On Thin Ice: Barriers to Adoption of Surveillance for Patients with Stage I Testicular Seminoma. Survey of US Radiation Oncologists

Overview

Journal Int Braz J Urol

Specialty Urology

Date 2018 Mar 10

PMID 29522295

Authors

Aditya Jain

Catherine Degnin

Yiyi Chen

Mike Craycraft

Arthur Hung

Jerry Jaboin

Charles R Thomas Jr

Timur Mitin

Affiliations

Soon will be listed here.

Abstract

Purpose: Most men with stage I testicular seminoma are cured with surgery alone, which is a preferred strategy per national guidelines. The current pattern of practice among US radiation oncologists (ROs) is unknown.

Materials And Methods: We surveyed practicing US ROs via an online questionnaire. Respondent's characteristics, self-rated knowledge, perceived patient compliance rates with observation were analyzed for association with treatment recommendations.

Results: We received 353 responses from ROs, of whom 23% considered themselves experts. A vast majority (84%) recommend observation as a default strategy, however this rate drops to 3% if the patient is believed to be noncompliant. 33% of respondents believe that survival is jeopardized in case of disease recurrence, and among these respondents only 5% support observation. 22% of respondents over-estimate the likelihood of noncompliance with observation to be in the 50-80% range. Responders with a higher perceived noncompliance rate are more likely to recommend adjuvant therapy (Fisher's exact p<0.01). Only 7% of respondents recommend observation for stage IS seminoma and 45% administer adjuvant RT in patients with elevated pre-orchiectomy alpha-fetal protein levels.

Conclusions: Many US ROs over-estimate the likelihood that stage I testicular seminoma patients will be noncompliant with surveillance and incorrectly believe that overall survival is jeopardized if disease recurs on surveillance. Observation is quickly dismissed for patients who are not deemed to be compliant with observation, and is generally not accepted for patients with stage IS disease. There is clearly an opportunity for improved physician education on evidence-based management of stage I testicular seminoma.

References

Zagars G, Ballo M, Lee A, Strom S . Mortality after cure of testicular seminoma. J Clin Oncol. 2004; 22(4):640-7. DOI: 10.1200/JCO.2004.05.205. View

Yu H, Madison R, Setodji C, Saigal C . Quality of surveillance for stage I testis cancer in the community. J Clin Oncol. 2009; 27(26):4327-32. PMC: 2744273. DOI: 10.1200/JCO.2008.19.9406. View

Oliver R, Mead G, Rustin G, Joffe J, Aass N, Coleman R . Randomized trial of carboplatin versus radiotherapy for stage I seminoma: mature results on relapse and contralateral testis cancer rates in MRC TE19/EORTC 30982 study (ISRCTN27163214). J Clin Oncol. 2011; 29(8):957-62. DOI: 10.1200/JCO.2009.26.4655. View

Ahmed K, Wilder R . Outcomes and treatment patterns as a function of time in stage IS testicular seminoma: a population-based analysis. Cancer Epidemiol. 2014; 38(2):124-8. DOI: 10.1016/j.canep.2014.02.003. View

Horwich A, Fossa S, Huddart R, Dearnaley D, Stenning S, Aresu M . Second cancer risk and mortality in men treated with radiotherapy for stage I seminoma. Br J Cancer. 2013; 110(1):256-63. PMC: 3887279. DOI: 10.1038/bjc.2013.551. View

Kollmannsberger C, Tandstad T, Bedard P, Cohn-Cedermark G, Chung P, Jewett M . Patterns of relapse in patients with clinical stage I testicular cancer managed with active surveillance. J Clin Oncol. 2014; 33(1):51-7. DOI: 10.1200/JCO.2014.56.2116. View

Gray P, Lin C, Sineshaw H, Paly J, Jemal A, Efstathiou J . Management trends in stage I testicular seminoma: Impact of race, insurance status, and treatment facility. Cancer. 2014; 121(5):681-7. DOI: 10.1002/cncr.29094. View

Chung P, Daugaard G, Tyldesley S, Atenafu E, Panzarella T, Kollmannsberger C . Evaluation of a prognostic model for risk of relapse in stage I seminoma surveillance. Cancer Med. 2014; 4(1):155-60. PMC: 4312129. DOI: 10.1002/cam4.324. View

Wilder R, Buyyounouski M, Efstathiou J, Beard C . Radiotherapy treatment planning for testicular seminoma. Int J Radiat Oncol Biol Phys. 2012; 83(4):e445-52. DOI: 10.1016/j.ijrobp.2012.01.044. View

10.

Mortensen M, Lauritsen J, Gundgaard M, Agerbaek M, Holm N, Christensen I . A nationwide cohort study of stage I seminoma patients followed on a surveillance program. Eur Urol. 2014; 66(6):1172-8. DOI: 10.1016/j.eururo.2014.07.001. View

11.

Tandstad T, Smaaland R, Solberg A, Bremnes R, Langberg C, Laurell A . Management of seminomatous testicular cancer: a binational prospective population-based study from the Swedish norwegian testicular cancer study group. J Clin Oncol. 2011; 29(6):719-25. DOI: 10.1200/JCO.2010.30.1044. View

12.

Arvold N, Catalano P, Sweeney C, Hoffman K, Nguyen P, Balboni T . Barriers to the implementation of surveillance for stage I testicular seminoma. Int J Radiat Oncol Biol Phys. 2012; 84(2):383-9. DOI: 10.1016/j.ijrobp.2011.11.064. View

13.

Ernst D, Brasher P, Venner P, Czaykowski P, Moore M, Reyno L . Compliance and outcome of patients with stage 1 non-seminomatous germ cell tumors (NSGCT) managed with surveillance programs in seven Canadian centres. Can J Urol. 2005; 12(2):2575-80. View

14.

Jones W, Fossa S, Mead G, Roberts J, Sokal M, Horwich A . Randomized trial of 30 versus 20 Gy in the adjuvant treatment of stage I Testicular Seminoma: a report on Medical Research Council Trial TE18, European Organisation for the Research and Treatment of Cancer Trial 30942 (ISRCTN18525328). J Clin Oncol. 2005; 23(6):1200-8. DOI: 10.1200/JCO.2005.08.003. View

15.

Warde P, Specht L, Horwich A, Oliver T, Panzarella T, Gospodarowicz M . Prognostic factors for relapse in stage I seminoma managed by surveillance: a pooled analysis. J Clin Oncol. 2002; 20(22):4448-52. DOI: 10.1200/JCO.2002.01.038. View

16.

Horwich A, Shipley J, Huddart R . Testicular germ-cell cancer. Lancet. 2006; 367(9512):754-65. DOI: 10.1016/S0140-6736(06)68305-0. View

17.

Alomary I, Samant R, Gallant V . Treatment of stage I seminoma: a 15-year review. Urol Oncol. 2006; 24(3):180-3. DOI: 10.1016/j.urolonc.2005.05.010. View

18.

van Leeuwen F, Stiggelbout A, van den Belt-Dusebout A, Noyon R, Eliel M, van Kerkhoff E . Second cancer risk following testicular cancer: a follow-up study of 1,909 patients. J Clin Oncol. 1993; 11(3):415-24. DOI: 10.1200/JCO.1993.11.3.415. View