Original Research

Testicular germ cell cancer in Africa: A survey on patterns of practice

Henriette Burger, Tara Rick, Pieter Spies, Ayun Cassel, Verna Vanderpuye, Luca Incrocci
South African Journal of Oncology | Vol 6 | a241 | DOI: https://doi.org/10.4102/sajo.v6i0.241 | © 2022 Henriette Burger, Tara Rick, Pieter Spies, Ayun Cassel, Verna Vanderpuye, Luca Incrocci | This work is licensed under CC Attribution 4.0
Submitted: 23 May 2022 | Published: 15 September 2022

About the author(s)

Henriette Burger, Department of Radiation Oncology, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa; and, Department of Radiation Oncology, Tygerberg Hospital, Cape Town, South Africa
Tara Rick, Department of Radiation Oncology, Faculty of Health Sciences, Erasmus Medical Centre, Rotterdam, the Netherlands; and, Department of Physician Assistant Studies, Faculty of Medicine, Saint Catherine University, St Paul, United States of America
Pieter Spies, Department of Urological Surgery, Faculty of Health Sciences, Stellenbosch University, Cape Town, South Africa; and, Division of Urological Surgery, Tygerberg Hospital, Cape Town, South Africa
Ayun Cassel, Department of Urology, Faculty of Medicine, John F. Kennedy Medical Center, Monrovia, Liberia
Verna Vanderpuye, National Center for Radiotherapy Oncology and Nuclear Medicine, Korle Bu Teaching Hospital, Accra, Ghana
Luca Incrocci, Department of Radiation Oncology, Faculty of Health Sciences, Erasmus Medical Centre, Rotterdam, the Netherlands


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Abstract

Background: Testicular germ cell tumours (GCTs) are rare malignancies most prevalent in 15–40-year-old men. Incidence rates of testicular cancer on a global level show marked geographic variation with higher incidence rates reported in predominantly Caucasian populations. African data on GCT management show low incidence rates but an advanced stage at presentation and high mortality rates.

Aim: The aim of the study was to explore patterns of practice in the management of testicual GCTs.

Setting: The study was conducted in an African oncology care setting.

Methods: A cross-sectional web-based survey was distributed to doctors or nurses providing oncology care for patients with testicular GCT in Africa. Data on staging procedures, chemotherapy and radiotherapy (RT) treatment schedules across institutions are reported and discussed in the context of international treatment guidelines and local resources.

Results: Eleven African countries contributed data. Epidemiological estimates were received from 20 institutions and management and outcome data from 18 institutions. The estimated ratio of seminoma to non-seminoma was 1:1.3. The stage at presentation was tumour-node-metastases-serum marker (TNM-S) Stage III at half of the institutions surveyed. Chemotherapy regimens mostly followed international guidelines, but certain essential drugs were not consistently accessible at all centres. Radiotherapy services were available to all but one respondent, with three-dimensional planning being widely used. There was marked variation in RT doses and treatment fields.

Conclusion: The resources to effectively manage testicular GCT appear to be accessible to most institutions surveyed. Regional management guidelines, sharing of clinical expertise within Africa through online platforms and centralised data collection on epidemiology, management and treatment efficacy are advocated to better allocate resources and improve the outcomes reported in this rare but potentially curable condition.


Keywords

testicular germ cell tumour; testicular cancer; Africa; multidisciplinary management; quality improvement

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