Implementation of Choosing Wisely guidelines: Omission of lymph node surgery

Area of Science:

• Oncology
• Surgical Oncology
• Health Services Research

Background:

• The Choosing Wisely campaign released guidelines in 2016 advising against sentinel lymph node biopsy for specific early-stage breast cancer patients.
• These guidelines target clinically node-negative women aged 70 years or older with hormone receptor-positive, HER2-negative early-stage breast cancers.

Purpose of the Study:

• To assess the real-world implementation of the 2016 Choosing Wisely guidelines regarding sentinel lymph node biopsy omission.
• To identify trends and factors associated with the adoption of these evidence-based recommendations.

Main Methods:

• Analysis of the National Cancer Database (2017-2020).
• Inclusion of patients meeting criteria for lymph node surgery omission.
• Comparison between patients who had omission versus those who underwent lymph node surgery.

Main Results:

• Over 79% of eligible patients underwent lymph node surgery, despite guidelines recommending omission.
• Lymph node surgery omission was more common in older patients, those with higher comorbidity scores, and at academic/research institutions.
• Omission rates increased from 17.7% in 2017 to 23.1% in 2020.

Conclusions:

• The adoption of the Choosing Wisely guideline for sentinel lymph node biopsy omission remains suboptimal.
• Further research is needed to understand barriers to guideline implementation.
• Strategies to improve adherence to evidence-based recommendations are warranted.