Special to The Dallas Examiner
UT Southwestern physicians were able to eliminate the sociodemographic disparities in survival and cancer recurrence rates typically seen nationally in testicular cancer patients by offering the same level of care and expertise to two very different populations.
A new paper appearing in the journal Cancer reported that men treated for testicular cancer at Parkland Memorial Hospital, a public safety net hospital, and at UT Southwestern Medical Center, an academic tertiary care center, had the same outcomes.
“It was really encouraging to verify that these men are being treated based on their disease characteristics, not on who they are or what hospital they’re being treated at,” said study leader Aditya Bagrodia, M.D., an assistant professor of urology at UT Southwestern. “It doesn’t – and shouldn’t – matter if you’re Black, White or Hispanic, rich or poor, insured or uninsured.”
Sociodemographic factors that include race, income, health insurance status, immigration status and education have all been shown to play a role in the detection, treatment and survivorship of many types of cancer. Testicular cancer, which affects an estimated 9,000 men a year in the United States, is typically diagnosed when patients are in their 30s.
“These young men often get embarrassed about their symptoms, and then they delay coming in to be seen for other reasons – they can’t miss work, they don’t have insurance, they’re worried about being deported,” Bagrodia said.
As a member of UTSW’s Harold C. Simmons Comprehensive Cancer Center and a Dedman Family Scholar in Clinical Care, Bagrodia noticed that men from lower socioeconomic groups tend to be treated at smaller safety net hospitals, where doctors might not see many cases of testicular cancer or be as familiar with current treatment guidelines as physicians at large academic hospitals are.
Bagrodia and his colleagues who treat testicular cancer at UTSW also treat patients with testicular cancer at Parkland Memorial Hospital, the public hospital in Dallas County. During multidisciplinary team meetings, the group of doctors – including urologists, oncologists, radiologists, radiation oncologists and pathologists – review patient cases from both locations simultaneously. The same clinicians rotate between hospitals to provide in-person care and surgeries.
The new study followed 201 patients diagnosed with testicular cancer between 2006 and 2018; 106 were treated at Parkland and 95 at UTSW. On average, the Parkland patients were younger – 29 years old on average, rather than 33, as with UTSW. Moreover, Parkland patients were more likely to be minority – with 79% Hispanic – and less likely to be insured. The study showed that 20% of Parkland patients had insurance, while 88% of UTSW patients were insured. It also showed that Parkland patients were 76% were seen in the emergency department rather than by a primary care physician, as opposed to the 8% of UTSW patients that come in through the emergency room. By the time of diagnosis, Parkland patients generally waited an average of 65 days after experiencing symptoms before seeking care, more than twice as long as UTSW patients, who waited an average of 31 days.
Despite these differences, the study showed that the groups were treated similarly. Men at Parkland received an orchiectomy – surgical removal of the testicle that’s the first-line treatment for testicular cancer – within an average of one day after diagnosis. This average was four days for UTSW patients. To overcome some of the socioeconomic barriers at Parkland, the team rapidly mobilizes relevant physicians and social workers to make sure the comprehensive needs of the patients are met. And after the initial orchiectomy, patients at Parkland and UTSW were equally likely to receive other chemotherapy and surgery treatments, depending on the stage of their tumor.
“If you have metastatic testicular cancer that isn’t fully treated by chemotherapy, the standard of care is to perform a very complex surgery,” Bagrodia said. “A lot of smaller hospitals – whether community or safety net – don’t do that because they don’t have experience with the surgery. So, we were happy to show that our patients get that surgery at equal rates between hospitals.”
There was no statistical difference between the recurrence rate of cancer in patients initially diagnosed with early stage disease: 4.7% of patients at Parkland and 6.3% of patients at UTSW experienced recurrence. Four patients at Parkland – 4% – died during the time period, while none at UTSW died, but the difference was not statistically attributable to the hospital, instead linked to the stage of cancer when patients were diagnosed.
Some factors still differed between the patient groups. Rates of sperm banking and testicular prosthesis –both expensive options for men going through testicular cancer treatment – were lower at Parkland. Compliance rates among men – how likely they were to make follow-up appointments – also were lower in the Parkland group.
The new data underscore how much of a difference it can make to have experienced clinicians – who see a high volume of rare cases – working at safety net hospitals and with community hospitals that would typically have less experience with these conditions, according to Bagrodia. Many major academic medical centers already have affiliated safety net hospitals, he points out, but there are ways to expand this idea even further.
“Whether it’s for cancer, refractory diabetes or heart failure, I think having mechanisms to make sure you have the right expertise and committed clinicians makes a big difference to patients,” Bagrodia said.