German second-opinion network for testicular cancer: sealing the leaky pipe between evidence and clinical practice.
In 2006, the German Testicular Cancer Study Group initiated an extensive evidence-based national second-opinion network to improve the care of testicular cancer patients. The primary aims were to reflect the current state of testicular cancer treatment in Germany and to analyze the project's effect on the quality of care delivered to testicular cancer patients. A freely available internet-based platform was developed for the exchange of data between the urologists seeking advice and the 31 second-opinion givers. After providing all data relevant to the primary treatment decision, urologists received a second opinion on their therapy plan within <48 h. Endpoints were congruence between the first and second opinion, conformity of applied therapy with the corresponding recommendation and progression-free survival rate of the introduced patients. Significance was determined by two-sided Pearson's χ2 test. A total of 1,284 second-opinion requests were submitted from November 2006 to October 2011, and 926 of these cases were eligible for further analysis. A discrepancy was found between first and second opinion in 39.5% of the cases. Discrepant second opinions led to less extensive treatment in 28.1% and to more extensive treatment in 15.6%. Patients treated within the framework of the second-opinion project had an overall 2-year progression-free survival rate of 90.4%. Approximately every 6th second opinion led to a relevant change in therapy. Despite the lack of financial incentives, data from every 8th testicular cancer patient in Germany were submitted to second-opinion centers. Second-opinion centers can help to improve the implementation of evidence into clinical practice.
Department of Urology, University Hospital of Ulm, Ulm, Germany.
Friedemann
F
Zengerling
Department of Urology, University Hospital Hamburg-Eppendorf, Hamburg, Germany.
Michael
M
Hartmann
Department of Urology, RWTH Aachen University, Aachen, Germany.
Axel
A
Heidenreich
Department of Urology, Alexianer Krefeld GmbH, Krefeld, Germany.
Susanne
S
Krege
Department of Urology, University of Düsseldorf, Düsseldorf, Germany.
Peter
P
Albers
Department of Urology, University of Munich, Munich, Germany.
Alexander
A
Karl
Men's Health Foundation, Berlin, Germany.
Lothar
L
Weissbach
Department of Urology, Federal Armed Forces Hospital, Hamburg, Germany.
Walter
W
Wagner
Department of Urology, University Hospital of Tübingen, Tübingen, Germany.
Jens
J
Bedke
Department of Urology, Medical Center Rechts Der Isar, Technical University of Munich, Munich, Germany.
Margitta
M
Retz
Department of Urology, Federal Armed Forces Hospital, Koblenz, Germany.
Hans U
HU
Schmelz
Center of Reproductive Medicine and Andrology-Clinical Andrology, University Hospital of Münster, Münster, Germany.
Sabine
S
Kliesch
Department of Urology, Hannover Medical School, Hannover, Germany.
Markus
M
Kuczyk
Department of Urology, HELIOS Hospital Schwerin, Schwerin, Germany.
Eva
E
Winter
Department of Urology, Asklepios Westklinikum, Hamburg, Germany.
Tobias
T
Pottek
Department of Urology, Albertinen Hospital, Hamburg, Germany.
Klaus-Peter
KP
Dieckmann
Department of Urology, University Hospital of Ulm, Ulm, Germany.
Andres Jan
AJ
Schrader
Department of Urology, University Hospital of Ulm, Ulm, Germany.
Mark
M
Schrader
D018572:Disease-Free Survival; D005858:Germany; D006801:Humans; D020407:Internet; D008297:Male; D010818:Practice Patterns, Physicians'; D012017:Referral and Consultation; D013736:Testicular Neoplasms / Q000175:diagnosis* / Q000453:epidemiology* / Q000473:pathology