The National second opinion project of the German Testicular Cancer Study Group (GTCSG)

Objectives• Describe, how the national second opinion network for testicular cancer works;• Assess the current state of testicular cancer treatment by primary practitioners in Germany;• Clarify the role of second opinion networks in improving guideline implementation.Difficulties:• The guidelines are regular updated and very precise;• The guideline implementation in clinical practice;• Hypothesis: An over-therapy is more frequent than an under-therapy.MethodsThe treatment is performed by primary practitioners. Second opinion is recommended by one of 30 approved second opinion centers via an internet-based platform. The recommended and the applied therapies were compared by the data center. Primary end points of the study were congruence between the first and second opinion, treatment changes based on the second opinion, and relapse-free 2-year survival. Results• Study from November 2006 to October 2011;• 1 523 requests for second opinions by 572 urologists;• 927 patients selected;• The response rate was 75.8% for treatment data and 74.4% for the 2-year-follow-up data;• Advice seekers and second opinion centers had discongruent treatment concepts in 43.3% of the cases;• 31.3% over-therapy by the primary practitioners;• The recommended therapies from the second opinion centers are applied in only 76.9% of the cases.Conclusions• Guidelines for the treatment of testicular cancer are inadequately implemented, especial by primary practitioners;• This type of project could ameliorate the quality of treatment for other types of cancer.