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Adherence to the EAU guideline recommendations for systemic chemotherapy in penile cancer: results of the E-PROPS study group survey

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World Journal of Urology Aims and scope Submit manuscript

Abstract

Objectives

To validate the adherence of urologists to chemotherapy recommendations given in the EAU guidelines on PeCa. The European Association of Urology (EAU) guidelines on penile cancer (PeCa) are predominantly based on retrospective studies with low level of evidence.

Materials and methods

A 14-item-survey addressing general issues of PeCa treatment was developed and sent to 45 European hospitals. 557 urologists participated in the survey of which 43.5%, 19.3%, and 37.2% were in-training, certified, and in leading positions, respectively. Median response rate among participating departments was 85.7% (IQR 75–94%). Three of 14 questions addressed clinical decisions on neoadjuvant, adjuvant, and palliative chemotherapy. Survey results were analyzed by bootstrap-adjusted multivariate logistic-regression-analysis to identify predictors for chemotherapy recommendations consistent with the guidelines.

Results

Neoadjuvant, adjuvant, and palliative chemotherapy was recommended according to EAU guidelines in 21%, 26%, and 48%, respectively. For neoadjuvant chemotherapy, urologists holding leading positions or performing chemotherapy were more likely to recommend guideline-consistent treatment (OR 1.85 and 1.92 with p(bootstrap) = 0.007 and 0.003, respectively). Supporting resources (i.e., guidelines, textbooks) were used by 23% of survey participants and significantly improved consistency between treatment recommendations and Guideline recommendations in all chemotherapy settings (p(bootstrap) = 0.010–0.001). Department size and university center status were no significant predictors for all three endpoints.

Conclusions

In this study, we found a very low rate of adherence to the EAU guidelines on systemic treatment for PeCa. Further investigations are needed to clarify whether this missing adherence is a consequence of limited individual knowledge level or of the low grade of guideline recommendations.

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Abbreviations

EAU:

European association of urology

IQR:

Interquartile range

PeCa:

Penile cancer

GoR:

Grade of recommendation

SR:

Supporting resources

SOP:

Standard operating procedure

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Acknowledgements

We thank Marlene Haccius from the Department of Urology at St. Elisabeth-Hospital Straubing (Germany) for her organizational assistance in questionnaire collection.

Funding

This research did not receive any supporting funding.

Author information

Author notes

  1. I. Wolff and M. May are contributed equally to this work

Authors and Affiliations

  1. Department of Urology, Klinikum Nuremberg, Paracelsus Medical University Nuremberg, Nuremberg, Germany

    F. A. Distler & S. Pahernik

  2. Department of Urology and Pediatric Urology, University Hospital of Würzburg, Würzburg, Germany

    G. Gakis

  3. Department of Urology, Medical University of Graz, Graz, Austria

    G. Hutterer

  4. Department of Urology, Brandenburg Medical School Theodor Fontane, Ruppiner Kliniken, Neuruppin, Germany

    S. Lebentrau

  5. Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany

    M. Rink

  6. Department of Urology, University Medical Centre Mannheim, University of Heidelberg, Mannheim, Germany

    P. Nuhn

  7. Department of Urology, Großhadern, LMU Munich, Munich, Germany

    S. Brookman-May

  8. Department of Urology, St. Josef-Hospital Regensburg, Medical University Regensburg, Regensburg, Germany

    M. Burger

  9. Department of Urology, University of Freiburg, Freiburg, Germany

    C. Gratzke

  10. Department of Urology, University Medicine Greifswald, Greifswald, Germany

    I. Wolff

  11. Department of Urology, St. Elisabeth-Hospital Straubing, Straubing, Germany

    M. May

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  1. F. A. Distler
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Contributions

All authors whose names appear on the submission have contributed sufficiently to the scientific work and therefore share collective responsibility and accountability for the results. F.A.D.: Data collection, data analysis, manuscript writing. I.W.: Data collection, manuscript writing/editing. G.G./G.H./S.L./M.R./P.N./S.B.M./M.B./C.G./S.P.: Data collection, manuscript editing. M.M.: Project development, data collection, data analysis, manuscript writing/editing.

Corresponding author

Correspondence to F. A. Distler.

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The authors declare that they have no conflict of interest.

Ethics statement

This study was conducted in accordance with the Declaration of Helsinki in its latest version. This article does not contain any studies with animals performed by any of the authors. Analyzed data were completely anonymized and derived from established databases with rigorous data protection measures. Hence, informed consent was not required.

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Distler, F.A., Pahernik, S., Gakis, G. et al. Adherence to the EAU guideline recommendations for systemic chemotherapy in penile cancer: results of the E-PROPS study group survey. World J Urol 38, 2523–2530 (2020). https://doi.org/10.1007/s00345-019-03052-7

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  • DOI: https://doi.org/10.1007/s00345-019-03052-7

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