Survivorship Outcomes and Patient Perceptions of Care in the Evolved Landscape of Stage I Testis Cancer Management

PURPOSE: To compare survivorship outcomes between patients with stage I testicular cancer (TCa) undergoing surveillance or adjuvant therapy and examine patient perceptions on counselling and management. METHODS: Administrative claims data from the Optum Labs Data Warehouse (2007-2022) were reviewed to identify patients with stage I TCa managed with either surveillance or adjuvant therapy. Trends in TCa management were evaluated, and survivorship outcomes were assessed using propensity score matched survival analyses. Qualitative surveys and interviews explored patient perspectives on decision-making and identified themes in patient experiences with counseling. RESULTS: Of 3,613 stage I TCa patients, the mean age at diagnosis was 38.6 years (SD 13.6) with surveillance rates increasing up to 78.7% by 2022. When comparing the matched surveillance to chemotherapy groups, there were higher rates of men's health diagnoses in the chemotherapy group (35.2% vs 23.9%, p=0.027). However, time-to-event analysis showed no difference in survivorship outcomes between surveillance or adjuvant therapy. Twenty surveyed stage I TCa patients revealed satisfaction and understanding of their care but endorsed concerns regarding survivorship outcomes. Five interviewed patients communicated four key themes: 1) trust in physician recommendations, 2) proactive personal and family research, 3) gaps in communication of care, and 4) coping. CONCLUSION: This study suggests adjuvant chemotherapy may be linked to higher rates of men's health diagnoses, but over time, these risks do not differ significantly from surveillance. Patient perspectives underscore the importance of communication, shared decision-making, and addressing survivorship concerns as part of comprehensive care. Further research into survivorship outcomes is needed.