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Overcoming sociodemographic factors in the care of patients with testicular cancer at a safety net hospital.

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.

journal_name

Cancer

journal_title

Cancer

authors

Chertack N,Ghandour RA,Singla N,Freifeld Y,Hutchinson RC,Courtney K,Bowman IA,Arafat W,Meng X,Moore JA,Aydin AM,Sagalowsky AI,Margulis V,Lotan Y,Woldu SL,Bagrodia A

doi

10.1002/cncr.33076

subject

Has Abstract

pub_date

2020-10-01 00:00:00

pages

4362-4370

issue

eissn

0008-543X

issn

1097-0142

journal_volume

126

pub_type

杂志文章

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Overcoming sociodemographic factors in the care of patients with testicular cancer at a safety net hospital.