American Society for Radiation Oncology

View all recommendations from this society

Released July 28, 2022

Do not routinely initiate radiation therapy, or other forms of cancer treatment, without consideration of potential financial toxicity to patients.

  • Cancer patients are at high risk for financial hardships due to lost productivity and uncovered treatment expenses.
  • Radiation treatment decisions, including implemented technology, fractionation regimen, and whether radiation can be omitted, all may meaningfully influence the financial impact of the treatment on the patient. Heavy financial burdens can accrue, sometimes to the point of financial insolvency.
  • Financial toxicity has been observed to be associated with reduced treatment compliance and lower overall survival.

These items are provided solely for informational purposes and are not intended as a substitute for consultation with a medical professional. Patients with any specific questions about the items on this list or their individual situation should consult their physician.

How The List Was Created

1–5: Following approval of the participation of the American Society for Radiation Oncology (ASTRO) in the Choosing Wisely campaign, a survey was sent to ASTRO committees and panels related to health policy, government relations, and clinical affairs and quality in order to identify potential items for inclusion in the list. A work group, comprised of seven physicians drawn from these three areas, was also selected and convened. The work group members were asked to pick their top eight items from the total of 34 topics that had been suggested in the initial survey. The results were tabulated and a list of the highest scoring items generated, creating a short list of 13 draft items.

Three conference calls were subsequently held to further refine the list and finalize the wording of the items based on input from ASTRO’s Board of Directors. A literature review was conducted for each topic by ASTRO staff and each work group member took the lead on writing text and selecting references for one or more draft items. The final items for submission were selected by ASTRO’s Board of Directors. ASTRO’s disclosure and conflict of interest policy can be found at: www.astro.org.

6–10: In January 2014, the American Society for Radiation Oncology (ASTRO) formed a group to develop its second Choosing Wisely list, which included representatives from health policy, government relations, and clinical affairs and quality. The work group began by narrowing a list of 28 draft concepts to nine potential Choosing Wisely items. Next, an electronic anonymous survey was sent to the ASTRO membership to rate the value and relevancy of each of the items. The survey also included an open text box for members to comment on the suggested items and to provide additional ideas for Choosing Wisely items. Based on the survey results, the work group submitted a short list of eight items to the ASTRO Board of Directors, from which the Board chose five items to move forward.

Literature reviews were conducted for the five Choosing Wisely items selected by the Board and the group drafted verbiage, bullet points and references for each item. Following a second review by the Board of Directors, one of the items was replaced with an alternate item from the short list. The final list received approval from the Board and was then submitted to the ABIM Foundation. ASTRO’s disclosure and conflict of interest policy can be found at: www.astro.org.

Sources

Altice CK, Banegas MP, Tucker-Seeley RD, Yabroff KR. Financial Hardships Experienced by Cancer Survivors: A Systematic Review. J Natl Cancer Inst. 2016;109(2):djw205.

Ma SJ, Iovoli AJ, Attwood K, et al. Association of significant financial burden with survival for head and neck cancer patients treated with radiation therapy. Oral Oncol. 2021;115:105196.

Palmer JD, Patel TT, Eldredge-Hindy H, et al. Patients Undergoing Radiation Therapy Are at Risk of Financial Toxicity: A Patient-based Prospective Survey Study. Int J Radiat Oncol Biol Phys. 2018;101(2):299-305.

Ramsey SD, Bansal A, Fedorenko CR, et al. Financial Insolvency as a Risk Factor for Early Mortality Among Patients With Cancer. J Clin Oncol. 2016;34(9):980-986.

Smith GL, Lopez-Olivo MA, Advani PG, et al. Financial Burdens of Cancer Treatment: A Systematic Review of Risk Factors and Outcomes. J Natl Compr Canc Netw. 2019;17(10):1184-1192.