Originally published as JCO Early Release 10.1200/JCO.2008.19.9406 on August 3 2009

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Quality of Surveillance for Stage I Testis Cancer in the Community

From the Department of Urology, University of California, Los Angeles School of Medicine, Los Angeles; and RAND Corporation, Santa Monica, CA.

Corresponding author: Christopher S. Saigal, MD, MPH, University of California Los Angeles School of Medicine, Department of Urology, 10833 LeConte Ave, Box 951738, Los Angeles, CA 90095; e-mail: csaigal{at}mednet.ucla.edu.

Purpose Patients with clinical stage I testicular germ cell tumors have been managed with adjuvant radiotherapy, chemotherapy, or retroperitoneal lymph node dissection (RPLND). The use of surveillance-only strategies at referral centers has yielded survival outcomes comparable to those achieved with adjuvant therapy. We evaluated compliance with follow-up protocols developed at referral centers within the community.

Methods We identified patients with stage I testis cancer within a large private insurance claims database and calculated compliance of follow-up test use with guidelines from the National Comprehensive Cancer Network.

Results Surveillance was widely used in the community. Compliance with surveillance and postadjuvant therapy follow-up testing was poor and degraded with increasing time from diagnosis. Nearly 30% of all surveillance patients received no abdominal imaging, chest imaging, or tumor marker tests within the first year of diagnosis. Patients who elected RPLND were most compliant with recommended follow-up testing within the first year. Recurrence rates were consistent with previously reported literature, despite poor compliance.

Conclusion Surveillance is a widely accepted strategy in clinical stage I testicular cancer treatment in the community. However, follow-up care recommendations developed at referral centers are not being adhered to in the community. Although recurrence rates are similar to those of reported literature, the clinical impact of noncompliance on recurrence severity and mortality are not known. Further prospective work needs to be done to evaluate this apparent quality of care problem in the community.

Written on behalf of the Urologic Diseases in America Project.

Supported by National Institute of Diabetes and Digestive and Kidney Diseases.

Presented in part at the American Urological Association Annual Meeting, May 17-22, 2008, Orlando, FL.

Authors' disclosures of potential conflicts of interest and author contributions are found at the end of this article.

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