Factors influencing adjuvant treatment choices in stage I seminoma: the patients perspective


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Alison Young, Jaishree Bhosle, Johnathon Joffe, Daniel Stark, Sue Rodwell, Gemma Glover, John Chester

St James's Institute of Oncology, Leeds, UK

Abstract

Background
Patient choice is a key aim of modern cancer care. For patients to exercise this choice they need appropriate information regarding available options. 80% of men with localised testicular seminoma are cured by orchidectomy alone. Historically, patients were given the choice between adjuvant radiotherapy and surveillance, with adjuvant radiotherapy showing reduction in the risk of relapse to ~3-4%. Recently, an EORTC/MRC trial showed non-inferiority of a single cycle of carboplatin compared with radiotherapy in reducing the risk of relapse1. We sought to gain insight into factors men consider important in choosing between radiotherapy, chemotherapy and surveillance.

Method
We conducted a retrospective, questionnaire-based study of men attending follow-up for stage I seminoma in a regional specialist germ cell clinic.

Results

  • 84 men completed the questionnaire and median time between treatment and completion was 70 weeks (range 12-196).
  • 89% of patients chose carboplatin.
  • Perceived important factors in deciding between treatments were: opinion of the doctor (96%), duration of treatment (75%) and the anticipated treatment side-effects (Immediate 71%, Long-term 88%).
  • ~ 60% felt their choice was that favoured by the doctor.
  • 96% agreed or strongly agreed they had made the correct treatment decision.
  • 90% agreed or strongly agreed that treatment was as expected, based on the information given, with <20% feeling recovery had taken longer than expected.
  • 72% felt chemotherapy side-effects were as expected or better.
  • Reported/subjective patient experience was independent of age, employment status and education.

Conclusion

  • The majority of patients chose carboplatin. They reported being influenced by doctors and duration of treatment in particular.
  • The great majority of patients were happy with the decision taken and the quality of information given.
  • QOL questionnaires incorporating these factors should be included in future prospective clinical trials for this group of patients.

References
Oliver RT, Mason MD, Mead GM et al. MRC TE19 collaborators and the EORTC 30982 collaborators. Radiotherapy versus single-dose carboplatin in adjuvant treatment of stage I seminoma: a randomised trial. Lancet 2005; 366(9482):293300.