Standardization of care at a safety net hospital with that of an academic tertiary cancer appeared to result in equivalent cancer-specific outcomes for men with testicular cancer, regardless of treatment site.
“Testicular cancer treatment has significantly evolved over the years, with the majority of cases being highly curable if managed and followed properly,” wrote researchers from the University of Texas Southwestern Medical Center, Dallas. “Conversely, deviations from guidelines and a lack of proper access to care have resulted in worse outcomes and higher mortality.”
In this study, the researchers analyzed outcomes in men treated at a safety net hospital and an academic tertiary care center by the same group of physicians in the context of multidisciplinary care.
Between 2006 and 2018, 106 men started treatment for germ cell tumors at the safety net hospital and 95 at the tertiary care center. The patients who presented to the safety net center were younger (P =.005), more likely to be Hispanic, and more likely to be uninsured (P <.001).
Additionally, patients at the safety net hospital were more likely to present via the emergency department and to have metastatic disease at diagnosis.
Hospital setting was not an independent predictor of mortality in the multivariable model. Four patients died in the safety net group and no patients died in the tertiary care group.
The multivariable analysis showed that among patients with stage I disease, both 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.
In patients with stage II/III nonseminomatous germ cell tumors, the rate of performance of postchemotherapy retroperitoneal lymph node dissection was similar between the 2 treatment centers.
Recurrence rates across the 2 groups were also similar.
“This is the first study directly comparing testicular cancer outcomes in an academic center neighboring a safety net hospital run by the same multidisciplinary physician team,” the researchers wrote. “Although our specific practice design may be difficult to replicate, we use guideline-directed care and multidisciplinary teams when caring for patients with testicular cancer and have institution-wide efforts to retain patients for follow-up.”
Chertack N, Ghandour RA, Singla N, et al. Overcoming sociodemographic factors in the care of patients with testicular cancer at a safety net hospital. Cancer. Published online August 10, 2020. doi:10.1002/cnce.33076