Presentation Authors: Joshua Aizen*, Ciro Andolfi, Chicago, IL, Madeleine Burg, Los Angeles, CA, Nimrod Barashi, Brittany Adamic, Craig Labbate, Chicago, IL, Siamak Daneshmand, Los Angeles, CA, Scott Eggener, Chicago, IL
Introduction: Despite well-established guidelines for the treatment of testicular cancer, nonguideline directed care (NGDC) is seen in 30% of patients and has been identified as a significant predictor of disease relapse. However, the potential impact of mismanagement on patient quality of life (QoL) has yet to be established. We aimed to compare QoL among testicular cancer survivors who received NGDC against patients who received guideline directed care (GDC).
Methods: We retrospectively reviewed data from men presenting with testicular cancer to two academic medical centers from 2007-2016. NGDC was defined as management differing from current National Comprehensive Care Network (NCCN) recommendations. Cases of NGDC were systematically described. Patients were later asked to complete the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire EORTC QLQ-C30, a previously validated oncology-specific survey. These were filled out either in person or via mail-in â‰¥6 months after treatment.
Results: A total of 120 men completed the EORTC QLQ-C30 questionnaire. The cohort had a mean age of 33.6Â±11.4 years and was predominantly Caucasian (100 [83.3%]). 34 men (28.3%) were deemed to have received NGDC, most commonly in the form of overtreatment (15 [44%]), wrong imaging (11 [32%]), and undertreatment (10 [29%]). Consistent with prior series, men who received NGDC had a more advanced clinical stage (â‰¥IIA: 63.6% v 32.2%, p < 0.01), were less likely to have undergone surveillance as primary mode of therapy (18.8% v 37.3%, p=0.02), and were more likely to relapse (34.4% v 12.8%, p < 0.01). In patients who received GDC, both self-reported global health status and physical functioning were superior when compared with patients receiving NGDC (p=0.015 and p=0.013, respectively). Men who were mismanaged were also more likely to report financial difficulties (p < 0.01). The remainder of the function and symptom scores were not significantly different between groups (Table 1).
Conclusions: In addition to treatment delay, avoidable morbidity, and higher rates of relapse, NGDC of testicular cancer leads to inferior global QoL, worse physical functioning, and more financial stress. This data reinforces the effort to increase awareness and implementation of recognized guidelines among providers.