Compliance with guidelines and correlation with outcome in patients with advanced germ-cell tumours |
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| Affiliation: | 1. Department of Cancer Medicine, University of Paris Sud, Institut Gustave Roussy, Villejuif, France;2. Department of Urology, Saint-Joseph Hospital, Paris, France;3. Department of Urology, Kremlin-Bicêtre Hospital, University of Paris-Sud, Kremlin-Bicêtre, France;1. Section of Environment and Radiation, International Agency for Research on Cancer (IARC), 150 Cours Albert Thomas, 69372 Lyon, France;2. German Childhood Cancer Registry, Institute for Medical Biostatistics, Epidemiology and Informatics, University Medical Center of the Johannes Gutenberg University Mainz, Obere Zahlbacher Strasse 69, 55101 Mainz, Germany;3. Department of Prevention and Evaluation, Leibniz Institute for Prevention Research and Epidemiology – BIPS GmbH, Achterstraße 30, 28359 Bremen, Germany;4. Department of Health Sciences, Epidemiology & Cancer Statistics Group, University of York, Seebohm Rowntree Building, Heslington, York YO10 5DD, UK;1. Department of Medical Oncology, West German Cancer Center, University Hospital Essen, University Duisburg-Essen, Essen, Germany;2. German Cancer Consortium (DKTK), Heidelberg, Germany;1. U.O. Senologia Clinica e Screening Mammografico, Department of Diagnostics, Azienda Provinciale Servizi Sanitari (APSS), Trento, Italy;2. Centro di Prevenzione Senologica, Marzana, Verona, Italy;3. Screening and Test Evaluation Program (STEP), School of Public Health, Sydney Medical School, University of Sydney, Sydney, Australia;1. Medizinische Klinik m. S. Hämatologie, Onkologie und Tumorimmunologie, Charité Campus Virchow-Klinikum, Universitätsmedizin Berlin, Germany;2. Onkologische Praxis Elisenhof, München, Germany;3. Gemeinschaftspraxis für Hämatologie und Onkologie, Magdeburg, Germany;4. Medizinische Klinik m. S. Hämatologie, Onkologie und Tumorimmunologie, Charité Campus Benjamin Franklin, Universitätsmedizin Berlin, Germany;1. The University of Queensland, UQ Centre for Clinical Research, Experimental Dermatology Group, Brisbane, QLD, Australia;2. The University of Queensland, UQ Diamantina Institute, Translational Research Institute, Woolloongabba, QLD, Australia;3. Erasmus MC Cancer Institute, Rotterdam, The Netherlands;4. QIMR Berghofer Medical Research Institute, Cancer and Population Studies Group, Brisbane, Australia;5. Queensland Melanoma Project, Discipline of Surgery, The University of Queensland, Princess Alexandra Hospital, Woolloongabba, QLD, Australia;6. Institut de Cancérologie Gustave Roussy, Villejuif-Paris, France;7. Institute of Inflammation and Repair, University of Manchester, Manchester Academic Health Sciences Centre, Manchester, UK;1. Tampere Pancreas Laboratory, Department of Gastroenterology and Alimentary Tract Surgery, Tampere University Hospital, Teiskontie 35, P.O. Box 2000, 33521 Tampere, Finland;2. Department of Surgery, Kumamoto Regional Medical Center, 5-16-10 Honjo, Kumamoto 860-0811, Japan;3. Department of Gastroenterological Surgery, Kumamoto University Graduate School of Medical Sciences, 1-1-1 Honjo, Kumamoto 860-8556, Japan |
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| Abstract: | PurposeTo evaluate prior compliance with guidelines in patients treated with salvage chemotherapy for advanced germ-cell tumours (GCT).Patients and methodsData concerning the initial management of patients requiring salvage chemotherapy for GCT at Institut Gustave Roussy between 2000 and 2010 were obtained and correlated with recommendations for treatment. Criteria of non-compliance were defined based on guidelines. Compliance with guidelines, predictive factors for non-compliance and the impact on outcome were analysed.ResultsAmong 82 patients treated in the salvage setting, guidelines to initial treatment were followed in only 41 cases (50%). The most common non-compliance criteria were non-adherence to the planned dose (16%), an inappropriate interval between first-line chemotherapy cycles (16%), the lack of post-chemotherapy surgery (16%) and a long interval to post-chemotherapy surgery (48%). Compliance with standard care was better in cancer centres than in other hospitals (private or public) (Odd Ratio (OR): 6.9, P = 0.001). A poor-risk status according to the International Germ Cell Cancer Collaborative Group (IGCCCG) was also predictive of compliance in univariate but not in multivariate analysis. No significant difference in outcome after salvage chemotherapy was observed. Patients relapsing after non-compliant first-line therapy tended to be more easily salvaged, which is consistent with the fact that their initial treatment was inadequate. Some of these relapses were therefore probably not due to true biologically refractory disease.ConclusionGuidelines for first-line treatment are adhered to in only half the patients requiring salvage chemotherapy. As the only predictive factor for non-compliance was the treating centre, centralisation of patients with GCT in well-trained hospitals should be recommended. |
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| Keywords: | Adult Germ-cell tumours Guidelines Neoplasms |
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