Section of Urology, University of Chicago Medicine, Chicago, IL, USA.
Department of Urology, Mayo Clinic, Rochester, MN, USA.
Eur Urol Focus. 2021 Sep;7(5):1137-1142. doi: 10.1016/j.euf.2020.10.005. Epub 2020 Oct 26.
Non-guideline-directed care (NGDC) is seen in ∼30% of testicular cancer patients and has been identified as a significant predictor of relapse. However, the potential impact of mismanagement on patient quality of life (QoL) is yet to be established.
To explore the impact of NGDC on long-term QoL in testicular cancer survivors (TCSs).
DESIGN, SETTING, AND PARTICIPANTS: A retrospective review of TCSs, who completed the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ-C30) in person or via mail ≥6 mo after completion of treatment, was conducted.
The validated questionnaire evaluates global health status (GHS); cognitive, social, physical, emotional, and role functioning; financial burden; and treatment-specific side effects.
A total of 120 men with a median age of 31.5 (interquartile range: 24-42) yr completed the questionnaire. Thirty-four (28%) men received NGDC: overtreatment (44%), improper imaging (32%), and undertreatment (29%). Men with NGDC presented with a more advanced clinical stage (≥IIA: 64% vs 32%, p = 0.007) and were less likely to undergo surveillance (19% vs 37%, p = 0.016). Patients receiving guideline-directed care reported higher GHS (84.1 vs 77.5, p = 0.015), higher physical function scores (98.5 vs 91.2, p = 0.013), and fewer financial difficulties (5.8 vs 18.6, p = 0.006) than those receiving NGDC. Multivariable linear regression showed a significant association between NGDC and poorer GHS (p = 0.002). Limitations of the study include its retrospective nature, modest sample size due to a 21% response rate, and quality-of-life assessment at a single time point rather than serially over time.
In addition to treatment delay, avoidable morbidity, and higher rates of relapse, NGDC leads to inferior global QoL, worse physical functioning, and more financial stress.
We have previously shown how mismanagement of testicular cancer results in a higher rate of disease relapse. In this study, we emphasize how the lack of adherence to standard treatment guidelines can lead to worse quality of life outcomes and financial stress in testicular cancer survivors.
约 30%的睾丸癌患者存在非指南指导的治疗（NGDC），并且已被确定为复发的重要预测因素。然而，管理不善对患者生活质量（QoL）的潜在影响尚未确定。
探讨 NGDC 对睾丸癌幸存者（TCS）长期 QoL 的影响。
设计、地点和参与者：对完成治疗后≥6 个月亲自或通过邮件完成欧洲癌症研究与治疗组织生活质量问卷（EORTC QLQ-C30）的 TCS 进行回顾性审查。
验证后的问卷评估总体健康状况（GHS）；认知、社会、身体、情感和角色功能；经济负担；和治疗特异性副作用。
共有 120 名中位年龄为 31.5（四分位距：24-42）岁的男性完成了问卷。34 名（28%）男性接受了 NGDC：过度治疗（44%）、不当影像学检查（32%）和治疗不足（29%）。接受 NGDC 的男性临床分期更晚（≥IIA：64% vs 32%，p=0.007），且更不可能接受监测（19% vs 37%，p=0.016）。接受指南指导治疗的患者报告的 GHS 更高（84.1 vs 77.5，p=0.015）、身体功能评分更高（98.5 vs 91.2，p=0.013）和经济困难更少（5.8 vs 18.6，p=0.006）。多变量线性回归显示 NGDC 与较差的 GHS 之间存在显著关联（p=0.002）。该研究的局限性包括其回顾性、由于 21%的应答率而导致的样本量较小、以及单次而非随时间进行的生活质量评估。
除了治疗延迟、可避免的发病率和更高的复发率之外，NGDC 还导致全球 QoL 下降、身体功能更差和经济压力更大。
我们之前已经表明睾丸癌管理不善如何导致疾病复发率更高。在这项研究中，我们强调了不遵守标准治疗指南如何导致睾丸癌幸存者的生活质量结果更差和经济压力更大。
