Testis Ca care deviates from guidelines in 30% of patients
Inappropriate imaging studies most frequent departure from guidelines, study finds
Nearly one-third of men with testicular cancer undergo diagnostic or therapeutic interventions that are at odds with guidelines from the National Comprehensive Cancer Network (NCCN), according a study published in the Journal of Urology (2017; 197:684-9).
Kevin Wymer, MD, and co-authors from the University of Chicago; Johns Hopkins University, Baltimore; and the University of Southern California, Los Angeles reported that non-guideline-directed care could be identified in 30% of men with testicular cancer.
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The investigators retrospectively analyzed their pooled data to determine the extent to which testicular cancer care follows the NCCN guidelines. Of the 705 consecutive patients with testicular tumor, 80% had the diagnosis made elsewhere before referral to these centers. After excluding non-germ cell or secondary or benign tumors, 536 patients had detailed records available for analysis.
A mismatch between the documented care and the 2015 NCCN guidelines was noted in 177 patients (30%). Higher likelihood of mismatched care was noted in Hispanic men or those who underwent an orchiectomy at a community site or had pain at presentation or had metastatic disease. The mismatched care was classified into four categories: overtreatment, under-treatment, misdiagnosis, and inappropriate treatment.