title: Barriers to the implementation of surveillance for stage I testicular seminoma.
abstract: OBJECTIVE
  Postorchiectomy adjuvant radiotherapy (RT) for Stage I seminoma can be associated with long-term toxicity, and management strategies with a lower treatment burden achieve the same excellent cure rate. Because studies suggest that radiation oncologists in the United States continue to recommend RT for these patients, we sought to identify factors associated with management recommendations.
  
  
  METHODS
  We conducted a one-time internet-based survey among 491 randomly selected American radiation oncologists self-described as specializing in genitourinary oncology.
  
  
  RESULTS
  Response rate was 53% (n = 261). Forty-nine percent of respondents worked in university-affiliated practices. Sixty-two percent of respondents always/usually recommended adjuvant RT for patients with Stage I seminoma, whereas 21% always/usually recommended surveillance and 3% always/usually recommended chemotherapy. One third (33%) expressed concerns that patients who experienced relapse during surveillance could not be salvaged. Although 88% of physicians were aware of an increased risk of second malignant neoplasms (SMN) after adjuvant RT, 85% underestimated its magnitude. Compared with physicians not typically recommending RT, physicians who always/usually recommended RT were more likely to believe that patients might not be salvaged at relapse during surveillance (p = 0.008) and were less aware of the association between RT and SMN (p = 0.04).
  
  
  CONCLUSIONS
  Respondents who always/usually recommend postorchiectomy RT for patients with Stage I seminoma are more likely to underestimate late RT morbidity and to believe that surveillance is associated with increased mortality. Given the equivalent efficacy and reduced morbidity of surveillance compared with RT, our findings underscore the need for ongoing physician education to increase appropriate clinical implementation of surveillance strategies.
authors.affiliation: Harvard Radiation Oncology Program, Harvard Medical School, Boston, Massachusetts, USA.
authors.forename: Nils D
authors.initials: ND
authors.lastname: Arvold
authors.forename: Paul J
authors.initials: PJ
authors.lastname: Catalano
authors.forename: Christopher J
authors.initials: CJ
authors.lastname: Sweeney
authors.forename: Karen E
authors.initials: KE
authors.lastname: Hoffman
authors.forename: Paul L
authors.initials: PL
authors.lastname: Nguyen
authors.forename: Tracy A
authors.initials: TA
authors.lastname: Balboni
authors.forename: Sophie D
authors.initials: SD
authors.lastname: Fosså
authors.forename: Lois B
authors.initials: LB
authors.lastname: Travis
authors.forename: Clair J
authors.initials: CJ
authors.lastname: Beard
mesh_terms: D000970:Antineoplastic Agents / Q000627:therapeutic use; D001291:Attitude of Health Personnel; D019538:Health Care Surveys / Q000379:methods / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D009367:Neoplasm Staging; D009381:Neoplasms, Radiation-Induced / Q000209:etiology; D016609:Neoplasms, Second Primary / Q000209:etiology; D009919:Orchiectomy; D011182:Postoperative Care; D018787:Radiation Oncology / Q000706:statistics & numerical data*; D018714:Radiotherapy, Adjuvant / Q000009:adverse effects / Q000706:statistics & numerical data*; D018239:Seminoma / Q000473:pathology / Q000532:radiotherapy* / Q000601:surgery; D013736:Testicular Neoplasms / Q000473:pathology / Q000532:radiotherapy* / Q000601:surgery; D014481:United States; D057832:Watchful Waiting / Q000706:statistics & numerical data*
chemical_list: D000970:Antineoplastic Agents