Barriers to the Implementation of Surveillance for Stage I Testicular Seminoma
- Harvard Radiation Oncology Program, Harvard Medical School, Boston, Massachusetts (United States)
- Department of Biostatistics, Harvard School of Public Health, and Department of Biostatistics and Computational Biology, Dana-Farber Cancer Institute, Boston, Massachusetts (United States)
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts (United States)
- Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas (United States)
- Department of Radiation Oncology, Brigham and Women's Hospital and Dana-Farber Cancer Institute, Boston, Massachusetts (United States)
- Department of Clinical Research, Norwegian Radium Hospital, Oslo University, Oslo (Norway)
- Department of Radiation Oncology, University of Rochester Medical Center, Rochester, New York (United States)
Purpose: 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 and Materials: 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.
- OSTI ID:
- 22149510
- Journal Information:
- International Journal of Radiation Oncology, Biology and Physics, Vol. 84, Issue 2; Other Information: Copyright (c) 2012 Elsevier Science B.V., Amsterdam, The Netherlands, All rights reserved.; Country of input: International Atomic Energy Agency (IAEA); ISSN 0360-3016
- Country of Publication:
- United States
- Language:
- English
Similar Records
Radiotherapy Treatment Planning for Testicular Seminoma
Surveillance and Radiation Therapy for Stage I Seminoma—Have We Learned From the Evidence?