A Canadian approach to the regionalization of testis cancer: A review

  • Gregory J. Nason Division of Urology, Department of Surgery, Princess Margaret Cancer Centre, Toronto, ON, Canada
  • Lori A. Wood Division of Medical Oncology, Queen Elizabeth II Health Sciences Centre, Halifax, NS, Canada
  • Robert A. Huddart The Institute of Cancer Research and the Royal Marsden NHS Foundation Trust, Sutton, UK
  • Peter Albers Department of Urology, Heinrich-Heine University, Medical Faculty, Düsseldorf, Germany
  • Ricardo A. Rendon Department of Urology, Dalhousie University, Halifax, NS, Canada
  • Lawrence H. Einhorn Department of Oncology, Indiana University School of Medicine, Indianapolis, IN, USA
  • Craig R. Nichols Testicular Cancer Multidisciplinary Clinic, Virginia Mason Medical Center, Seattle, WA, USA
  • Christian Kollmannsberger British Columbia Cancer Agency Vancouver Cancer Center, University of British Columbia, Vancouver, BC, Canada
  • Lynn Anson-Cartwright Division of Urology, Department of Surgery, Princess Margaret Cancer Centre, Toronto, ON, Canada
  • Joan Sweet . Department of Pathology, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada.
  • Padraig Warde Department of Radiation Oncology, Radiation Medicine Program, Princess Margaret Hospital, University of Toronto, Toronto, ON, Canada
  • Michael A.S. Jewett Division of Urology, Department of Surgery, Princess Margaret Cancer Centre, Toronto, ON, Canada
  • Peter Chung Department of Radiation Oncology, Radiation Medicine Program, Princess Margaret Hospital, University of Toronto, Toronto, ON, Canada
  • Philippe L. Bedard Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, Toronto, ON, Canada
  • Aaron R. Hansen Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, Toronto, ON, Canada
  • Robert J. Hamilton Division of Urology, Department of Surgery, Princess Margaret Cancer Centre, Toronto, ON, Canada
Keywords: : Regionalization; Testis cancer; Canada

Abstract

At the Canadian Testis Cancer Workshop, the rationale and feasibility of regionalization of testis cancer care were discussed. The two-day workshop involved urologists, medical and radiation oncologists, pathologists, radiologists, physician’s assistants, residents and fellows, and nurses, as well as patients and patient advocacy groups.

This review summarizes the discussion and recommendations of one of the central topics of the workshop — the centralization of testis cancer in Canada. It was acknowledged that non-guideline-concordant care in testis cancer occurs frequently, in the range of 18–30%. The National Health Service in the U.K. stipulates various testis cancer care modalities be delivered through supraregional network. All cases are reviewed at a multidisciplinary team meeting and aspects of care can be delivered locally through the network. In Germany, no such network exists, but an insurance-supported online second opinion network was developed that currently achieves expert case review in over 30% of cases. There are clear benefits to regionalization in terms of survival, treatment morbidity, and cost. There was agreement at the workshop that a structured pathway for diagnosis and treatment of testis cancer patients is required.

Regionalization may be challenging in Canada because of geography; independent administration of healthcare by each province; physicians fearing loss of autonomy and revenue; patient unwillingness to travel long distances from home; and the inability of the larger centers to handle the ensuing increase in volume. We feel the first step is to identify the key performance indicators and quality metrics to track the quality of care received. After identifying these metrics, implementation of a “networks of excellence” model, similar to that seen in sarcoma care in Ontario, could be effective, coupled with increased use of health technology, such as virtual clinics and telemedicine.

Published
2020-05-12
How to Cite
Nason, G. J., Wood, L. A., Huddart, R. A., Albers, P., Rendon, R. A., Einhorn, L. H., Nichols, C. R., Kollmannsberger, C., Anson-Cartwright, L., Sweet, J., Warde, P., Jewett, M. A., Chung, P., Bedard, P. L., Hansen, A. R., & Hamilton, R. J. (2020). A Canadian approach to the regionalization of testis cancer: A review. Canadian Urological Association Journal, 14(10), 346-51. https://doi.org/10.5489/cuaj.6268