Association of Guideline-Concordant Care with Survival in Adolescent and Young Adult Patients with Germ Cell Tumors.

Abstract

Purpose: Treatment for germ cell tumors (GCTs) in adolescent and young adults (AYA: 15-39) spans different primary sites and multiple specialties. Little is known about the treatment patterns outside of clinical trials, including the delivery of guideline-concordant care. Methods: This is a population-based, retrospective cohort study of AYAs diagnosed (2004-2018) with GCT. Guideline-concordant care was determined using treatment text-field data from the California Cancer Registry. Survival models measured the impact of guideline-concordant care as a time-dependent variable on overall survival accounting for known prognostic factors. GCTs were analyzed separately by primary site (extragonadal, ovarian, and testicular). Results: The majority of patients had testicular GCT (90.4%), early-stage disease (stage I/II: 75.3%), and received part/no treatment at a specialized cancer center (SCC) (77.5%). For treatment, 37.6% of patients received surgery plus chemotherapy, followed by surgery alone (36.2%). The most common chemotherapy regimen was bleomycin, etoposide, and cisplatin. Sixty-four percent of patients received guideline-concordant care, with variations by primary site (extragonadal 54.7%, ovarian 70.1%, and testicular 64.6%). Receipt of guideline-concordant care was associated with superior survival for testicular primaries (hazard ratio = 0.56, confidence interval: 0.45-0.69). Patients with testicular primaries who had no treatment at an SCC were less likely to receive guideline-concordant care. Conclusion: This study identified that receipt of guideline-concordant care was associated with improved survival; however, a substantial proportion of AYA patients do not receive this care, highlighting the need to investigate the barriers to the delivery of guideline-concordant care in this patient population.