Adherence outcomes and risk factors predicting non-adherence to active surveillance in patients with stage 1 testicular germ cell tumours

Microabstract Adherence with active surveillance for stage 1 testicular cancer is often suboptimal. This retrospective study assessed adherence to active surveillance and analysed factors impacting adherence. This cohort had a high rate of loss to follow-up of 38%. Significant risk factors for non-adherence included being from non-culturally and linguistically diverse background, employment, smoking, single relationship status, and earlier date of diagnosis. PURPOSE Adherence to active surveillance in patients with stage 1 testicular cancers may be influenced by factors affecting capacity and motivation to attend appointments. The aims of this study were to assess adherence to active surveillance and analyse factors which may impact adherence. PATIENTS AND METHODS A retrospective cohort study was conducted in patients diagnosed with stage 1 testicular cancer between 2005 and 2020, and managed with active surveillance at three institutions in South Western Sydney, Australia. Adherence with active surveillance was followed to 2023 and patients were subsequently classified into three groups: ‘Optimal’, ‘Adequate’ or ‘Loss to follow-up’ (LTFU). Factors for adherence were analysed using multivariable logistic regression. Disease recurrence was analysed using multivariable Cox regression. RESULTS In 125 patients, adherence with active surveillance was assessed as Optimal in 64 (51%), Adequate in 14 (11%), and LTFU in 47 (38%). Multivariable analysis demonstrated that patients had higher odds of being in the Optimal or Adequate categories if they were from a culturally and linguistically diverse (CALD) background (OR 4.86, p=0.026), non-smokers (OR 7.63, p=0.0002), not employed (OR 4.93, p=0.0085), had a partner (OR 2.74, p=0.0326), or were diagnosed after June 2016 (OR 5.22, p=0.0016). Recurrence occurred in 21 patients (17%). The risk of recurrence increased with the presence of multiple pathological risk factors (HR 5.77, p=0.0032), if patients were unemployed (HR 2.57, p=0.032), or if they had Optimal or Adequate adherence (HR 12.74, p=0.0136). CONCLUSION Adherence with active surveillance was poorer in this cohort of stage 1 testicular cancer patients. Patients from CALD backgrounds and those who were non-smokers, unemployed, with a partner, and later date of diagnosis, were more likely to be adherent with active surveillance.