Mohamed H Kamel1, Mohammed Elfaramawi2, Supriya Jadhav2, Ahmed Saafan3, Omer A Raheem4, Rodney Davis5. 1. Department of Urology, University of Arkansas for Medical Sciences, Little Rock, AR. 2. Department of Epidemiology, University of Arkansas for Medical Sciences, Little Rock, AR. 3. Department of Urology, Aswan University, Aswan, Egypt. 4. Department of Urology, University of California, San Diego, San Diego, CA. 5. Department of Urology, Ain Shams University, Cairo, Egypt. Electronic address: rdavis@uams.edu.
Abstract
OBJECTIVE: To explore the relationship between insurance status and differences in treatment and survival of testicular cancer patients. The Surveillance, Epidemiology, and End Results (SEER) database was utilized for this study. MATERIALS AND METHODS: Between 2007 and 2011, 5986 testicular cancer patients were included in the SEER database. Patients were classified into nonseminoma and seminoma groups. We compared mortality rates, metastasis (M+) at diagnosis, and rates of adjuvant treatments between the uninsured (UI) and insured (I) populations. RESULTS: Overall, 2.64% of UI vs 1.36% of I died from testicular cancer (P = .025) and 16.73% of UI vs 10.52% of I had M+ at diagnosis (P <.0001). In the nonseminoma group, 4.19% of UI vs 2.79% of I died from testicular cancer (P = .326) and 25.92% of UI vs 18.46% of I had M+ at diagnosis (P = .0007). Also 17.28% of UI vs 20.88% of I had retroperitoneal lymph node dissection (RPLND; P = .1). In the seminoma group, 1.06% of UI vs 0.33% of I died from testicular cancer (P = .030) and 7.43% of UI vs 4.81% of I had M+ at diagnosis (P = .029). Also 34.75% of UI vs 48.4% of I received adjuvant radiation (P = .0083). The lack of health insurance predicted poor survival after adjusting for tumor stage, receiving adjuvant radiation or RPLND. CONCLUSION: UI testicular cancer patients present with more advanced cancer stages and have higher mortality rates than I patients. UI seminoma patients received less adjuvant radiation. This may be related to lack of access to care or more advanced cancer stage at diagnosis.
OBJECTIVE: To explore the relationship between insurance status and differences in treatment and survival of testicular cancerpatients. The Surveillance, Epidemiology, and End Results (SEER) database was utilized for this study. MATERIALS AND METHODS: Between 2007 and 2011, 5986 testicular cancerpatients were included in the SEER database. Patients were classified into nonseminoma and seminoma groups. We compared mortality rates, metastasis (M+) at diagnosis, and rates of adjuvant treatments between the uninsured (UI) and insured (I) populations. RESULTS: Overall, 2.64% of UI vs 1.36% of I died from testicular cancer (P = .025) and 16.73% of UI vs 10.52% of I had M+ at diagnosis (P <.0001). In the nonseminoma group, 4.19% of UI vs 2.79% of I died from testicular cancer (P = .326) and 25.92% of UI vs 18.46% of I had M+ at diagnosis (P = .0007). Also 17.28% of UI vs 20.88% of I had retroperitoneal lymph node dissection (RPLND; P = .1). In the seminoma group, 1.06% of UI vs 0.33% of I died from testicular cancer (P = .030) and 7.43% of UI vs 4.81% of I had M+ at diagnosis (P = .029). Also 34.75% of UI vs 48.4% of I received adjuvant radiation (P = .0083). The lack of health insurance predicted poor survival after adjusting for tumor stage, receiving adjuvant radiation or RPLND. CONCLUSION: UI testicular cancerpatients present with more advanced cancer stages and have higher mortality rates than I patients. UI seminomapatients received less adjuvant radiation. This may be related to lack of access to care or more advanced cancer stage at diagnosis.
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