By Dr. Sadia Sadiq
Abstract:
Background:
The Choosing Wisely campaign, initiated by the ABIM
Foundation, aims to promote evidence-based decision-making
and reduce unnecessary medical interventions that provide
little benefit to patients. While several countries have adopted
national versions of this initiative, Pakistan currently lacks an
organized framework to translate these recommendations into
practice within its healthcare system.
Objective:
To explore the key principles of the Choosing Wisely campaign
and propose Pakistan-specific strategies for optimizing cancer
care delivery through judicious use of investigations and
treatments, ensuring better utilization of limited oncology
resources.
Materials/Methods:
This concept originates from an early-career oncologist’s
perspective, based on day-to-day clinical observations in
tertiary cancer care. Pakistan faces unique challenges,
including limited healthcare resources, absence of national
clinical guidelines, lack of patient awareness, and frequent
overutilization of diagnostic procedures .Existing Choosing Wisely Oncology recommendations were reviewed, and areas
of potential adaptation were identified, emphasizing
diagnostic, treatment, and radiotherapy practices commonly
observed in Pakistan.
Results:
Several potentially low-value practices were recognized, such
as performing FNAC instead of core biopsy in breast cancer
patients, initiating suboptimal surgery before receptor status
determination or multidisciplinary input, and overuse of
PET-CT in cases where results are unlikely to alter
management. Other gaps include delayed diagnosis due to
empirical treatment in lung cancer, lack of awareness in
cervical cancer and fear of needle biopsy in head and neck
cancer patients. Lack of prioritization for patients receiving
radical radiotherapy is also a common practice. These issues
highlight opportunities for evidence-based and
patient-centered decision-making. Implementation of
Choosing Wisely Pakistan would require:
Encouragement of multidisciplinary tumor boards and
peer review to reduce redundant imaging and overtreatment.
Conclusion:
Adopting a Choosing Wisely Pakistan framework could
substantially enhance value-based oncology practice.
Collaborative national efforts to establish specialty-specific
recommendations and virtual tumor boards would help ensure
equitable, cost-effective, and evidence-driven cancer care
across Pakistan.