Overcoming sociodemographic factors in the care of patients with testicular cancer at a safety net hospital. Issue 19 (10th August 2020)

• Record Type: Journal Article
• Authors: Chertack, Nathan; Ghandour, Rashed A.; Singla, Nirmish; Freifeld, Yuval; Hutchinson, Ryan C.; Courtney, Kevin; Bowman, I. Alex; Arafat, Waddah; Meng, Xiaosong; Moore, Joseph A.; Aydin, Ahmet M.; Sagalowsky, Arthur I.; Margulis, Vitaly; Lotan, Yair; Woldu, Solomon L.; Bagrodia, Aditya
• Is Part Of: Cancer. Volume 126:Issue 19(2020)
• Page Start: 4362
• Page End: 4370
• Publication Date: 2020-08-10
• Subjects: germ cell tumor -- multidisciplinary -- outcomes -- safety net -- sociodemographic -- testis cancer; Cancer -- Periodicals; Cancer -- Cytopathology -- Periodicals; 616.99405
• DOI: 10.1002/cncr.33076
• Languages: English
• ISSNs: 0008-543X

Abstract

Abstract : Background: The objective of this study was to determine whether standardized treatment of germ cell tumors (GCTs) could overcome sociodemographic factors limiting patient care. Methods: The records of all patients undergoing primary treatment for GCTs at both a public safety net hospital and an academic tertiary care center in the same metropolitan area were analyzed. Both institutions were managed by the same group of physicians in the context of multidisciplinary cancer care. Patients were grouped by care center; clinicopathologic features and outcomes were analyzed. Results: Between 2006 and 2018, 106 and 95 patients underwent initial treatment for GCTs at the safety net hospital and the tertiary care center, respectively. Safety net patients were younger (29 vs 33 years; P = .005) and were more likely to be Hispanic (79% vs 11%), to be uninsured (80% vs 12%; P < .001), to present via the emergency department (76% vs 8%; P < .001), and to have metastatic (stage II/III) disease (42% vs 26%; P = .025). In a multivariable analysis, an absence of lymphovascular invasion (odds ratio [OR], 0.30; P = .008) and an embryonal carcinoma component (OR, 0.36; P = .02) were associated with decreased use of adjuvant treatment for stage I patients; hospital setting was not (OR, 0.67; P = .55). For patients with stage II/III nonseminomatous GCTs, there was no difference in the performance of postchemotherapy retroperitoneal lymph node dissection between the safety net hospital and the tertiary care center (52% vs 64%; P = .53). No difference in recurrence rates was observed between the cohorts (5% vs 6%; P = .76). CONCLUSIONS: Sociodemographic factors are often associated with adverse clinical outcomes in the treatment of GCTs; they may be overcome with integrated, standardized management of testicular cancer. Abstract : Sociodemographic factors have been shown to negatively affect patient care. Standardized care between a safety net county hospital and a tertiary care center demonstrates improved outcomes despite patient factors.