Patient Story: Adventures in Choosing Wisely

Here's an awesome example of a patient who worked with her doctors to Choose Wisely.

Amy Berman has breast cancer that has metastasized to bone. She is a Registered Nurse (RN), a Senior Program Officer at the Hartford Foundation, and a vocal advocate for patient-centred care.

She decided with her doctors that she would benefit most from treatment with a single fraction of palliative radiotherapy instead of an extended course. The goal of this being some relief from the pain that stemmed from the new area of cancer on her ribs.

Her choice is in keeping with the evidence and recommendations of the Choosing Wisely items in Radiation Oncology. In the USA, the guidelines developed by The American Society for Radiation Oncology (ASTRO) suggest:

  • "Don’t routinely use extended fractionation schemes (>10 fractions) for palliation of bone metastases." 

 The Canadian Association of Radiation Oncology, in their version of recommendations, suggest:

  • "Don’t recommend more than a single fraction of palliative radiation for an uncomplicated painful bone metastasis."

Further, they explain: "Randomized trials have established that single-fraction radiation to a previously unirradiated, uncomplicated peripheral bone or vertebral metastasis provides comparable pain relief and morbidity compared to multiple-fraction regimens, while optimizing patient and caregiver convenience. Although it results in a higher incidence of retreatment at a later date (20% vs. 8 % for multi-fraction regimens), the decreased patient burden usually outweighs any considerations of long-term effectiveness for those with a limited life expectancy."

Arranging this appropriate treatment was harder for Amy (and her doctor) than just making the choice. See her blog post to find out more, as there was more to the story! It appears that not everyone is on board with Choosing Wisely, yet  . . .