Personalizing, not patronizing: The case for patient autonomy by unbiased presentation of management options in stage I testicular cancer

Jan Oldenburg, J. Aparicio, J. Beyer, G. Cohn-Cedermark, M. Cullen, T. Gilligan, U. De Giorgi, M. De Santis, R. de Wit, S. D. Fosså, J. R. Germà-Lluch, S. Gillessen, H. S. Haugnes, F. Honecker, A. Horwich, A. Lorch, D. Ondruš, G. Rosti, A. J. Stephenson, T. Tandstad

Research output: Contribution to journalArticle

37 Citations (Scopus)

Abstract

Testicular cancer (TC) is the most common neoplasm in males aged 15-40 years. The majority of patients have no evidence of metastases at diagnosis and thus have clinical stage I (CSI) disease [Oldenburg J, Fossa SD, Nuver J et al. Testicular seminoma and non-seminoma: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol 2013; 24(Suppl 6): vi125-vi132; de Wit R, Fizazi K. Controversies in the management of clinical stage I testis cancer. J Clin Oncol 2006; 24: 5482-5492.]. Management of CSI TC is controversial and options include surveillance and active treatment. Different forms of adjuvant therapy exist, including either one or two cycles of carboplatin chemotherapy or radiotherapy for seminoma and either one or two cycles of cisplatin-based chemotherapy or retroperitoneal lymph node dissection for non-seminoma. Long-term disease-specific survival is ~99% with any of these approaches, including surveillance. While surveillance allows most patients to avoid additional treatment, adjuvant therapy markedly lowers the relapse rate. Weighing the net benefits of surveillance against those of adjuvant treatment depends on prioritizing competing aims such as avoiding unnecessary treatment, avoiding more burdensome treatment with salvage chemotherapy and minimizing the anxiety, stress and life disruption associated with relapse. Unbiased information about the advantages and disadvantages of surveillance and adjuvant treatment is a prerequisite for informed consent by the patient. In a clinical scenario like CSI TC, where different disease-management options produce indistinguishable longterm survival rates, patient values, priorities and preferences should be taken into account. In this review, we provide an overview about risk factors for relapse, potential benefits and harms of adjuvant chemotherapy and active surveillance and a rationale for involving patients in individualized decision making about their treatment rather than adopting a uniform recommendation for all.

Original languageEnglish
Article numbermdu514
Pages (from-to)833-838
Number of pages6
JournalAnnals of Oncology
Volume26
Issue number5
DOIs
Publication statusPublished - May 1 2015

Fingerprint

Testicular Neoplasms
Seminoma
Therapeutics
Recurrence
Drug Therapy
Salvage Therapy
Wit and Humor
Carboplatin
Adjuvant Chemotherapy
Disease Management
Lymph Node Excision
Informed Consent
Psychological Stress
Practice Guidelines
Cisplatin
Decision Making
Radiotherapy
Survival Rate
Anxiety
Neoplasm Metastasis

Keywords

  • Active surveillance
  • Adjuvant chemotherapy
  • Non-seminoma
  • Risk factors
  • Seminoma
  • Testicular cancer stage I

ASJC Scopus subject areas

  • Oncology
  • Hematology

Cite this

Oldenburg, J., Aparicio, J., Beyer, J., Cohn-Cedermark, G., Cullen, M., Gilligan, T., ... Tandstad, T. (2015). Personalizing, not patronizing: The case for patient autonomy by unbiased presentation of management options in stage I testicular cancer. Annals of Oncology, 26(5), 833-838. [mdu514]. https://doi.org/10.1093/annonc/mdu514

Personalizing, not patronizing : The case for patient autonomy by unbiased presentation of management options in stage I testicular cancer. / Oldenburg, Jan; Aparicio, J.; Beyer, J.; Cohn-Cedermark, G.; Cullen, M.; Gilligan, T.; De Giorgi, U.; De Santis, M.; de Wit, R.; Fosså, S. D.; Germà-Lluch, J. R.; Gillessen, S.; S. Haugnes, H.; Honecker, F.; Horwich, A.; Lorch, A.; Ondruš, D.; Rosti, G.; Stephenson, A. J.; Tandstad, T.

In: Annals of Oncology, Vol. 26, No. 5, mdu514, 01.05.2015, p. 833-838.

Research output: Contribution to journalArticle

Oldenburg, J, Aparicio, J, Beyer, J, Cohn-Cedermark, G, Cullen, M, Gilligan, T, De Giorgi, U, De Santis, M, de Wit, R, Fosså, SD, Germà-Lluch, JR, Gillessen, S, S. Haugnes, H, Honecker, F, Horwich, A, Lorch, A, Ondruš, D, Rosti, G, Stephenson, AJ & Tandstad, T 2015, 'Personalizing, not patronizing: The case for patient autonomy by unbiased presentation of management options in stage I testicular cancer', Annals of Oncology, vol. 26, no. 5, mdu514, pp. 833-838. https://doi.org/10.1093/annonc/mdu514
Oldenburg, Jan ; Aparicio, J. ; Beyer, J. ; Cohn-Cedermark, G. ; Cullen, M. ; Gilligan, T. ; De Giorgi, U. ; De Santis, M. ; de Wit, R. ; Fosså, S. D. ; Germà-Lluch, J. R. ; Gillessen, S. ; S. Haugnes, H. ; Honecker, F. ; Horwich, A. ; Lorch, A. ; Ondruš, D. ; Rosti, G. ; Stephenson, A. J. ; Tandstad, T. / Personalizing, not patronizing : The case for patient autonomy by unbiased presentation of management options in stage I testicular cancer. In: Annals of Oncology. 2015 ; Vol. 26, No. 5. pp. 833-838.
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