Optimizing Outcomes in Testicular Cancer by Simply Following the Rules

摘要

Just as the fall of the Soviet Union led to Western world relaxation, complacency and inattention to troubles unmasked by the retreating Cold War threat, the near elimination of death from testicular cancer has led to complacency and inattention to existing challenges in care delivery for this most curable solid tumor. There appears to be a naive assumption of cure and little recognition of the unacceptable variation in outcomes, quality of survivorship, and resource utilization occurring across different geographies and different care delivery settings. In settings such as clinical stage I disease (CSI), the abundance of effective options has led to broad inconsistency in approaches often at the cost of unnecessary short- and long-term toxicity. Herein, we will frame the scale of differences in outcomes across varied care settings, the variable impact of guidelines in the community, ongoing efforts at remediating the problem of uneven care delivery in this rare, highly curable disease, and suggest a simple rules-based approach.