Standardized Care for Testicular Cancer May Help Overcome Disparities

By Lisa Rapaport

August 12, 2020

(Reuters Health) - Offering standardized care for testicular cancer at both academic medical centers and safety net hospitals may help reduce sociodemographic disparities in survival and cancer recurrence rates, a new study suggests.

Researchers examined outcomes for 201 patients diagnosed with testicular cancer from 2006 to 2018. The cohort included 106 men treated at Parkland Memorial Hospital, the safety net public hospital in Dallas County, Texas, as well as 95 men treated at UT Southwestern Medical Center, a National Cancer Institute-designated comprehensive cancer center.

A single multidisciplinary team - including urologists, oncologists, radiologists, radiation oncologists, and pathologists - managed patients at both hospitals, according to the report in Cancer.

On average, the Parkland patients were younger than at UT Southwestern (29 vs 33 years, respectively) and more likely to be Hispanic (79% vs 11%).

In addition, the men treated at Parkland were less likely to have health insurance (20% vs 88%, respectively) and more likely to first be seen in the emergency department rather than by a primary care physician (76% vs 8%); on average, they also experienced symptoms for more than twice as long before seeking treatment (65 vs 31 days).

However, men at Parkland underwent orchiectomy within an average of one day after diagnosis, compared with four days for UT Southwestern patients. Men were equally likely to receive follow-up treatment including chemotherapy and surgery at both hospitals, depending on the stage of their tumor.

There was no statistical difference in cancer recurrence rates among patients diagnosed with early-stage disease: 4.7% among Parkland patients and 6.3% among patients at UTSW.

Four patients at Parkland (4%) died during the study, while none at UT Southwestern did, but the difference was not statistically significant after accounting for cancer stage at diagnosis.

"Existing sociodemographic barriers lead to delayed presentation as well as more advanced stage at presentation, and this is directly related to the intensity of treatment that is required and patient survival," said senior study author Dr. Aditya Bagrodia of UT Southwestern Medical Center and Parkland Memorial Hospital.

"However, once a patient walks in the door--regardless of race, education, insurance--we can ensure best possible outcomes by offering the highest level of care from physicians that are familiar with the disease," Dr. Bagrodia said by email.

The results might not be generalizable to other communities, said Michael Rovito, a researcher in population health sciences at the University of Central Florida in Orlando who wasn't involved in the study.

"To have a standardization of care no matter the socioeconomic bracket is a wonderful concept, and it works," Rovito said by email. "However, how many regions/systems are capable of doing this?"

SOURCE: Cancer, online August 10, 2020.