title: Management trends in stage I testicular seminoma: Impact of race, insurance status, and treatment facility.
abstract: BACKGROUND
  The management of stage I testicular seminoma is evolving rapidly. This study examined modern trends in the management of stage I testicular seminoma and the effects of sociodemographic factors on therapy choice.
  
  
  METHODS
  Data from the National Cancer Data Base on 34,067 patients with stage I testicular seminoma who were treated between 1998 and 2011 were analyzed. Multivariate logistic regression models were used to assess factors associated with adjuvant management strategies.
  
  
  RESULTS
  For patients with stage IA/B testicular seminoma, rates of observation after orchiectomy increased from 23.7% to 54.0%, the receipt of adjuvant chemotherapy increased from 1.5% to 16.0%, and the receipt of radiotherapy decreased from 70.8% to 28.8%. A similar pattern was seen in stage IS testicular seminoma, although these patients were more likely to receive adjuvant radiotherapy/chemotherapy (60.7% vs 44.8% for stage IA/B in 2011, P < .001). For patients with stage IA/B testicular seminoma, observation after orchiectomy was more common in racial minorities (odds ratio [OR] for blacks vs whites, 1.31, P < .001; OR for Hispanics vs whites, 1.39, P < .001) and in the uninsured (OR for uninsured vs privately insured, 1.33, P < .001) and less common at community centers (OR for community centers vs National Cancer Institute-designated cancer centers, 0.80, P = .044). In those with stage IA/B testicular seminoma who received adjuvant radiotherapy/chemotherapy, the receipt of chemotherapy was more common at academic centers and for patients with nonprivate insurance.
  
  
  CONCLUSIONS
  Postorchiectomy observation in stage I testicular seminoma has increased significantly in recent years, as has the receipt of chemotherapy, whereas the receipt of radiotherapy has declined, particularly at academic centers. Race, insurance status, and facility type are strongly associated with the choice of adjuvant management.
authors.affiliation: Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts.
authors.forename: Phillip J
authors.initials: PJ
authors.lastname: Gray
authors.forename: Chun Chieh
authors.initials: CC
authors.lastname: Lin
authors.forename: Helmneh
authors.initials: H
authors.lastname: Sineshaw
authors.forename: Jonathan J
authors.initials: JJ
authors.lastname: Paly
authors.forename: Ahmedin
authors.initials: A
authors.lastname: Jemal
authors.forename: Jason A
authors.initials: JA
authors.lastname: Efstathiou
mesh_terms: D000328:Adult; D017024:Chemotherapy, Adjuvant; D003131:Combined Modality Therapy; D054625:Healthcare Disparities / Q000706:statistics & numerical data*; D006801:Humans; D019458:Insurance Coverage; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D009919:Orchiectomy; D010818:Practice Patterns, Physicians'; D044469:Racial Groups; D018714:Radiotherapy, Adjuvant; D012189:Retrospective Studies; D018239:Seminoma / Q000188:drug therapy / Q000532:radiotherapy / Q000601:surgery; D013736:Testicular Neoplasms / Q000188:drug therapy / Q000532:radiotherapy / Q000601:surgery
keywords: chemotherapy; practice patterns; radiotherapy; seminoma; testicular cancer