Disparities in Access and Regionalization of Care in Testicular Cancer.

ABSTRACT

INTRODUCTION: Timely mobilization of specialized resources are needed to achieve optimal outcomes in testicular cancer. We used the National Cancer Database to investigate the hospital and demographic features driving disparity. PATIENTS AND METHODS: We identified adult men with testicular tumors diagnosed from 2004 to 2013. We a priori examined the association among race/ethnicity, socioeconomic status (SES), travel burden, hospital characteristics, and indicators of delays in testicular cancer care. The outcomes included large primary tumor, stage III at diagnosis, orchiectomy delay, and mortality. The analyses included multivariable Cox proportional hazards regression for time-dependent outcomes and logistic regression for categorical outcomes. RESULTS: Of 31,964 men, 29% had a large primary tumor, 17% presented with stage III disease, 10% experienced an orchiectomy delay, and 6% died. Black race or Hispanic ethnicity, low SES, and underinsurance were associated with poorer outcomes (P < .001 for all). Higher hospital volume, cancer center status, and lower travel burden were associated with improved outcomes (P < .001 for all). CONCLUSION: Nonwhite race/ethnicity, low SES, and underinsurance were associated with diminished access to testicular cancer care. Insurance status, a marker of SES, had the most consistent association with poor outcomes. This finding highlights the oncologic imperative to improve access to adequate health insurance. Regionalization of subspecialty care might, paradoxically, improve outcomes but also create additional barriers in the form of an added travel burden.