Poster, Podium & Video Sessions
Presentation Authors: Liam Macleod*, Shannon Cannon, Seattle, WA, Oliver Ko, Chicago, IL, Jonathan Wright, George Schade, Daniel Lin, John Gore, Atreya Dash, Seattle, WA
Introduction: Testis cancer is often curable, yet early presentation is a key determinant of survival and treatment morbidity. Testis cancer affects the young, who may have less consistent health care access. This may result in delay in diagnosis and impede timely mobilization of complex healthcare resources needed for cancer care. In this context, we analyze men with testis cancer in the National Cancer Database (NCDB).
Methods: The NCDB identified adult males with testicular germ cell tumors (2004-2013). Markers of care delays included: higher stage presentation (stage III+), large primary lesion (>6cm), delayed orchiectomy (>10 days post-diagnosis), and overall mortality. Key risk factors we hypothesized to be associated with care delays included race/ethnicity, socioeconomic factors and insurance status. Outcomes were assessed with multivariable hazards regression (survival) or logistic regression (others).
Results: Among 31,964 men, 17% had higher stage presentation, 29% had a large primary, and 9.9% had delayed orchiectomy and 4.8% died during follow up. All outcomes were significantly associated with multiple risk factors for care delays on multivariable analysis. Between 2004 and 2013, Medicaid coverage increased from 6.6% to 11.2%, and uninsured status increased from 10.4% to 13.1% (Pearson p for linear trend <0.001). The most consistent and greatest magnitude association with poor disease specific outcomes was insurance status (e.g. for mortality HR for Medicaid 1.9, 95% CI 1.6-2.3, and for uninsured HR 1.7, 95% CI 1.5-2.1, for large primary Medicaid OR 1.8, 95% CI 1.7-2.0, uninsured OR 2.1, 95% CI 2.0-2.3 [referent private payer]).
Conclusions: We find association between severity of disease and markers of poor access to care. Medicaid expansion is a strategy employed to increase coverage by the Affordable Care Act. As such, it will be important to monitor whether gains in coverage translate to improvements in cancer outcomes.
Source Of Funding: This work was supported by a data grant from the National Cancer Database, a collaboration between the Commission on Cancer, the American Cancer Society and the American College of Surgeons.
University of Washington
Dr. Macleod is a Chief Resident in Urology at Universty of Washington. He attended Stanford University School of Medicine and the Mailman School of Public Health where he obtained his MPH. He will begin a Society of Urologic Oncology certified fellowship in Urologic Oncology in 2017 at University of Pittsburgh Medical Center. His interests are in health services research, health disparities, health policy as well as retroperitoneal surgery (renal cell carcinoma, upper tract urothelial carcinom, testis cancer).