Cancer of the testes is considered a “rare” disease, occurring in fewer than 10,000 men between 15 and 40 years old in the United States annually.
About 150 of those cases are diagnosed across Kaiser Permanente’s Northern California Region. The cancer is so rare that each of the region’s urologists may diagnose just one case in any given year. That doesn’t mean the disease is any less devastating to those who have it.
Now urologists and medical oncologists in Northern California have teamed up to ensure that they are all providing consistent, expert care for every single case of testicular cancer.
The effort began in 2016, when medical oncologist Andrea Harzstark, MD, and urologist Joseph Presti, MD, both based at the Kaiser Permanente Oakland Medical Center, spearheaded the establishment of a regional multidisciplinary Testicular Cancer Review Panel, which convenes four urologic and medical oncology specialists twice a month to review new cases.
“We are identifying patients as quickly as we can to make sure they are all on the right treatment path,” Dr. Harzstark said.
During its first year, the panel reviewed 131 new diagnoses, according to research presented by Drs. Harzstark and Presti earlier this year. The panel requested the re-review of pathology or radiology in 20 percent of the cases.
“I was on the phone with the mom of a patient, and she said, ‘I cannot tell you how comforted I am to hear that a panel of experts has reviewed my son’s case,’” Dr. Presti said.
Research and technology make panel possible
Drs. Harzstark and Presti received critical assistance to form the review panel from Lisa Herrinton, PhD, research scientist at the Kaiser Permanente Division of Research, and Yi-Fen (Irene) Chen, MD, associate executive director of The Permanente Medical Group.
First, Dr. Herrinton used an analytical technique called natural language processing in Kaiser Permanente’s comprehensive electronic medical record, Kaiser Permanente HealthConnect®, to create spreadsheets of all new and ongoing testicular cancer cases, called a miniregistry.
“We were able to quickly give the testicular cancer panel the analytical tools so they could design a miniregistry that was exactly what they needed,” said Herrinton, whose team has created about 20 such miniregistries for other rare diseases, such as melanoma and sickle cell disease.
Then Dr. Chen’s System X team — a multidisciplinary group of TPMG technology, health care and quality leaders — piloted a powerful new clinical tool in Kaiser Permanente HealthConnect®, which allows the panel to access the complete lists of testicular cancer patients at all stages of treatment.
“Think of it as a spreadsheet on steroids,” Dr. Chen said. “We are supporting clinicians with very powerful system tools with dynamic data that allow them to efficiently and effectively take actions to close the care gap.”
With access to the tool, members of the panel can ensure that all appropriate follow-up imaging and laboratory tests are being done in a timely manner, specific to the type and stage of the testicular cancer.
Mark St. Lezin, MD, chair of chiefs of Urology for Kaiser Permanente Northern California, said the review panel “puts together true national experts who determine what is ideal care and use a marvelous computer system that assures that every man gets consistent, expert-level care.”
“That means a young man avoids chemo he doesn’t need, or gets the chemo that may prevent recurrence.”