Choosing Wisely Pakistan: A call for value-based oncology practice in resource-limited settings.

Abstract

e13532 Background: The Choosing Wisely initiative promotes evidence-based oncology care by reducing low-value interventions. While several low- and middle-income countries (LMICs) have successfully launched national Choosing Wisely oncology campaigns, Pakistan currently lacks a structured framework. With a rising cancer burden, limited diagnostic and treatment resources, financial constraints, and delays in radiotherapy access, there is a critical need to prioritize high-value cancer care. This study describes the development of a multidisciplinary roadmap for initiating Choosing Wisely Pakistan. Methods: This initiative is informed by real-world clinical practice in tertiary cancer care and review of existing Choosing Wisely oncology recommendations from high-income countries and LMICs. A multidisciplinary working group comprising radiation oncologists, medical oncologists, surgical oncologists, radiologists, and nuclear medicine physicians was formed. Common low-value practices in Pakistan were identified across diagnosis, treatment planning, imaging, and radiotherapy access. A consensus-driven process was followed including shortlisting practices based on frequency, cost–benefit ratio, clinical impact, and feasibility, followed by expert voting and structured multidisciplinary discussions. Engagement with relevant national professional societies is underway to seek formal support and facilitate implementation. Results: Several potentially low-value practices were identified, including inappropriate use of FNAC in breast cancer, initiation of surgery without receptor status or multidisciplinary input, overuse of PET-CT where it does not alter management, delays in lung cancer diagnosis due to empirical treatment, underutilization of cervical cancer screening, biopsy avoidance in head and neck cancers, and lack of prioritization for patients awaiting radical radiotherapy. These practices represent opportunities for improved and value-based cancer care. Specialty specific recommendations have been made and will be shared on various platforms in national and local languages after endorsement from official societies. Conclusions: Choosing Wisely Pakistan represents a feasible, multidisciplinary, and nationally scalable approach to optimizing oncology care in a resource-limited setting. Formal endorsement by professional societies and integration into clinical practice could reduce unnecessary interventions and improve equitable access to cancer care in Pakistan.