Compliance of clinical stage I nonseminomatous germ cell tumor patients with surveillance.
OBJECTIVE
We evaluate compliance and its effect on the outcome of patients with clinical stage I nonseminomatous germ cell tumor who underwent post-orchiectomy surveillance at the Tom Baker Cancer Centre.


METHODS
From 1980 to 1994, 76 evaluable patients underwent surveillance at the Tom Baker Cancer Centre. The surveillance protocol consisted of clinical evaluation, chest x-ray and serum tumor marker measurements monthly in year 1, every 2 months in year 2, every 6 months in years 3 to 5 and yearly in years 6 to 10. Abdomen and pelvic computerized tomography (CT) were scheduled every 2 months in year 1 and every 4 months in year 2. Noncompliance was defined as missing 2 or more consecutive clinic visits, tumor marker measurements or chest x-rays or 1 or more CT scans.


RESULTS
Compliance with clinical evaluations was 61.5% in year 1 and 35.5% in year 2, whereas compliance with CT was only 25% and 11.8% in years 1 and 2, respectively. By univariate analysis diagnosis before 1990 predicted noncompliance, while age, marital status and distance from the center did not. Recurrent disease was detected in 28 patients (37%) at a median of 5.5 months after orchiectomy (range 1 to 49.5). Among the 47 compliant patients 23 had relapse and none died. Among the 29 noncompliant patients 5 had relapse and 2 died with central nervous system disease.


CONCLUSIONS
Overall compliance with this surveillance program was poor but this study was too small to demonstrate whether poor compliance adversely affects overall survival.
Department of Medicine, Centre for Advancement of Health, Foothills Hospital and the University of Calgary, Alberta, Canada.
D
D
Hao
J
J
Seidel
R
R
Brant
F
F
Alexander
D S
DS
Ernst
N
N
Summers
J A
JA
Russell
D A
DA
Stewart
D000293:Adolescent; D000328:Adult; D001290:Attitude; D002648:Child; D005298:Fertility; D018237:Germinoma / Q000473:pathology / Q000523:psychology / Q000601:surgery / Q000628:therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D009919:Orchiectomy; D010349:Patient Compliance; D011159:Population Surveillance; D011795:Surveys and Questionnaires; D013736:Testicular Neoplasms / Q000473:pathology / Q000523:psychology / Q000601:surgery / Q000628:therapy*