Stage I testicular cancer: Five-year follow-up rates and reasons for non-adherence.

Abstract

412 Background: For stage I testicular cancer patients, active surveillance or follow up (f/u) post treatment is an integral part of quality care. Most guidelines recommend a minimum of 5 years of f/u however, it is known that a significant proportion of patients do not meet this milestone. The goal of this project was to determine what proportion of patients did not undergo ≥ 5 years of f/u in Nova Scotia (NS) and to document the reasons why. This would allow one to develop strategies to improve compliance and quality care. Methods: A review of all patients from NS diagnosed with testicular cancer between 2006-2015 was conducted. REB approval was obtained. Data from the provincial registry and electronic medical records was used to determine date of diagnosis, relapse/death, and f/u dates. Complete f/u was defined as: a patient having tumor markers, imaging studies, and/or clinical documentation ≥ 5 after initial diagnosis or relapse. The adequacy of f/u investigations was not recorded. If follow up was < 5 years, the reason for this was recorded. Results: In this cohort, 151 patients had stage I testicular cancer; 108 with seminoma (75% on surveillance) and 43 with nonseminoma (93% on surveillance). The median age was: 35.8 years. 48 pts (31.8%) were not seen at a cancer center (until relapse in 5 pts). Excluding 2 pts who died of unrelated causes, 44 patients (29.5%) had < 5 years f/u in NS. The most common reasons were: moved or probably moved in 17 (38.6%) and patient compliance/missing ≥2 appointments in 10 (22.7%). Modifiable reasons for incomplete f/u include: discharged too early from the cancer center in 3 patients, f/u never arranged post orchiectomy in 2 patients, and care transferred to primary care which did not occur in 1 patient. 22 patients relapsed: 3 in patients with lack of ≥ 5 years of f/u causing excess morbidity in 1 case. No patients died of testicular cancer. Conclusions: The majority of men with stage I testicular cancer had ≥ 5 years of f/u in NS as recommended by guidelines. However, 30% did not, with the most common reason being that the patient moved in 39% (where they may or may not have had f/u) and noncompliance in 23%. This study reinforces the need to have a seamless transition of care for this young, mobile patient population and easy, automated, regular appointment reminders. These results have led us to explore the creation of a phone-based app to improve follow up care and transition of care.