The use of tumor markers in testis cancer in the United States: A potential quality issue☆

Abstract 

Background

Performance measurement is currently being implemented at various levels to address issues related to quality of care. Administrative data and cancer registries provide a measure of health care delivery (processes) at the population level. In testis cancer, the use of tumor markers is an important component of care and may represent a measurable quality indicator. We analyzed the use of testis cancer tumor markers across the United States.

Methods

Incident germ cell testis cancer cases between 1998 and 2002 were abstracted from the Surveillance, Epidemiology, and End Results (SEER) program. Tumor marker codes were categorized as performed and not performed. Bivariate and multivariable analyses were performed. Logistic regression was used to determine the independent association of demographic and clinical factors with the failure to measure or document tumor markers.

Results

In 4,742 testis cancer cases, performance of both alpha fetoprotein and human chorionic gonadotropin was recorded in 44.7% of cases, while performance of alpha fetoprotein, human chorionic gonadotropin, and lactate dehydrogenase together occurred in only 16%. Tumor marker use did not increase considerably between 1998 and 2002, and significant variation existed between SEER sites. In multivariable models, disease stage and the interaction between SEER site and year were significantly associated with tumor marker use.

Conclusions

We have identified low and variable rates of tumor marker use in testis cancer cases recorded in SEER. As pay-for-performance evolves, standardized metrics for recommended processes of care (e.g., measurement of tumor markers in patients with testis cancer) may be tied to reimbursement. In this context, failure to document the use of tumor markers will be interpreted as less than optimal care.

Keywords: Testis cancer, Tumor markers, Quality of care, Performance measures