EAU 2018: Study Finds a Quarter of Penile Cancer Patients Do Not Receive Recommended Treatment
A major international survey has found that around a quarter of patients with penile cancer are not receiving the recommended treatment, and that these patients had half the survival rate of those who were treated according to guidelines. The study, presented at the European Association of Urology (EAU) Conference in Copenhagen, finds that nonadherence can be due to patients refusing treatment or doctors being reluctant to treat appropriately or being unfamiliar with the best procedures.
Penile cancer is considered a rare human cancer. Around one in 100,000 men contract penile cancer every year in the West—however, in recent years, this rate has risen by 20% to 25% in many countries, especially in older men.
Cancer of the penis can be extremely distressing for patients. According to the American Cancer Society, “Cancer of the penis can be a frightening prospect. Partially or completely removing the penis is often the most effective way to cure penile cancer, but for many men, this cure seems worse than the disease.”
Survey Findings
Researchers from 12 centers in the U.S, Italy, Spain, Brazil, and Hungary looked at adherence to the EAU guidelines on treatment of penile cancer. They retrospectively examined the records of 425 patients who had been treated in the 2010–2016 period.
Researchers found that a significant minority (25%) of patients do not receive the recommended treatment. In part, this is due to patients being reluctant to go ahead with surgery which removes all or part of the penis, and also in part due to doctors not proceeding with the appropriate surgery to treat this rare cancer.
Lead author Luca Cindolo, MD, FEBU, said, “We found that most patients were treated in accordance with the gold-standard EAU recommendations, but around 25% of patients had not received appropriate treatment. From our work, we see that around twice as many patients survive if they have been treated according to recommended guidelines.”
He continued, “In around half of those patients not treated according to guidelines, the decision was made by the doctor, and we suspect that this is because many doctors are unfamiliar with treating this rare but devastating cancer. In one in six cases, the patient or the patient’s carers made the decision not to be treated according to guidelines. We often find that patients don’t want to be treated or that the patients’ carers are unwilling to take the decision to treat.”
“These are often difficult treatment decisions to take, and so they need to be arrived at after open discussion between the patient and the medical team. It’s a condition which most urologists don’t see very often, so it’s best if the medical team is experienced in dealing with the condition. This may mean that the treatment in national or international centers of excellence is the best way to proceed,” Dr. Cindolo concluded.
Commentary
Commenting, Vijay Sangar, MBChB, MD, FCRS (Urol), Director of Surgery at Christie Hospital Manchester, said, “We often find that patients with rare cancers get short-changed because the cancer is so seldom encountered by doctors. We can suggest that if we treat rare cancers in national or even international centers of excellence, the chances of better management improve. In the UK for example, we centralized the treatment of penis cancer into just 10 centers of excellence, whereas in some countries such as Hungary, Spain, and Italy, these rare urologic cancers are still treated locally, which may reflect the lower survival rates.”
“Generally, the more penile cancer a team sees, the better they become at managing the disease. The recently established eUROGEN consortium will make a huge difference to European patient care; this gives patients with rare urologic diseases access to the best management no matter where they are in Europe.”
The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.
