Browsing by Author "Albers, Peter"

Now showing 1 - 5 of 5
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    A Canadian approach to the regionalization of testis cancer: A review
    (CUA, 2020) Nason, Gregory J.; Wood, Lori; Huddart, Robert A.; Albers, Peter; Rendon, Ricardo A.; Einhorn, Lawrence H.; Nichols, Craig R.; Kollmannsberger, Christian; Anson-Cartwright, Lynn; Sweet, Joan; Warde, Padraig; Jewett, Michael A. S.; Chung, Peter; Bedard, Philippe L.; Hansen, Aaron R.; Hamilton, Robert J.; Radiation Oncology, School of Medicine
    At the Canadian Testis Cancer Workshop, the rationale and feasibility of regionalization of testis cancer care were discussed. The two-day workshop involved urologists, medical and radiation oncologists, pathologists, radiologists, physician’s assistants, residents and fellows, and nurses, as well as patients and patient advocacy groups. This review summarizes the discussion and recommendations of one of the central topics of the workshop — the centralization of testis cancer in Canada. It was acknowledged that non-guideline-concordant care in testis cancer occurs frequently, in the range of 18–30%. The National Health Service in the U.K. stipulates various testis cancer care modalities be delivered through supra-regional network. All cases are reviewed at a multidisciplinary team meeting and aspects of care can be delivered locally through the network. In Germany, no such network exists, but an insurance-supported online second opinion network was developed that currently achieves expert case review in over 30% of cases. There are clear benefits to regionalization in terms of survival, treatment morbidity, and cost. There was agreement at the workshop that a structured pathway for diagnosis and treatment of testis cancer patients is required. Regionalization may be challenging in Canada because of geography; independent administration of healthcare by each province; physicians fearing loss of autonomy and revenue; patient unwillingness to travel long distances from home; and the inability of the larger centers to handle the ensuing increase in volume. We feel the first step is to identify the key performance indicators and quality metrics to track the quality of care received. After identifying these metrics, implementation of a “networks of excellence” model, similar to that seen in sarcoma care in Ontario, could be effective, coupled with increased use of health technology, such as virtual clinics and telemedicine.
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    Clinical dilemmas in local and regional testis cancer
    (Canadian Urological Association, 2021-01) Nason, Gregory J.; Rendon, Ricardo A.; Wood, Lori; Huddart, Robert A.; Albers, Peter; Einhorn, Lawrence H.; Nichols, Craig R.; Kollmannsberger, Christian; Anson-Cartwright, Lynn; Warde, Padraig; Jewett, Michael A.S.; Chung, Peter; Bedard, Philippe L.; Hansen, Aaron R.; Hamilton, Robert J.; Medicine, School of Medicine
    At the Canadian Testis Cancer Workshop, the multidisciplinary management of testis cancer care was discussed. The two-day workshop involved urologists, medical and radiation oncologists, pathologists, radiologists, physician's assistants, residents, fellows, nurses, patients, and patient advocacy group members.This review summarizes the discussion regarding clinical dilemmas in local and regional testis cancer. We present cases that highlight the need for a coordinated approach to individualize care. Overarching themes include the importance of a multidisciplinary approach to testis cancer, willingness to involve a high-volume experienced center, and given that the oncological outcomes are excellent, a reminder that clinical decisions need to prioritize selecting a strategy with the least treatment-related morbidity when safe.
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    Controversies in the management of clinical stage 1 testis cancer
    (Canadian Urological Association, 2020-11) Nason, Gregory J.; Chung, Peter; Warde, Padraig; Huddart, Robert; Albers, Peter; Kollmannsberger, Christian; Booth, Christopher M.; Hansen, Aaron R.; Bedard, Philippe L.; Einhorn, Lawrence; Nichols, Craig; Rendon, Ricardo A.; Wood, Lori; Jewett, Michael A.S.; Hamilton, Robert J.; Medicine, School of Medicine
    In November 2018, The Canadian Testis Cancer Workshop was convened. The two-day workshop involved urologists, medical and radiation oncologists, pathologists, radiologists, physician’s assistants, residents and fellows, nurses, patients and patient advocacy groups. One of the goals of the workshop was to discuss the challenging areas of testis cancer care where guidelines may not be specific. The objective was to distill through discussion around cases, expert approach to working through these challenges. Herein we present a summary of discussion from the workshop around controversies in the management of clinical stage 1 (CS1) disease. CS1 represents organ confined non-metastatic testis cancer that represents approximately 70-80% of men at presentation. Regardless of management, CS1 has an excellent prognosis. However, without adjuvant treatment, approximately 30% of CS1 nonseminomatous germ cell tumors (NSGCT) and 15% of CS1 seminoma relapse. The workshop reviewed that while surveillance has become the standard for the majority of patients with CS1 disease there remains debate in the management of patients at high-risk of relapse. The controversy in the management of CS1 testis cancer surrounds the optimal balance between the morbidity of overtreatment and the identification of patients who may derive most benefit from adjuvant treatment. The challenge lies in a shared decision process where discussion of options extends beyond the simple risk of relapse but to include the long-term toxicities of adjuvant treatments and the favorable cancer-specific survival.
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    Oncological Follow-up Strategies for Testicular Germ Cell Tumours: A Narrative Review
    (Elsevier, 2022-09-07) Kaufmann, Ernest; Antonelli, Luca; Albers, Peter; Cary, Clint; Gillessen Sommer, Silke; Heidenreich, Axel; Oing, Christoph; Oldenburg, Jan; Pierorazio, Phillip Martin; Stephenson, Andrew J.; Fankhauser, Christian Daniel; Urology, School of Medicine
    Context: The aim of this review is to describe the proportion of testicular germ cell tumours (tGCTs) with recurrence, and the timing and anatomical sites of relapse across different disease stages and after different treatment options. We summarise published follow-up protocols and discuss current and future developments to personalise follow-up for patients with tGCT. Evidence acquisition: A systematic literature search was conducted and current guidelines and selected institutional follow-up protocols were reviewed. Evidence synthesis: Of 302 publications, we screened 68 full texts and included 29 studies; 22 of these were retrospective and seven were prospective in nature, contributing data for 20 570 patients. The number of patients included per study ranged from 119 to 2483. We compared the guideline follow-up protocols of the European Society for Medical Oncology, European Association of Urology, National Comprehensive Cancer Network, and American Urological Association, as well as institutional follow-up protocols. The protocols differed in terms of the number, time points, and type of follow-up investigations. Conclusions: Future research should assess how tGCT can be followed to ensure high adherence, define the role of miR-371a-3p microRNA during follow-up, and develop follow-up protocols after curative treatment in the metastatic setting. Patient summary: In this review of follow-up protocols for men with testis cancer, we observed different recommendations and discuss future research areas to improve follow-up for these patients.
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    Practice Makes Perfect: The Rest of the Story in Testicular Cancer as a Model Curable Neoplasm
    (American Society of Clinical Oncology, 2017-11-01) Tandstad, Torgrim; Kollmannsberger, Christian K.; Roth, Bruce J.; Jeldres, Claudio; Gillessen, Silke; Fizazi, Karim; Daneshmand, Siamak; Lowrance, William T.; Hanna, Nasser H.; Albany, Costantine; Foster, Richard; Cedermark, Gabriella Cohn; Feldman, Darren R.; Powles, Thomas; Lewis, Mark A.; Grimison, Peter Scott; Bank, Douglas; Porter, Christopher; Albers, Peter; De Santis, Maria; Srinivas, Sandy; Bosl, George J.; Nichols, Craig R.; Medicine, School of Medicine