COMPLIANCE OF CLINICAL STAGE-I NONSEMINOMATOUS GERM-CELL TUMOR PATIENTS WITH SURVEILLANCE

Purpose: We evaluate compliance and its effect on the outcome of patie nts with clinical stage I nonseminomatous germ cell tumor who underwen t post-orchiectomy surveillance at the Tom Baker Cancer Centre. Materi als and Methods: From 1980 to 1994, 76 evaluable patients underwent su rveillance at the Tom Baker Cancer Centre. The surveillance protocol c onsisted of clinical evaluation, chest x-ray and serum tumor marker me asurements monthly in year 1, every 2 months in year 2, every 6 months in years 3 to 5 and yearly in years 6 to 10. Abdomen and pelvic compu terized tomography (CT) were scheduled every 2 months in year 1 and ev ery 4 months in year 2. Noncompliance was defined as missing 2 or more consecutive clinic visits, tumor marker measurements or chest x-rays or 1 or more CT scans. Results: Compliance with clinical evaluations w as 61.5% in year 1 and 35.5% in year 2, whereas compliance with CT was only 25% and 11.8% in years 1 and 2, respectively. By univariate anal ysis diagnosis before 1990 predicted noncompliance, while age, marital status and distance from the center did not. Recurrent disease was de tected in 28 patients (37%) at a median of 5.5 months after orchiectom y (range 1 to 49.5). Among the 47 compliant patients 23 had relapse an d none died. Among the 29 noncompliant patients 5 had relapse and 2 di ed with central nervous system disease. Conclusions: Overall complianc e with this surveillance program was poor but this study was too small to demonstrate whether poor compliance adversely affects overall surv ival.