Adherence to National Comprehensive Cancer Network® Guidelines for Testicular Cancer.
Testicular cancer is the most common malignancy among young men and well established treatment guidelines exist to optimize outcomes. We characterized errors in the management of testicular cancer observed among patients seen at 3 referral centers in the United States.



We retrospectively reviewed data from 593 patients presenting with testicular cancer to 3 academic medical centers from 2007 to 2016. Nonguideline directed care was defined as management differing from National Comprehensive Care Network guideline recommendations. Cases of nonguideline directed care were systematically described. Patient and tumor characteristics were compared between guideline directed care and nonguideline directed care. Multivariable logistic regression was used to identify predictors of nonguideline directed care, and Cox regression modeling was used to assess the association between nonguideline directed care and relapse-free survival.



Nonguideline directed care was identified in 177 of 593 (30%) patients. Inappropriate imaging (44%) and overtreatment (40%) were the most common classifications. Misdiagnosis (24%) and under treatment (16%) occurred relatively frequently, while inappropriate treatment (6%) was rare. Multivariable Cox regression modeling controlling for race, tumor stage and tumor histology identified nonguideline directed care as a significant predictor of relapse (HR 2.49, 95% CI 1.61-3.85, p <0.01).



Nonguideline directed care of patients with testicular cancer is common, most frequently in the form of inappropriate imaging and overtreatment. Nonguideline directed care leads to delayed definitive therapy, unnecessary morbidity and higher rates of relapse.
Pritzker School of Medicine, University of Chicago, Chicago, Illinois.
Kevin M
KM
Wymer
Section of Urology, Department of Surgery, University of Chicago, Chicago, Illinois.
Shane M
SM
Pearce
The James Buchanan Brady Urological Institute, The Johns Hopkins University School of Medicine, Baltimore, Maryland.
Kelly T
KT
Harris
The James Buchanan Brady Urological Institute, The Johns Hopkins University School of Medicine, Baltimore, Maryland.
Phillip M
PM
Pierorazio
Institute of Urology, USC/Norris Comprehensive Cancer Center, University of Southern California Keck School of Medicine, Los Angeles, California.
Siamak
S
Daneshmand
Section of Urology, Department of Surgery, University of Chicago, Chicago, Illinois. Electronic address: seggener@surgery.bsd.uchicago.edu.
Scott E
SE
Eggener
D000328:Adult; D019983:Guideline Adherence; D006801:Humans; D016015:Logistic Models; D008297:Male; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians'; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D013736:Testicular Neoplasms / Q000175:diagnosis* / Q000401:mortality / Q000628:therapy*; D014481:United States; D055815:Young Adult
guideline adherence; nonseminomatous germ cell tumor; seminoma; testicular neoplasms