Quality Assurance in Testicular Cancer

1
Quality Assurance in Testicular Cancer

• Craig R. Nichols, MD
• Earle Chiles Research Institute
• Robert Franz Cancer Research Center
• Providence Health Systems
• Portland, Oregon

2
Why do we need to pay attention to quality for a
disease that we cure 95 of the time??

• Minimize overtreatment and associated
  complications
• Minimize undertreatment and the need for salvage
  therapies
• Minimize complications of chemotherapy, surgery
  and/or radiation
• Cost efficient diagnosis, staging treatment and
  follow-up
• Quality long term survival

3
Examples in Testis Cancer

• Way too many PET scans and CTs
• Treating patients without active disease- second
  primary, sarcoid, bleo nodules, teratoma
• Not utilizing surgery appropriately
• Misinterpreting the IGCCC in face of intact
  primary
• Not aware of IGCCC
• Caprious dosing and substitutions

4
Centers and Center-Directed Care

• Certainly for uncommon diseases, care in centers
  of excellence exceeds care in general oncology
  clinics
• Iterative relationship between volumes and
  excellence
• Evidence-based approaches
• Database development and reporting
• On going clinical and translational research
• Experience and creativity

5
FutureCenters as Knowledge Distribution Centers

• Center sits in the middle of a hub and spoke
  relationship with the community (Speichennetz)
• Improved electronics will allow for virtual
  pathology/radiology central review
• Centers will direct care for all patients with
  uncommon (or common) diseases including
• Central decision making and oversight
• Distribution of order sets for chemotherapy
  delivery in the community, survivorship
  guidelines and virtual clinical trials
• Patients travel to centers only for high tech
  needs- surgery, advanced imaging, early phase
  clinical trials