More Appropriate Testicular Cancer Treatment Through Second Opinions

Since 1996, the German Testicular Cancer Study Group has published guidelines to improve treatment quality. The 2008 edition became the “European Consensus on Diagnosis and Treatment of Germ Cell Cancer”. Some guideline studies had limited clinical impact. Therefore, in 2006, the group established a national second-opinion system for staging and treatment planning after orchiectomy (surgical testis removal), aiming to improve care.

The study examined the impact of guidelines incorporating this second-opinion system.

An online information network linked urologists seeking advice with second-opinion centers. These centers, comprising 18 clinics, contributed to guideline development.

Data included clinical, radiological and histopathological information, planned treatment, center recommendations and surveillance without treatment.

Between February 2006 and September 2008, there were 642 second-opinion requests. Planned and recommended treatments differed in %32.3. Differences were greater in nonseminomatous than seminomatous tumors and tended to increase in advanced disease. Recommended treatment was implemented in %71.8. Different opinions reportedly prevented unnecessary treatment in %40.3 and inadequate treatment in %26.5.

Treatment changed in approximately one in six patients. Even life-threatening diseases can involve major differences of opinion; such systems improve access to specialized physicians. We believe second opinions will develop further and become an important part of diagnosis and treatment decisions across cancers.