Study Finds Way to Overcome Sociodemographic Factors in Treatment of Germ Cell Tumors

A study published in Cancer found that sociodemographic factors often associated with adverse clinical outcomes in the treatment of germ cell tumors (GCTs) may be overcome with integrated, standardized management of testicular cancer.

“Although differences in ethnicity, insurance status, timing of presentation, and stage at presentation between patient groups do exist, cancer recurrence and mortality appear similar in our study cohort,” the authors wrote. “The integrated care of safety net patients at our high-volume academic center appears to offer equivalent cancer-specific outcomes, regardless of care site.”

To determine whether the standardized treatment of GCTs could be overcome by sociodemographic factors limiting patient care, researchers evaluated 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. Importantly, both institutions were managed by the same group of physicians in the context of multidisciplinary cancer care.

Between 2006 and 2018, 106 and 95 patients underwent initial treatment for GCTs at the safety net hospital and the tertiary care center, respectively. Overall, patients within the safety net cohort 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 disease (42% vs 26%; P = .025).

“Our practice is to perform same-day or next-day orchiectomy, obtain complete staging, have inpatient medical oncology referrals for patients with metastatic disease, and use social work infrastructure to confirm that requisite follow-up care and monitoring are expedited and available,” the authors from the safety net hospital noted. “Furthermore, case-specific considerations such as pulmonary function tests and sperm bank counseling are made on an inpatient basis if there is an anticipated delay in care before patients can be integrated into the outpatient safety net care structure.”

“Although these interventions do not change the initial stage disparity noted between the patient populations, they do allow for similar outcomes of same-stage disease across care locations,” the authors continued.

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 correlated with decreased use of adjuvant treatment for patients with stage I cancer; however, hospital setting was not (OR, 0.67; P = .55). Moreover, for those with stage II or III nonseminomatous GCTs, there was no difference observed in the performance of postchemotherapy retroperitoneal lymph node dissection between the safety net hospital and the tertiary care center (52% vs 64%; P = .53).

Overall, no difference in recurrence rates was observed between the 2 cohorts (5% vs 6%; P = .76).

“Despite the numerous benefits, the potential overall increases in costs of care and the cost-effectiveness of implementation need to be further considered,” the authors explained. “However, our granular data demonstrating consistent practice patterns and equivalent clinical outcomes between a high-risk safety net cohort and a standard-risk academic hospital population support the notion that early involvement of experienced multidisciplinary teams can, in fact, overcome adverse sociodemographic factors.”

Notably, these findings may not be generalizable to other safety net hospitals due to variability in academic institution affiliation, available resources, and funding allocation or differences in patient and cancer characteristics.

Reference:

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. doi: 10.1002/cncr.33076