A Scottish national mortality study assessing cause of death, quality of and variation in management of patients with testicular non-seminomatous germ-cell tumours

Abstract

1983 -87 (Sharp et al., 1993b, largely due to the introduction of platinum-based chemotherapy (Ellis and Sikora, 1987). The complete excision of residual masses following chemotherapy is now accepted practice with more experinced surgeons in this area more likely to perform adequate resection (Ewing et al., 1987;Hendry et al., 1987;Whillis et al., 1991). It has also been suggested that results of therapy for this diease in Scotland are better in centres where a large number of patients are seen (Harding et al., 1993). In Scotland there are five oncology centres, patients with NSGCT being treated in them all. The audit was designed to assess if there was any variation in the success of therapy across the country for this usually curable cancer.This audit, and those reported in the accompanying two papers (Clarke et al., 1995;Howard et al., 1995) were part of a Scottish National Audit assessing the appropriateness and variation in manag t strategies and success of therapy for testicular NSGCIT. The (Clarke et al., 1995). New registrations not referred to oncology centres were excluded from the survival analysis as their diagnosis had not been validated.The end of the follow-up period was defined as 31 December 1992 and survival time was caculated from date of diagnosis until death, or the end of follow-up. Actuarial survival curves based on Kaplan-Mewer estimates were described and the log rank chi-square test for differences in survival rates alculated. These data are summarised by means of the 5 year survival rates with associated standard error. Deaths from causes other than the disease or its treatment, as assessed by the reviewer in this study, were censored.As numbers of patients in some health boards were small these were grouped crudely according to population density to investigate area of residence at diagnosis of cancer. A priori the following groupings were defined (1)

Rural factors and survival from cancer: analysis of Scottish cancer registrations

“…They have also been found less likely to be referred to specialist centres (Greenberg et al, 1988a;Launoy et al, 1992) or receive adjuvant treatment with radiotherapy and chemotherapy (Greenberg et al 1988b;Craft et al, 1997). In Scotland, rural residence has been associated with suboptimal treatment for testicular cancer (Howard et al, 1995). Our findings are in line with these studies and suggest that the problem is primarily one of distance from cancer centres.…”

Results and long term follow-up for 1581 patients with metastatic breast carcinoma treated with standard dose doxorubicin-containing chemotherapy

“…In patients with nonseminomatous germ cell tumors, the outcome has been reported to be significantly better if they were treated in referral centers compared with the community centers. 27,28 Whether treatment of a relatively more common disease like MBC in a tertiary-care center by an interested investigator will also affect patient outcome has not been studied. However, it has been observed repeatedly that a newer therapy that appeared very promising in a single-arm trial conducted in a referral center had much inferior results when tested in a multiinstitutional randomized trial.…”

Access to specialist cancer care: is it equitable?

“…Studies in the United States, France and Scotland have all shown that patients from rural areas are less likely to be treated in a specialist centre and to have poorer survival rates (Launoy et al, 1992;Howard et al, 1995;Greenberg et al, 1988). Campbell et al (2000) indicated that distance from a cancer centre might be a determining factor in survival.…”