Treatment of testicular cancer--is quality management possible?

The incidence of testicular cancer has continuously increased during the last decades, especially in the developed countries. The prognosis for a great number of young patients with this terminal illness was dramatically improved to a cure rate of 95% through the introduction of Cisplatin chemotherapy in the late seventies. Einhorn demonstrated the excellent efficacy of Cisplatin in 1977 [see 1]. At that time, germ cell tumors were the cause of death in 400 males per year in Germany. The propagation of chemotherapy could have reduced the number of deaths to 100 per year, but in 1996 there were still 200 deaths from this type of cancer [2]. This fact demonstrates, firstly, that in general practice, the excellent results gained on the efficacy of new agents only asserted themselves slowly, and secondly, that even after 20 years, the success rates derived from study evaluations on testicular cancer have still not been achieved in practice. Although it is accepted that the results of study evaluation are not representative for the general population, improved treatment strategies that were confirmed as a result of study evaluation have to be implemented more rapidly into general therapy. Quality management will ensure the introduction of results from study evaluation into general practice. It will also ensure continuous progress.