Pia Paffenholz1, Isabel Maria Heidegger2, Kathrin Kuhr3, Sven Heiko Loosen4, David Pfister1, Axel Heidenreich5. 1. Department of Urology, Uro-Oncology, Robot Assisted and Reconstructive Urologic Surgery, University Hospital Cologne, Cologne, Germany. 2. Department of Urology, Medical University Innsbruck, Innsbruck, Austria. 3. Institute of Medical Statistics, Informatics and Epidemiology, University Hospital Cologne, Cologne, Germany. 4. Department of Medicine III, University Hospital RWTH Aachen, Aachen, Germany. 5. Department of Urology, Uro-Oncology, Robot Assisted and Reconstructive Urologic Surgery, University Hospital Cologne, Cologne, Germany. Electronic address: axel.heidenreich@uk-koeln.de.
Abstract
INTRODUCTION: The management of testicular cancer (TC) requires a complex multimodal therapeutic approach. Despite the availability of regularly updated guidelines, non-guideline-concordant treatment of TC still occurs. The purpose of the present study was to evaluate the compliance patterns in diagnosis and therapy and their potential effects on patient outcomes with respect to the guidelines of the European Association of Urology. PATIENTS AND METHODS: We performed a retrospective analysis of 131 patients diagnosed with TC who had been referred to our department from September 2015 to October 2016. Patient characteristics were compared with European Association of Urology guideline recommendations. RESULTS: Of the 131 primary treated patients, 23 (18%) had received a non-guideline-concordant treatment. The most common error was undertreatment (n = 12; 52%), mainly due to missing chemotherapy cycles. Overtreatment occurred in 30% of patients (n = 7); however, inappropriate treatment (n = 2; 9%) and misdiagnosis (n = 2; 9%) were rarely observed. In salvage therapy, non-guideline concordant treatment was observed less frequently compared to patients receiving primary therapy (12% vs. 18%). Of the 131 patients, 35 developed a relapse, 23 of whom were treated correctly and 6 of whom were undertreated. Undertreatment of patients resulted in significantly reduced relapse-free survival compared with guideline-concordant management in primary treated patients (P = .005). CONCLUSION: Despite the standardization of treatment by interdisciplinary guidelines, its integration into daily practice remains limited. Undertreatment of TC patients is associated with significantly reduced relapse-free survival and should thus be avoided.
INTRODUCTION: The management of testicular cancer (TC) requires a complex multimodal therapeutic approach. Despite the availability of regularly updated guidelines, non-guideline-concordant treatment of TC still occurs. The purpose of the present study was to evaluate the compliance patterns in diagnosis and therapy and their potential effects on patient outcomes with respect to the guidelines of the European Association of Urology. PATIENTS AND METHODS: We performed a retrospective analysis of 131 patients diagnosed with TC who had been referred to our department from September 2015 to October 2016. Patient characteristics were compared with European Association of Urology guideline recommendations. RESULTS: Of the 131 primary treated patients, 23 (18%) had received a non-guideline-concordant treatment. The most common error was undertreatment (n = 12; 52%), mainly due to missing chemotherapy cycles. Overtreatment occurred in 30% of patients (n = 7); however, inappropriate treatment (n = 2; 9%) and misdiagnosis (n = 2; 9%) were rarely observed. In salvage therapy, non-guideline concordant treatment was observed less frequently compared to patients receiving primary therapy (12% vs. 18%). Of the 131 patients, 35 developed a relapse, 23 of whom were treated correctly and 6 of whom were undertreated. Undertreatment of patients resulted in significantly reduced relapse-free survival compared with guideline-concordant management in primary treated patients (P = .005). CONCLUSION: Despite the standardization of treatment by interdisciplinary guidelines, its integration into daily practice remains limited. Undertreatment of TC patients is associated with significantly reduced relapse-free survival and should thus be avoided.
Authors: Gregory J Nason; Ricardo A Rendon; Lori Wood; Robert A Huddart; Peter Albers; Lawrence H Einhorn; Craig R Nichols; Christian Kollmannsberger; Lynn Anson-Cartwright; Padraig Warde; Michael A S Jewett; Peter Chung; Philippe L Bedard; Aaron R Hansen; Robert J Hamilton Journal: Can Urol Assoc J Date: 2021-01 Impact factor: 1.862
Authors: Pia Paffenholz; Tim Nestler; Yasmine Maatoug; Melanie von Brandenstein; Barbara Köditz; David Pfister; Axel Heidenreich Journal: Urologe A Date: 2021-01-11 Impact factor: 0.639
Authors: Klaus-Peter Dieckmann; Tomas Pokrivcak; Lajos Geczi; David Niehaus; Inken Dralle-Filiz; Cord Matthies; Tamas Dienes; Stefanie Zschäbitz; Pia Paffenholz; Tanja Gschliesser; Renate Pichler; Michal Mego; Pia Bader; Friedemann Zengerling; Julia Heinzelbecker; Philipp Krausewitz; Susanne Krege; Gaetano Aurilio; Cem Aksoy; Marcus Hentrich; Christoph Seidel; Péter Törzsök; Tim Nestler; Matthaeus Majewski; Andreas Hiester; Tomas Buchler; Sonia Vallet; Hana Studentova; Sandra Schönburg; Dora Niedersüß-Beke; Julia Ring; Emanuela Trenti; Axel Heidenreich; Christian Wülfing; Hendrik Isbarn; Uwe Pichlmeier; Martin Pichler Journal: Ther Adv Med Oncol Date: 2022-03-31 Impact factor: 8.168