Nachsorge von Patienten mit Hodentumoren

Hartmann, Matthias; Krege, Susanne; Souchon, Rainer; Santis, Maria De; Gillessen, Silke; Cathomas, Richard; Hodentumore, Interdisziplinäre Arbeitsgruppe

doi:10.1007/s00120-011-2556-0

Cited by 35 publications

(6 citation statements)

References 37 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…This clearly indicates a trend toward fewer follow-up examinations associated with a decline in corresponding costs [10]. A similar tendency can be observed in German national recommendations, which to date have the level of an expert consensus while official evidence-based guidelines are still under development [14]. As only a minority of patients underwent AS in the beginning of the study and follow-up frequency after chemotherapy, RPLND, or radiotherapy is less intense, actual follow-up costs in our cohort are markedly below the calculated costs in Table 3.…”

Section: Resultsmentioning

confidence: 66%

Economy of Standards: European Association of Urology Guideline Changes Influence Treatment Costs in Stage I Testicular Cancer Patients

John¹,

Baumgart

Worst

et al. 2018

Urol Int

View full text Add to dashboard Cite

Objective: The study aimed to calculate direct medical costs (DMC) during the first year of diagnosis and to evaluate the impact of guideline changes on treatment costs in clinical stage (CS) I testicular germ cell tumor (TGCT) patients in a German healthcare system. Materials and Methods: Healthcare expenditures as DMC during the first year of diagnosis for 307 TGCT patients in CS I treated at our institution from 1987 to 2013 were calculated from the statutory health insurance perspective using patient level data. Three periods were defined referring to the first European Association of Urology (EAU) guideline in 2001 as well as to subsequent major guideline changes in 2005 and 2010. Data source for cost calculations were the German Diagnosis Related Groups system for inpatient stays (version 2014) and the German system for reimbursement of outpatient care (EBM – Einheitlicher Bewertungsmaßstab, edition 2014). Results: During our 25 years of study period, mean DMC in the first year after diagnosis for the entire cohort of TGCT patients in CS I almost halved from EUR 13.000 to EUR 6.900 (p < 0.001). From 1987 to 2001, DMC for CS I seminomatous germ cell tumor (SGCT) patients were EUR 13.790 ± 4.700. From 2002 to 2010, mean costs were EUR 10.900 ± 5.990, and from 2011 to 2013, mean costs were EUR 5.190 ± 3.700. For CS I non-seminomatous germ cell tumor (NSGCT) patients, from 1987 to 2001, mean DMC were EUR 11.650 ± 5.690. From 2002 to 2010, mean costs were EUR 11.230 ± 5.990, and from 2011 to 2013, mean costs were EUR 11.170 ± 7.390. Follow-up examinations became less frequent over time, which caused a significant cost reduction for NSGCT (p = 0.042) while costs remained stable for SGCT. When adding costs of relapse treatment, active surveillance (AS) was the most cost-effective adjuvant treatment option in CS I NSGCT whereas one course carboplatin or AS caused similar expenditures in SGCT patients. Conclusion: The introduction of the EAU guidelines in 2001 caused a decrease in DMC in CS I seminoma patients. This cost reduction mainly took place due to the declining importance of radiation therapy. No substantial changes were seen in patients with CS I NSGCT. Costs for follow-up care also diminished, but to a lesser degree. Even when considering expenditures for relapse treatment, AS remained cost-effective in CS I TCGT patients. Our data show that evidence-based medicine in TGCT can reduce DMC in the first year after diagnosis.

show abstract

Section: Resultsmentioning

confidence: 66%

Economy of Standards: European Association of Urology Guideline Changes Influence Treatment Costs in Stage I Testicular Cancer Patients

John¹,

Baumgart

Worst

et al. 2018

Urol Int

View full text Add to dashboard Cite

show abstract

“…Follow-up examinations were performed by local urologists according to current guidelines (Hartmann et al 2011 ). Results of the examinations were documented in a patient logbook with a copy of each report sent to the study center (Dieckmann 2009 ).…”

Section: Patients Methodsmentioning

confidence: 99%

Testicular seminoma clinical stage 1: treatment outcome on a routine care level

Dieckmann

Dralle-Filiz

Matthies

et al. 2016

J Cancer Res Clin Oncol

View full text Add to dashboard Cite

PurposeClinical stage 1 (CS1) testicular seminoma involves an almost 100 % disease-specific survival in controlled clinical trials. We aimed to find out whether these results can be matched in patients managed on the routine care level.Patients, methodsIn total, 725 patients with seminoma CS1 were prospectively enrolled from 130 institutions. Adjuvant management as decided by local physicians involved surveillance (n = 256), radiotherapy (41), 1× Carboplatin (362), and 2× Carboplatin (66). We registered type of management, age, duration of follow-up (F/U), relapse, rete testis invasion (RTI), and tumor size. Actuarial relapse-free survival curves were calculated for treatment modalities and stratified for tumor sizes and RTI. A Cox regression model was calculated to explore for factors influencing relapses.ResultsDisease-specific survival was 100 %. Crude relapse rates were 8.2, 2.4, 5.0, and 1.5 % for surveillance, radiotherapy, 1× Carboplatin, and 2× Carboplatin after a median F/U of 30 months. RTI and tumor size were not associated with progression in surveillance patients. One course Carboplatin caused relapses in 6.8 % in tumor sizes >4 cm and 9.3 % (actuarial 13 %) in sizes >5 cm. The Cox model revealed the association of tumor size with recurrence in the entire seminoma population (Hazard ratio 1.17; 95 % confidence intervals 1.03–1.33).ConclusionsThe overall outcome of CS1 seminoma managed on the routine care level mirrors that of controlled trials. Unexpectedly, the risk factors in surveillance patients were not confirmed, but tumor size proved to be a risk indicator in the entire group of seminoma. Importantly, one course Carboplatin involved low efficacy to control the disease in large tumors.Electronic supplementary materialThe online version of this article (doi:10.1007/s00432-016-2162-z) contains supplementary material, which is available to authorized users.

show abstract

“…However, CT scans of the pelvic region were seldom ordered as tumor recurrence in this anatomic region is rare [24]. According to current guidelines, pelvic scans are only required in the presence of bulky abdominal disease (> 5 cm) and in case of previous scrotal surgery [25]. A tendency for slightly higher numbers of abdomen scans applied in younger patients was seen.…”

Section: Discussionmentioning

confidence: 99%

Frequency of Computed Tomography Examinations in the Follow-Up Care of Testicular Cancer Patients - an Evaluation of Patterns of Care in Germany

Rusner

Stang

Dieckmann³

et al. 2013

Oncol Res Treat

View full text Add to dashboard Cite

Background: Exposure to radiation resulting from diagnostic imaging procedures probably increases late cancer risk. Patterns of care regarding the application of computed tomography (CT) imaging in testicular cancer patients were investigated. Methods: The database of a large German health insurance company comprising 850,000 insured men was searched for cases of testicular cancer arising in the years 2005 and 2006. The number of CT scans applied during a 3-year period of follow-up was noted for each individual patient and the resulting cumulative radiation dose was estimated. The number of CT scans actually observed was compared to guideline recommendations. Results: 177 patients were identified. Within the 3-year observation period, patients received a mean of 4.4 CT scans (standard error: 0.4) whereas a number of 6.2 would have been expected according to contemporary guidelines. Patients were exposed to an estimated total median diagnostic radiation dose of 30 millisieverts (mSv) (interquartile range: 10-54 mSv). Conclusion: There is a considerable gap between recommendation and actual performance regarding the number of CT scans applied to testicular cancer patients. Unfamiliarity of clinicians with guidelines as well as poor acceptance of high numbers of CT scans scheduled may have contributed to create this particular pattern of care.

show abstract

Nachsorge von Patienten mit Hodentumoren

Cited by 35 publications

References 37 publications

Economy of Standards: European Association of Urology Guideline Changes Influence Treatment Costs in Stage I Testicular Cancer Patients

Economy of Standards: European Association of Urology Guideline Changes Influence Treatment Costs in Stage I Testicular Cancer Patients

Testicular seminoma clinical stage 1: treatment outcome on a routine care level

Frequency of Computed Tomography Examinations in the Follow-Up Care of Testicular Cancer Patients - an Evaluation of Patterns of Care in Germany

Contact Info

Product

Resources

About