AUA 2019: Impact of Mismanagement on Quality of Life in Testicular Cancer Survivors

Chicago, IL ( The National Comprehensive Cancer Network (NCCN) has established specific guideline-based treatment for men who present with testicular cancer. Despite this, prior studies have shown that up to 30% of patients undergo care protocols that are outside of the guidelines. Because the guidelines are evidence-based, care outside of the guidelines can potentially have negative repercussions for patients. To better assess how care outside of the established affects men’s quality of life, Dr. Joshua Aizen and colleagues at the University of Chicago performed a questionnaire-based study looking at patient-reported outcomes. 

They retrospectively reviewed data from men presenting with testicular cancer to two different academic medical centers between 2007-2016. They reviewed the care pathways that men underwent and defined nonguideline-directed care (NGDC) as any management that varied from the NCCN recommendations. They next asked patients to complete the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ-C30), a validated cancer-specific survey.

A total of 120 men completed the survey. Upon review of the data 28.3% of men received NGDC, including overtreatment, incorrect imaging, or undertreatment. They found that men who received NGDC tended to have more advanced clinical stage and were less likely to have undergone surveillance as a primary treatment. These men were also more likely to relapse (34.4% versus 12.8%). Those patients who received NGDC were more likely to report lower global health status and physical functioning as compared to those who received guideline-directed care. Furthermore, men who were mismanaged with NGDC were more likely to report financial difficulties.

Aizen and his group concluded that NGDC leads to lower global quality of life and worse physical functioning than men who underwent goal-directed care. This study emphasizes the importance that urologists attempt to adhere to the NCCN guidelines, not only for ideal cancer-specific outcomes, but also for patient-reported outcomes.

Presented by: Joshua Aizen, MD, University of Chicago 

Written by: Brian Kadow, MD, Society of Urologic Oncology Fellow, Fox Chase Cancer Center @btkmduro at the American Urological Association's 2019 Annual Meeting (AUA 2019), May 3 – 6, 2019 in Chicago, Illinois
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