These practices were selected for their high frequency, marginal benefit, and potential for cost reduction in resource-limited settings.Conclusion:
CWB has identified 10 low-value cancer interventions that should be avoided in Bangladesh. The success of this initiative will depend on its implementation across LMICs, where it can enhance cost-effective cancer care delivery. This campaign presents a critical step in transforming cancer care policies, ensuring that resources are prioritized for the most urgent cases. Future efforts will focus on integrating these recommendations into national cancer care protocols to improve patient outcomes despite resource limitations.