Huang Mitchell M, Cheaib Joseph G, Su Zhuo T, Biles Michael J, Sharma Ritu, Zhang Allen, Singla Nirmish, Bass Eric B, Pierorazio Phillip M
The James Buchanan Brady Urological Institute and Department of Urology, Johns Hopkins University School of Medicine, Baltimore, MD.
The Johns Hopkins Evidence-Based Practice Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD.
Urol Oncol. 2021 Jul;39(7):400-408. doi: 10.1016/j.urolonc.2021.02.001. Epub 2021 Feb 26.
To review the current literature on quality of care in the diagnosis and management of early-stage testicular cancer.
PubMed, Embase, and the Cochrane Central Register of Controlled Trials were searched for studies on quality of care in testicular cancer diagnosis and management from January 1980 to August 2018. Major overlapping themes related to quality of care in the diagnosis and management of TGCT were identified and evidence related to these themes were abstracted.
62 studies were included in the review. A number of themes were identified including (1) trends in survival and outcomes, (2) management patterns, (3) adherence to evidence-based clinical guidelines, (4) delays in care, (5) treatment complications and toxicities, (6) sociodemographic factors, (7) volume of patients treated, (8) gaps in provider knowledge and medical errors, and (9) multidisciplinary approaches to care.
As survival for patients with testicular cancer improves, there has been a greater emphasis on other components of quality of care, such as reducing treatment toxicity and minimizing delays in diagnosis. Efforts to meet these goals include encouragement of adherence to evidence-based guidelines, greater utilization of surveillance, and promotion of multidisciplinary team-based care. Although outcomes have improved, social determinants of health, such as insurance status, race, and geographical residence all may influence survival and cancer-related outcomes. Additionally, qualitative review indicates patients who receive care at high-volume institutions appear to experience better outcomes than those treated at smaller centers.
As outcomes and survival improve for patients with testicular cancer, quality of care has become an important consideration. Future avenues of research on this topic include identifying an appropriate balance between centralization of care and expanding access to underserved areas, minimizing delays in care, ensuring greater adherence to clinical guidelines, and addressing sociodemographic and racial disparities in outcomes.
回顾当前关于早期睾丸癌诊断与治疗中医疗质量的文献。
检索PubMed、Embase和Cochrane对照试验中心注册库，查找1980年1月至2018年8月期间有关睾丸癌诊断与治疗中医疗质量的研究。确定了与睾丸生殖细胞肿瘤（TGCT）诊断和治疗中医疗质量相关的主要重叠主题，并提取了与这些主题相关的证据。
该综述纳入了62项研究。确定了多个主题，包括（1）生存和结局趋势，（2）治疗模式，（3）遵循循证临床指南，（4）治疗延迟，（5）治疗并发症和毒性，（6）社会人口统计学因素，（7）治疗患者数量，（8）医疗服务提供者知识差距和医疗差错，以及（9）多学科治疗方法。
随着睾丸癌患者生存率的提高，人们更加重视医疗质量的其他方面，如降低治疗毒性和尽量减少诊断延迟。为实现这些目标所做的努力包括鼓励遵循循证指南、更多地采用监测手段以及推广多学科团队治疗。尽管治疗结局有所改善，但健康的社会决定因素，如保险状况、种族和地理居住位置，都可能影响生存率和与癌症相关的结局。此外，定性综述表明，在大型机构接受治疗的患者似乎比在小型中心接受治疗的患者结局更好。
随着睾丸癌患者的治疗结局和生存率提高，医疗质量已成为一个重要的考量因素。该主题未来的研究方向包括确定在医疗集中化与扩大对服务不足地区的可及性之间的适当平衡、尽量减少治疗延迟、确保更严格地遵循临床指南，以及解决结局方面的社会人口统计学和种族差异问题。
