MANAGEMENT PREFERENCES IN STAGE-I NONSEMINOMATOUS GERM-CELL TUMORS OFTHE TESTIS - AN INVESTIGATION AMONG PATIENTS, CONTROLS AND ONCOLOGISTS

Increasingly, treatment choices leading to the same survival outcome c an be offered to cancer patients (e.g. mastectomy or conservative surg ery in early breast cancer). Two approaches available for post-orchide ctomy, stage I patients with non-seminomatous germ cell tumours of the testis (NSGCTT), particularly those at high risk of relapse, include immediate adjuvant chemotherapy (two courses) or surveillance, with ch emotherapy (typically four courses) given only on relapse. The aim of this study was to investigate which approach patients prefer. Question naires were given to newly diagnosed NSGCTT patients, to patients with previous experience of the two options and to non-cancer controls, in cluding specialist testicular tumour oncologists. Participants were as ked to choose between immediate chemotherapy, surveillance or for the doctor to decide, at recurrence risk levels ranging from 10% to 90%. Q uestionnaires were returned by 207 subjects in nine different groups. The risk thresholds at which subjects' management preference changed, within apparently homogeneous groups, varied greatly, although at leas t one subject in each group selected adjuvant chemotherapy at the lowe st (10%) level of risk. Subjects tended to favour options of which the y had previous experience. Cancer patients wanted the doctor to decide more frequently than controls. The wide variability observed makes it difficult to predict which option an individual will select. Personal ity factors and personal circumstances, other than specific experience and knowledge, are obviously influential. Many patients would prefer their doctor to decide, but variability among oncologists is as great as that among their patients.