Racial disparities and socioeconomic status in men diagnosed with testicular germ cell tumors

Abstract

BACKGROUND: Previous reports indicated that African-American men with testicular germ cell tumors (TGCTs) have more aggressive tumor characteristics and less favorable outcomes than other men. The authors of this report evaluated the effects of race and socioeconomic status (SES) on stage distribution, overall mortality (OM), and cancerspecific mortality (CSM) in men with TGCTs. METHODS: The Surveillance, Epidemiology, and End Results (SEER) database was used to identify 22,553 men who were diagnosed with TGCTs between 1988 and 2006. Kaplan-Meier and Cox regression analyses were generated to predict OM and CSM. Covariates of the analyses included race, SES, age, histologic subtype, disease stage, procedure type, SEER registry, and year of diagnosis. The interaction between race and SES also was examined. RESULTS: Overall, there were 516 African-American men, 21,090 Caucasian men, and 947 men of other races. African-Americans (14.9%) and individuals with low SES (10.7%) had a higher proportion of distant stage disease. CSM and OM rates were significantly higher for African-American patients and for patients who resided in low SES counties. Multivariate analyses revealed that African-American men and men with low SES were more likely to die of OM and CSM relative to Caucasian men (P < .001) and men with high SES (P < .001), respectively. The interaction between race and SES was not significant. CONCLUSIONS: African-American race and low SES appeared to predispose men to more advanced disease stages and to higher OM and CSM rates. These observations may warrant race-specific and/or SES-specific adjustments in the treatment of TGCT. Cancer 2011;117:4277-

Testicular cancer: A narrative review of the role of socioeconomic position from risk to survivorship

“…Given the younger ages of adolescents and men affected by TC, long-term physical and psychological outcomes must be addressed as well. As with other cancers, there is evidence that TC outcomes are worse in older persons [78] and minorities, especially African Americans [64]. Access to care and receipt of state of the art treatment should be given to ensure equitable outcomes.…”

“…"Low" and "High" SEP categories were created using median score as the cut point. In multivariate analysis, individuals living in areas with "Low" SEP scores (vs. "High" SEP) had significantly higher cancer-specific mortality and overall mortality HR = 1.41 (P = 0.002) and 1.28 (P < 0.001), respectively [64]. Davies et al also reported higher mortality for men with professional jobs [20].…”

“…Papers were further excluded for the following reasons: there was no SEP information reported in the paper (10), they were letters or commentaries (3), or they were older reviews (9). The reference lists of the remaining 41 papers were reviewed and 5 [60][61][62][63][64] additional papers were identified. We abstracted information on SEP, including occupation, education, income, and combinations of the 3.…”

“…Seven studies were reviewed on survival and SEP [18,37,38,49,[62][63][64]. There were 2 distinct time survival periods based upon the availability of effective chemotherapy treatment with cisplatin.…”

“…Davies analyzed a cohort of men diagnosed before the effective chemotherapy in 1975 and reported higher mortality in higher SEP populations [20]. Six studies examined SEP and survival in TC patients in the cisplatinera (after 1977) [18,37,49,[62][63][64]. Sun et al reviewed 22,553 TGCT cases in SEER databases from 1998-2006 and used a composite, area-based SEP score based upon median family income, percentage of individuals living below the poverty line, and percentage of individuals without a high school diploma.…”