Deficits in follow-up for testicular cancer patients after platin-based chemotherapy

Objective The extent to which guideline-recommended examinations for long-term toxicities after chemotherapy are performed in testicular cancer survivors is insufficiently characterized in routine care. This study evaluated the quality of outpatient follow-up with a focus on monitoring chemotherapy-related long-term effects. Methods All testicular cancer patients treated with chemotherapy at a German tertiary care center between 2011 and 2021 were retrospectively surveyed. A structured questionnaire assessed the performance of eight recommended follow-up examinations, including four targeting long-term toxicities (renal function and lipid profile, blood pressure measurement, anthropometric assessment, and patient-reported health problems). Incomplete follow-up was defined as completion of ≤2 of these four examinations. Clinical and sociodemographic data were obtained from medical records. Predictors of complete follow-up were analyzed using univariate and multivariate logistic regression. Results A total of 198 survivors responded (response rate 64%). Tumor-specific examinations were performed in 76-84% of patients, whereas monitoring for long-term toxicities was less consistent (47-74%). General practitioners more frequently assessed blood pressure and anthropometric parameters, while urologists primarily conducted tumor-specific evaluations. Overall, 49% of patients received incomplete follow-up for long-term toxicities. In multivariate analysis, higher body mass index (OR 1.9, p = 0.04) and Charlson comorbidity index ≥3 (OR 3.6, p = 0.004) were independently associated with complete follow-up, whereas patients who had received ≥3 chemotherapy cycles were less likely to receive complete follow-up (OR 0.3, p = 0.04). Conclusion Nearly half of chemotherapy-treated testicular cancer survivors did not receive complete monitoring for long-term toxicities despite high adherence to tumor-specific follow-up. Patients with higher comorbidity and elevated body mass index were more likely to receive sufficient follow-up, whereas patients after more intensive chemotherapy, who are at the highest risk of late toxicity, were less likely to do so. This suggests that follow-up is driven by general medical risk profiles rather than by treatment-related risk and structured, guideline-based survivorship care.