Adherence to National Comprehensive Cancer Network® Guidelines for Testicular Cancer

Wymer, Kevin; Pearce, Shane M.; Harris, Kelly T.; Pierorazio, Phillip M.; Daneshmand, Siamak; Eggener, Scott E.

doi:10.1016/j.juro.2016.09.073

Cited by 52 publications

(35 citation statements)

References 27 publications

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“…The cohorts were well matched and proportions of the IGCCCG risk groups were consistent with the literature (Table 1) [14,26]. All patients with metastatic disease received cisplatin based chemotherapy.…”

Section: Resultssupporting

confidence: 53%

Risk stratification for venous thromboembolism in patients with testicular germ cell tumors

et al. 2017

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BackgroundPatients with testicular germ cell tumors (TGCT) have an increased risk for venous thromboembolism (VTE). We identified risk factors for VTE in this patient cohort and developed a clinical risk model.MethodsIn this retrospective cohort study at the Medical University of Graz we included 657 consecutive TGCT patients across all clinical stages. A predictive model for VTE was developed and externally validated in 349 TGCT patients treated at the University Hospital Zurich.ResultsVenous thromboembolic events occurred in 34 (5.2%) patients in the Graz cohort. In univariable competing risk analysis, higher clinical stage (cS) and a retroperitoneal lymphadenopathy (RPLN) were the strongest predictors of VTE (p<0.0001). As the presence of a RPLN with more than 5cm in greatest dimension without coexisting visceral metastases is classified as cS IIC, we constructed an empirical VTE risk model with the following four categories (12-month-cumulative incidence): cS IA-B 8/463 patients (1.7%), cS IS-IIB 5/86 patients (5.9%), cS IIC 3/21 patients (14.3%) and cS IIIA-C 15/70 patients (21.4%). This risk model was externally validated in the Zurich cohort (12-month-cumulative incidence): cS IA-B (0.5%), cS IS-IIB (6.0%), cS IIC (11.1%) and cS IIIA-C (19.1%). Our model had a significantly higher discriminatory performance than a previously published classifier (RPLN-VTE-risk-classifier) which is based on the size of RPLN alone (AUC-ROC: 0.75 vs. 0.63, p = 0.007).ConclusionsAccording to our risk stratification, TGCT patients with cS IIC and cS III disease have a very high risk of VTE and may benefit from primary thromboprophylaxis for the duration of chemotherapy.

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Section: Resultssupporting

confidence: 53%

Risk stratification for venous thromboembolism in patients with testicular germ cell tumors

et al. 2017

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“…Testicular germ-cell tumors (TGCTs) remain the most common solid neoplasms among young men aged 20-40 yr, with an incidence of 3-10 cases per 100 000 men in industrialized countries [1]. Although the cure rate even among patients with extensive metastatic disease is still excellent owing to the high chemosensitivity of TGCT, a multidisciplinary approach and strict adherence to guidelines are mandatory to achieve and maintain excellent treatment results [2,3]. These recommendations are underlined by a recently published study demonstrating that approximately one-fifth of all patients receive a nonguideline-recommended treatment [4] leading to significantly lower relapse-free survival in comparison to guideline-concordant management (p = 0.005).…”

Section: Introductionmentioning

confidence: 99%

European Association of Urology Guidelines on Testis Cancer: Important Take Home Messages

Heidenreich

Paffenholz

Nestler

et al. 2019

European Urology Focus

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“…For initial staging, chest CT and abdominal CT were correctly utilised by >80% of urologists. Our guideline compliance rates were significantly improved as compared with a previous study that retrospectively analysed 593 TC patients and found an inappropriate imaging rate of 44% with respect to the NCCN guidelines (Wymer et al, 2017). A French survey of 289 urologists revealed a guideline adherence rate of 66% for the initial radiological workup (Rigaud et al, 2014).…”

Section: Discussionmentioning

confidence: 53%

“…For optimal staging, treatment and follow‐up, it is essential to utilise current guidelines (Albers et al, ; Motzer et al, ). A previous study showed that non‐guideline‐directed care led to inappropriate imaging (44%), overtreatment (40%) and misdiagnosis (24%) (Wymer et al, ). Additional studies have found insufficient post‐treatment imaging rates and unnecessary adjuvant therapy regimens when compared with current guideline recommendations (Matulewicz, Oberlin, Sheinfeld, & Meeks, ; Rusner, Stang, Dieckmann, & Friedel, ).…”

Section: Introductionmentioning

confidence: 99%

Testicular cancer guideline adherence and patterns of care in Germany: A nationwide survey

Nestler

Baunacke²,

Dräger

et al. 2018

Eur J Cancer Care

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Testicular cancer has excellent cure rates; however, poor guideline adherence can lead to inappropriate management, with a detrimental effect on outcomes. Therefore, we aimed to investigate the current patterns of care for testicular cancer patients and to evaluate guideline adherence. A 19‐item survey was distributed among German urologists between September 2015 and September 2016. The response rate was 45% (411/920). Staging imaging of the chest was performed by computed tomography (CT) in 85.5% and X‐ray in 17.7%, and for the abdomen, by CT in 83.7% and by magnetic resonance imaging (MRI) in 21.1%. Areas of discrepancy with respect to guideline recommendations included underuse of MRI and infrequent follow‐up examinations for changes in the cardiovascular, endocrine, neurological, and pulmonary systems, in addition to psychological burden. Further deviations of reported routine procedures from guideline recommendations were identified in the fields of active surveillance in Stage I seminoma, contralateral biopsies (63.1% overuse) and cryopreservation (19.2% underuse). Moreover, we found that hospital‐based clinicians and younger specialists, with ≤5 years of practice following board certification, perform a more accurate and thorough follow‐up. German urologists show relatively strong guideline adherence in staging patterns. Significant improvements are necessary in the following areas: recommending cryopreservation, imaging modalities and accurate follow‐up examinations with a focus on late toxicities.

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Adherence to National Comprehensive Cancer Network® Guidelines for Testicular Cancer

Abstract: Nonguideline directed care of patients with testicular cancer is common, most frequently in the form of inappropriate imaging and overtreatment. Nonguideline directed care leads to delayed definitive therapy, unnecessary morbidity and higher rates of relapse.

Cited by 52 publications

References 27 publications

Risk stratification for venous thromboembolism in patients with testicular germ cell tumors

Risk stratification for venous thromboembolism in patients with testicular germ cell tumors

European Association of Urology Guidelines on Testis Cancer: Important Take Home Messages

Testicular cancer guideline adherence and patterns of care in Germany: A nationwide survey

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