Objective: The introduction of cisplatin in testis cancer therapy significantly reduced the mortality rate. However, data from previous studies indicate that mortality is higher than expected. The aim of our retrospective study in a single center was to evaluate the mortality rate of testicular germ cell tumors. Further to this, a failure analysis was carried out to determine the cause of death, taking the compliance of both the patient and clinician into consideration.
Methods: The mortality rate was evaluated in patients referred to and/or treated for testis cancer at the Department of Urology of the Mannheim University Hospital between 1986 and 2000. The causes of death were determined in this group of patients and divided into four categories: 1) death from tumor progression without management failure, 2) death caused by toxicity or side effects of the treatment, 3) death from poor patient compliance, 4) death from poor compliance of the clinician.
Results: There were 16 deaths in 139 patients treated up to 2000 (mortality rate 11.5%). The causes were determined as tumor progression and toxicity in 19%. In 31% of the cases, poor compliance of both patient and clinician contributed significantly to the cause of death.
Conclusions: Our study supports the theory that negligence to follow the guidelines specified for the treatment of testis cancer may be related to the death of patients with this disease. This could be an explanation for the discrepancy between the expected and actual mortality rate. The quality management of testicular cancer by further standardized failure analysis could reduce the mortality rate.