Abstract
BackgroundPenile cancer represents a rare malignant disease, whereby a small caseload is associated with the risk of inadequate treatment expertise. Thus, we hypothesized that strict guideline adherence might be considered a potential surrogate for treatment quality. This study investigated the influence of the annual hospital caseload on guideline adherence regarding treatment recommendations for penile cancer.MethodsIn a 2018 survey study, 681 urologists from 45 hospitals in four European countries were queried about six hypothetical case scenarios (CS): local treatment of the primary tumor pTis (CS1) and pT1b (CS2); lymph node surgery inguinal (CS3) and pelvic (CS4); and chemotherapy neoadjuvant (CS5) and adjuvant (CS6). Only the responses from 206 head and senior physicians, as decision makers, were evaluated. The answers were assessed based on the applicable European Association of Urology (EAU) guidelines regarding their correctness. The real hospital caseload was analyzed based on multivariate logistic regression models regarding its effect on guideline adherence.ResultsThe median annual hospital caseload was 6 (interquartile range (IQR) 3–9). Recommendations for CS1–6 were correct in 79%, 66%, 39%, 27%, 28%, and 28%, respectively. The probability of a guideline-adherent recommendation increased with each patient treated per year in a clinic for CS1, CS2, CS3, and CS6 by 16%, 7.8%, 7.2%, and 9.5%, respectively (each p < 0.05); CS4 and CS5 were not influenced by caseload. A caseload threshold with a higher guideline adherence for all endpoints could not be perceived. The type of hospital care (academic vs. non-academic) did not affect guideline adherence in any scenario.ConclusionsGuideline adherence for most treatment recommendations increases with growing annual penile cancer caseload. Thus, the results of our study call for a stronger centralization of diagnosis and treatment strategies regarding penile cancer.
Highlights
In Europe, the age-standardized incidence rate for penile cancer in 2018 was 0.9/100,000 [1]
Several studies support the association between annual caseload and outcomes, suggesting that improved guideline adherence has a beneficial impact on the prognosis of penile cancer patients [6,7,8,9,10,11]
Of 557 evaluable questionnaires, only those completed by chief physicians and senior staff members (n = 206) were selected for analysis, assuming that this occupational group is largely responsible for all treatment decisions in penile cancer patients
Summary
In Europe, the age-standardized incidence rate for penile cancer in 2018 was 0.9/100,000 [1]. Penile cancer represents a rare malignant disease, whereby due to a low annual caseload, most centers have limited experience in the accurate management of such patients [2]. Guideline adherence in the treatment of penile cancer is low [4, 5]. Several studies support the association between annual caseload and outcomes, suggesting that improved guideline adherence has a beneficial impact on the prognosis of penile cancer patients [6,7,8,9,10,11]. Penile cancer represents a rare malignant disease, whereby a small caseload is associated with the risk of inadequate treatment expertise. This study investigated the influence of the annual hospital caseload on guideline adherence regarding treatment recommendations for penile cancer
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