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Lancet Oncol. 2019 Apr;20(4):e218-e223. doi: 10.1016/S1470-2045(19)30092-0. Epub 2019 Mar 8.

Choosing Wisely India: ten low-value or harmful practices that should be avoided in cancer care.

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Department of Surgical Oncology, Tata Memorial Centre, Mumbai, India. Electronic address:
Department of Surgical Oncology, Max Hospital, New Delhi, India.
Department of Radiation Oncology, Apollo Hospitals, Hyderabad, India.
Department of Medical Oncology, Prince Aly Khan Hospital, Mumbai, India.
Department of Radiation Oncology, Post Graduate Institute of Medical Education and Research, Chandigarh, India.
Tata Trusts, Mumbai, India.
Department of Medical Oncology, Kidwai Memorial Institute of Oncology, Bengaluru, India.
Jeet Association for Support to Cancer Patients, Mumbai, India.
Department of Surgical Oncology, Asian Institute of Oncology, Mumbai, India.
Department of Health Policy, Management and Evaluation, University of Toronto, Canada.
Institute of Cancer Policy, King's College London, and King's Health Partners Comprehensive Cancer Centre, London, UK.
Department of Cancer Care and Epidemiology, Queen's University Cancer Research Institute, Kingston, ON, Canada.


The Choosing Wisely India campaign was an initiative that was established to identify low-value or potentially harmful practices that are relevant to the Indian cancer health-care system. We undertook a multidisciplinary framework-driven consensus process to identify a list of low-value or harmful cancer practices that are frequently undertaken in India. A task force convened by the National Cancer Grid of India included Indian representatives from surgical, medical, and radiation oncology. Each specialty had representation from the private and public sectors. The task force included two representatives from national patient and patient advocacy groups. Of the ten practices that were identified, four are completely new recommendations, and six are revisions or adaptations from previous Choosing Wisely USA and Canada lists. Recommendations in the final list pertain to diagnosis and treatment (five practices), palliative care (two practices), imaging (two practices), and system-level delivery of care (two practices). Implementation of this list and reporting of concordance with its recommendations will facilitate the delivery of high-quality, value-based cancer care in India.

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