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Metastatic non-seminomatous germ cell (testicular) cancer is a rare but curable cancer. Because of the rarity, some treatment centers are unlikely to encounter many patients with this cancer in a single year and therefore may not have extensive treatment experience. Common standardized treatment protocols have been developed to assure appropriate treatment, but the impact of treatment experience is unknown. Physicians in Europe evaluated the association between the experience of the treating cancer institution and the long-term outcome of patients.
The outcomes for 380 patients treated in one of 49 institutions participating in the European Organization for Research and Treatment of Cancer/Medical Research Council performed a randomized trial of 2 different treatment regimens in patients with "poor-prognosis" non-seminomatous germ cell cancer. The institutions were divided into 4 groups based on the total number of patients entered on the clinical trial. Patients treated in the 26 institutions that entered fewer than 5 patients into the trial had an overall survival that was worse than that of patients treated in the 23 institutions that entered 5 patients or more. The overall survival and failure-free survival were similar among institutions that entered at least 5 patients.
These physicians concluded that patients treated in institutions that entered fewer than 5 patients into the trial appeared to have a poorer survival than those treated in institutions that entered a larger number of patients. The observed effect may be related to differences in adherence to the chemotherapy protocol, the frequency and extent of surgery for residual masses, and/or the experience of the treating institution. It is unknown whether these observations are relevant in the United States. The implications seem clear, however; patients with a potentially curable disease may want to inquire about the doctor’s experience with their specific situation. ( Journal of the National Cancer Institute, Vol 91, No. 10, pp 839-846, 1999)
The outcomes for 380 patients treated in one of 49 institutions participating in the European Organization for Research and Treatment of Cancer/Medical Research Council performed a randomized trial of 2 different treatment regimens in patients with "poor-prognosis" non-seminomatous germ cell cancer. The institutions were divided into 4 groups based on the total number of patients entered on the clinical trial. Patients treated in the 26 institutions that entered fewer than 5 patients into the trial had an overall survival that was worse than that of patients treated in the 23 institutions that entered 5 patients or more. The overall survival and failure-free survival were similar among institutions that entered at least 5 patients.
These physicians concluded that patients treated in institutions that entered fewer than 5 patients into the trial appeared to have a poorer survival than those treated in institutions that entered a larger number of patients. The observed effect may be related to differences in adherence to the chemotherapy protocol, the frequency and extent of surgery for residual masses, and/or the experience of the treating institution. It is unknown whether these observations are relevant in the United States. The implications seem clear, however; patients with a potentially curable disease may want to inquire about the doctor’s experience with their specific situation. ( Journal of the National Cancer Institute, Vol 91, No. 10, pp 839-846, 1999)
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