Low socioeconomic position is a risk factor for delay to treatment and mortality of testicular cancer patients in Hungary, a prospective study

Abstract

Background In Hungary, the mortality rate for testicular germ cell cancer (TGCC) is 0,9/100000 which is significantly higher than the EU average. We prospectively evaluated the effect of socioeconomic position on patient delay and therapy outcomes. Methods Questionnaires on subjective social status (MacArthur Subjective Status Scale), objective socioeconomic position (wealth, education, and housing data), and on patient’s delay were completed by newly diagnosed TGCC patients. Results Patients belonged to a relatively high socioeconomic class, a university degree was double the Hungarian average, Cancer-specific mortality in the highest social quartile was 1.56% while in the lowest social quartile 13.09% (p = 0.02). In terms of patient delay, 57.2% of deceased patients waited more than a year before seeking help, while this number for the surviving patients was 8.0% (p = 0.0000). Longer patient delay was associated with a more advanced stage in non-seminoma but not in seminoma, the correlation coefficient for non-seminoma was 0.321 (p < 0.001). For patient delay, the most important variables were the mother’s and patient’s education levels (r = − 0.21, p = 0.0003, and r = − 0.20, p = 0.0005), respectively. Since the patient delay was correlated with the social quartile and resulted in a more advanced stage in non-seminoma, the lower social quartile resulted in higher mortality in non-seminoma patients (p = 0.005) but not in seminoma patients (p = 0.36) where the patient delay was not associated with a more advanced stage. Conclusions Based on our result, we conclude that to improve survival, we should promote testicular cancer awareness, especially among the most deprived populations, and their health care providers.

Underlying reasons for post-mortem diagnosed lung cancer cases – A robust retrospective comparative study from Hungary (HULC study)

“…A recent study conducted in the U.S. showed that the perceived lifetime risk of pancreatic cancer was significantly higher among people with high school education compared to those with lower educational attainment, leading to a higher chance of cancer detection (17). A recent Hungarian study identified education level as one of the most relevant factors leading to delays in the recognition of testicular cancer-related symptoms and found better survival rates among patients with higher levels of education (18). In a robust Danish study, the risk of advanced-stage lung cancer was lower in people with higher education levels, but higher in people living alone.…”

Risk analysis of subsequent therapies after first-line chemotherapy in advanced testicular cancer patients

“…19 Their findings corresponded to another Hungarian group in which a parent’s education level was associated with patient delay. 20 However, while the lower social quartile was associated with higher mortality, it was not related to more advanced stages. There was no direct evidence regarding one’s socioeconomic association being a factor in our series.…”

Reasons behind the Delayed Diagnosis of Testicular Cancer: A Retrospective Analysis

“…A larger study, including male respondents with more variable sociodemographic backgrounds, would allow us to verify the findings presented herein and perhaps identify some additional factors contributing to the delayed diagnosis of testicular cancer. Second, we retrospectively analyzed available data included in the survey and hence were unable to consider some other well-known determinants of diagnostic delay in cancer patients, such as economic status [ 4 , 21 ]. Third, analyzing the outcomes, we relied on the respondents’ subjective declarations instead of verifying their cancer awareness and psychological disposition with validated instruments.…”

“…However, still little is known about the causes of diagnostic delay in men with testicular malignancies. Some authors pointed to poor socioeconomic status as an obstacle in seeking medical advice early [ 20 , 21 ], but this explanation is not necessarily applicable to men from developed countries having unrestricted access to healthcare resources.…”