The impact of clinical trial evidence and sociodemographic factors on institutional practice patterns for stage I testicular cancer.

372 Background: Contemporary management for patients with stage I testicular cancer (TC) continues to evolve. Survival is dependent upon staging, surveillance, and the treatment(s) rendered. We sought to determine whether treatment recommendations have been impacted by evidence gained from recent clinical trials and how sociodemographic factors might affect therapeutic decisions for patients with stage I pure seminoma (PS) and nonseminoma (NSGCT). Methods: We performed a single institution, institutional review board approved, retrospective review of patients evaluated for TC from 1999 to 2013. Chi-square and logistic regression analyses were performed between multiple variables including: type of treatment, specialty of the provider, year of treatment, insurance status, distance traveled to our hospital, and education level. Results: Four hundred forty patients were evaluated; of this group 121 patients had stage I TC. For NSGCT patients, living further than 50 miles from our center was associated with treatment (p=0.013). NSGCT patients who had completed an undergraduate education were more likely to undergo surveillance compared to those with a high school education (p<0.01). If intervention was recommended, NSGCT patients evaluated prior to 2010 were more likely to undergo primary retroperitoneal lymph node dissection (RPLND) (p<0.01). After 2010 these patients were more likely to have primary chemotherapy (PC) (p<0.01). NSGCT patients evaluated by urologic oncologists had higher RPLND rates while patients evaluated by medical oncologists more often received PC (p<0.01). The percentage of PS patients receiving external beam radiation decreased from 40% to 5% after 2010, while the rate of surveillance increased from 47% to 79% (p=0.016). For all stage I patients the presence of lymphovascular invasion was associated with treatment compared to surveillance (p<0.001). Conclusions: The management of patients with stage I TC has changed significantly over the past decade. In our study, management recommendations have been shown to be dependent upon the specialty of the provider and other social factors such as distance from the hospital as well as education level, which suggests the possibility of bias during patient counseling.