Do referral patterns in adolescents and young adults with testicular cancer impact oncologic outcomes?

Nicholas G. Cost, Brian T. Caldwell, Mehrad Adibi, Ganesh Raj, Arthur I Sagalowsky, Vitaly Margulis

Research output: Contribution to journalArticle

1 Citation (Scopus)

Abstract

Purpose: Oncologic outcomes in advanced testicular cancer (TC) depend on appropriate and timely care. Often this care is referred to tertiary academic medical centers (AMCs). The aim of this study was to compare oncologic outcomes of adolescent and young adult (AYA) patients with TC treated from the outset at an AMC to those whose care was initiated elsewhere with subsequent referral. Methods: An institutional TC database was reviewed, and those AYA patients initiating TC care either inside or outside an AMC were compared. Patients were classified as initiating care outside if they had any non-orchiectomy surgery, chemotherapy, or radiotherapy for TC outside an AMC. Results: A total of 183 patients were reviewed, of whom 59 initiated TC care outside and 124 were managed initially at an AMC. Patients initiating care outside were more likely to have non-seminoma histology and more often presented with metastatic disease (Stage II [30.5%] or III [35.6%] vs. Stage II [19.4%] or III [19.4%]; p = 0.007). Lower 3-year event-free survival (EFS) was observed in those initiating treatment outside an AMC (60.6% vs. 78.7%; p = 0.027). However, on multivariate analysis adjusting for stage and histology, the location of initiating TC care was no longer significant (hazard ratio = 1.5, 95% confidence interval 0.8-2.9). Conclusion: AYA patients initially treated for TC in the community and subsequently referred to an AMC were initially observed to experience worse EFS than those who were managed at an AMC from the outset. However, on multivariate analysis, these findings were largely explained by referral bias, where AYA patients with advanced disease were more likely to be referred to AMCs.

Original languageEnglish (US)
Pages (from-to)248-253
Number of pages6
JournalJournal of Adolescent and Young Adult Oncology
Volume5
Issue number3
DOIs
StatePublished - Sep 1 2016

Fingerprint

Testicular Neoplasms
Young Adult
Referral and Consultation
Disease-Free Survival
Histology
Multivariate Analysis
Patient Care
Radiotherapy
Databases
Confidence Intervals
Drug Therapy

Keywords

  • germ-cell malignancy
  • oncologic outcomes
  • testicular cancer

ASJC Scopus subject areas

  • Oncology
  • Pediatrics, Perinatology, and Child Health

Cite this

Do referral patterns in adolescents and young adults with testicular cancer impact oncologic outcomes? / Cost, Nicholas G.; Caldwell, Brian T.; Adibi, Mehrad; Raj, Ganesh; Sagalowsky, Arthur I; Margulis, Vitaly.

In: Journal of Adolescent and Young Adult Oncology, Vol. 5, No. 3, 01.09.2016, p. 248-253.

Research output: Contribution to journalArticle

@article{0639e1234cd74f8a8d24f8ce5dc8536f,
title = "Do referral patterns in adolescents and young adults with testicular cancer impact oncologic outcomes?",
abstract = "Purpose: Oncologic outcomes in advanced testicular cancer (TC) depend on appropriate and timely care. Often this care is referred to tertiary academic medical centers (AMCs). The aim of this study was to compare oncologic outcomes of adolescent and young adult (AYA) patients with TC treated from the outset at an AMC to those whose care was initiated elsewhere with subsequent referral. Methods: An institutional TC database was reviewed, and those AYA patients initiating TC care either inside or outside an AMC were compared. Patients were classified as initiating care outside if they had any non-orchiectomy surgery, chemotherapy, or radiotherapy for TC outside an AMC. Results: A total of 183 patients were reviewed, of whom 59 initiated TC care outside and 124 were managed initially at an AMC. Patients initiating care outside were more likely to have non-seminoma histology and more often presented with metastatic disease (Stage II [30.5{\%}] or III [35.6{\%}] vs. Stage II [19.4{\%}] or III [19.4{\%}]; p = 0.007). Lower 3-year event-free survival (EFS) was observed in those initiating treatment outside an AMC (60.6{\%} vs. 78.7{\%}; p = 0.027). However, on multivariate analysis adjusting for stage and histology, the location of initiating TC care was no longer significant (hazard ratio = 1.5, 95{\%} confidence interval 0.8-2.9). Conclusion: AYA patients initially treated for TC in the community and subsequently referred to an AMC were initially observed to experience worse EFS than those who were managed at an AMC from the outset. However, on multivariate analysis, these findings were largely explained by referral bias, where AYA patients with advanced disease were more likely to be referred to AMCs.",
keywords = "germ-cell malignancy, oncologic outcomes, testicular cancer",
author = "Cost, {Nicholas G.} and Caldwell, {Brian T.} and Mehrad Adibi and Ganesh Raj and Sagalowsky, {Arthur I} and Vitaly Margulis",
year = "2016",
month = "9",
day = "1",
doi = "10.1089/jayao.2015.0057",
language = "English (US)",
volume = "5",
pages = "248--253",
journal = "Journal of Adolescent and Young Adult Oncology",
issn = "2156-5333",
publisher = "Mary Ann Liebert Inc.",
number = "3",

}

TY - JOUR

T1 - Do referral patterns in adolescents and young adults with testicular cancer impact oncologic outcomes?

AU - Cost, Nicholas G.

AU - Caldwell, Brian T.

AU - Adibi, Mehrad

AU - Raj, Ganesh

AU - Sagalowsky, Arthur I

AU - Margulis, Vitaly

PY - 2016/9/1

Y1 - 2016/9/1

N2 - Purpose: Oncologic outcomes in advanced testicular cancer (TC) depend on appropriate and timely care. Often this care is referred to tertiary academic medical centers (AMCs). The aim of this study was to compare oncologic outcomes of adolescent and young adult (AYA) patients with TC treated from the outset at an AMC to those whose care was initiated elsewhere with subsequent referral. Methods: An institutional TC database was reviewed, and those AYA patients initiating TC care either inside or outside an AMC were compared. Patients were classified as initiating care outside if they had any non-orchiectomy surgery, chemotherapy, or radiotherapy for TC outside an AMC. Results: A total of 183 patients were reviewed, of whom 59 initiated TC care outside and 124 were managed initially at an AMC. Patients initiating care outside were more likely to have non-seminoma histology and more often presented with metastatic disease (Stage II [30.5%] or III [35.6%] vs. Stage II [19.4%] or III [19.4%]; p = 0.007). Lower 3-year event-free survival (EFS) was observed in those initiating treatment outside an AMC (60.6% vs. 78.7%; p = 0.027). However, on multivariate analysis adjusting for stage and histology, the location of initiating TC care was no longer significant (hazard ratio = 1.5, 95% confidence interval 0.8-2.9). Conclusion: AYA patients initially treated for TC in the community and subsequently referred to an AMC were initially observed to experience worse EFS than those who were managed at an AMC from the outset. However, on multivariate analysis, these findings were largely explained by referral bias, where AYA patients with advanced disease were more likely to be referred to AMCs.

AB - Purpose: Oncologic outcomes in advanced testicular cancer (TC) depend on appropriate and timely care. Often this care is referred to tertiary academic medical centers (AMCs). The aim of this study was to compare oncologic outcomes of adolescent and young adult (AYA) patients with TC treated from the outset at an AMC to those whose care was initiated elsewhere with subsequent referral. Methods: An institutional TC database was reviewed, and those AYA patients initiating TC care either inside or outside an AMC were compared. Patients were classified as initiating care outside if they had any non-orchiectomy surgery, chemotherapy, or radiotherapy for TC outside an AMC. Results: A total of 183 patients were reviewed, of whom 59 initiated TC care outside and 124 were managed initially at an AMC. Patients initiating care outside were more likely to have non-seminoma histology and more often presented with metastatic disease (Stage II [30.5%] or III [35.6%] vs. Stage II [19.4%] or III [19.4%]; p = 0.007). Lower 3-year event-free survival (EFS) was observed in those initiating treatment outside an AMC (60.6% vs. 78.7%; p = 0.027). However, on multivariate analysis adjusting for stage and histology, the location of initiating TC care was no longer significant (hazard ratio = 1.5, 95% confidence interval 0.8-2.9). Conclusion: AYA patients initially treated for TC in the community and subsequently referred to an AMC were initially observed to experience worse EFS than those who were managed at an AMC from the outset. However, on multivariate analysis, these findings were largely explained by referral bias, where AYA patients with advanced disease were more likely to be referred to AMCs.

KW - germ-cell malignancy

KW - oncologic outcomes

KW - testicular cancer

UR - http://www.scopus.com/inward/record.url?scp=85000416247&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85000416247&partnerID=8YFLogxK

U2 - 10.1089/jayao.2015.0057

DO - 10.1089/jayao.2015.0057

M3 - Article

C2 - 26871870

AN - SCOPUS:85000416247

VL - 5

SP - 248

EP - 253

JO - Journal of Adolescent and Young Adult Oncology

JF - Journal of Adolescent and Young Adult Oncology

SN - 2156-5333

IS - 3

ER -