Adherence to active surveillance in patients with stage 1 testicular cancers may be influenced by factors affecting capacity and motivation to attend appointments. The aims of this study were to assess adherence to active surveillance and analyze factors which may impact adherence.
A retrospective cohort study was conducted in patients diagnosed with stage 1 testicular cancer between 2005 and 2020, and managed with active surveillance at 3 institutions in South Western Sydney, Australia. Adherence with active surveillance was followed to 2023 and patients were subsequently classified into 3 groups: "Optimal," "Adequate" or "Loss to follow-up" (LTFU). Factors for adherence were analyzed using multivariable logistic regression. Disease recurrence was analyzed using multivariable Cox regression.
In 125 patients, adherence with active surveillance was assessed as "Optimal" in 64 (51%), "Adequate" in 14 (11%), and LTFU in 47 (38%). Multivariable analysis demonstrated that patients had higher odds of being in the "Optimal" or "Adequate" categories if they were from a culturally and linguistically diverse background (OR 4.86, P = .026), nonsmokers (OR 7.63, P = .0002), not employed (OR 4.93, P = .0085), had a partner (OR 2.74, P = .0326), or were diagnosed after June 2016 (OR 5.22, P = .0016). Recurrence occurred in 21 patients (17%). The risk of recurrence increased with the presence of multiple pathological risk factors (HR 5.77, P = .0032), if patients were unemployed (HR 2.57, P = .032), or if they had "Optimal" or "Adequate" adherence (HR 12.74, P = .0136).
Adherence with active surveillance was poorer in this cohort of stage 1 testicular cancer patients. Patients from culturally and linguistically diverse backgrounds and those who were nonsmokers, unemployed, with a partner, and later date of diagnosis, were more likely to be adherent with active surveillance.
Clinical genitourinary cancer. 2024 May 07 [Epub ahead of print]
Roger Liang, Diana Adams, Felicia Roncolato, Ray Asghari, Joseph Descallar, Abhijit Pal, Wei Chua, Bavanthi Balakrishnar
Cancer Therapy Centre, Liverpool Hospital, Liverpool, New South Wales, Australia; Macarthur Cancer Therapy Centre, Campbelltown Hospital, Campbelltown, New South Wales, Australia; Bankstown Cancer Centre, Bankstown-Lidcombe Hospital, Bankstown, New South Wales, Australia. Electronic address: ., Macarthur Cancer Therapy Centre, Campbelltown Hospital, Campbelltown, New South Wales, Australia., Bankstown Cancer Centre, Bankstown-Lidcombe Hospital, Bankstown, New South Wales, Australia., Ingham Institute for Applied Medical Research, Liverpool, New South Wales, Australia; South West Sydney Clinical Campuses, School of Clinical Medicine, UNSW Sydney, New South Wales, Australia., Cancer Therapy Centre, Liverpool Hospital, Liverpool, New South Wales, Australia; Bankstown Cancer Centre, Bankstown-Lidcombe Hospital, Bankstown, New South Wales, Australia., Cancer Therapy Centre, Liverpool Hospital, Liverpool, New South Wales, Australia.