Choosing Wisely for Cancer Care in India
Choosing Wisely India (CWI) is an initiative to identify lowvalue and/or potentially harmful practices in cancer care in India. Modelled after Choosing Wisely in the USA and Canada [1 3] the CWI project was intended to facilitate a conversation between patients, clinicians, hospitals and policy makers on delivering high quality, affordable cancer care. By identifying common low value and/or harmful practices, this process aims to reduce unnecessary interventions to improve overall quality of care, reduce patient toxicity and reduce the financial burden on both the patient and system. The formal CWI report has been recently published in Lancet Oncology [4] in this commentary, we provide a summary of the process, describe the Top 10 CWI list and offer suggestions for future actions to improve the delivery of high quality cancer in India's cancer system. The National Cancer Grid (NCG) was established in 2012 and now includes 171 cancer centres, research institutes, patient advocacy groups, charitable organizations and professional societies. The NCG coordinates national efforts related to cancer control, research and education. A key initiative of the NCG has been the creation of context specific clinical practice guidelines for common cancers, the goal of which is to standardize and improve the quality of care delivered [5] In a parallel project, the NCG undertook Choosing Wisely India to identify and eventually reduce utilization of interventions which do not offer meaningful benefit to patients. The high proportion of out of pocket spending among Indian cancer patients makes this highly relevant in a system where a substantial proportion of patients incur catastrophic health expenditures [6] The Choosing Wisely initiative has been adopted globally by more than 20 countries as a disease specific process to identify unnecessary (often expensive) interventions that should be avoided [7] Within the USA and Canada, there are now over 800 Choosing Wisely recommendations from more than 120 national societies covering a range of diseases [8, 9] Choosing Wisely initiatives focused on cancer have been published in the USA and Canada [1 3] Choosing Wisely India represents the first Choosing Wisely initiative within any disease area from a low middle income country and represents an important step on the path to Universal Health Coverage and the achievement of health Sustainable Development Goals. In 2017, the NCG convened a nine member Choosing Wisely India Task Force including two members from
Indian Journal of Surgery