Testis Cancer Care in North Carolina: Implications for Real-World Evidence and Cancer Surveillance

• Published in: Clinical genitourinary cancer 2022-08, Vol.20 (4), p.307-318
• Main Authors: McMahon, Stephen, Zhou, Xi, Baggett, Christopher D., Bjurlin, Marc A., Chen, Ronald C., Riggs, Stephen B., Litwin, Mark S., Milowsky, Matthew I., Wallen, Eric M., Tan, Hung-Jui
• Format: Article
• Language: English
• Subjects: Active surveillance; Clinical guidelines; Germ Cell Tumor; Practice patterns; Quality
• ISSN: 1558-7673; 1938-0682
• DOI: 10.1016/j.clgc.2022.04.006

Contemporary testis cancer management requires fastidious adherence to clinical guidelines and care principles, especially for those pursuing active surveillance (AS). However, real-world testis cancer care remains largely undescribed. Accordingly, we sought to assess the rigor of evaluation and monitoring among men with testis cancer. Using North Carolina Central Cancer Registry data linked to insurance claims, we selected adult males diagnosed with primary testis cancer from 2003 to 2013. After identifying demographics, care setting, histology, stage, and index management, we evaluated the receipt of tumor markers, imaging, and clinic visits during initial evaluation and subsequent monitoring with respect to contemporaneous clinical guidelines. Care patterns were compared using chi-squared testing and multivariable logistic regression. Of 2526 men with primary testis cancer, we assembled a cohort of 487 with seminoma (59.3%) or nonseminoma (40.7%), losing most to a lack of insurance or continuous coverage. The cohort was predominantly white (92.4%) and had stage I disease (87.9%). Overall, 18.9% had complete tumor markers, staging imaging, and visits with 2 relevant specialists as recommended during their initial evaluation. For subsequent monitoring, 17.5% of patients with seminoma on active surveillance met minimal thresholds for recommended testing and follow-up during the first year vs. 21.9% and 34.9% of patients with seminoma treated with adjuvant radiation and chemotherapy, respectively. For nonseminoma, 10.1% of men on active surveillance met the minimal thresholds for recommended monitoring compared with 60.4% and 62.0% of those treated with surgery and chemotherapy, respectively. Recommended monitoring also differed by academic vs. community setting and receipt of recommended evaluation (P < .05). From real-world data, the evaluation and monitoring of patients with testis cancer appears substandard. Ongoing data and quality gaps highlight potential challenges with generating real-world evidence and ensuring adequate surveillance in this population. Testis cancer care requires fastidious adherence to clinical guidelines, especially for those pursuing active surveillance. However, quality remains largely unknown. Using linked NC Cancer Registry-insurance claims data, we assessed whether patients received recommended evaluation and monitoring. Among 487 men diagnosed between 2003 and 2013, 18.9% had a complete evaluation and even fewer of those on