Associations of education, residence, and travel distance to oncology center on survival outcomes in patients with penile cancer: A tertiary care referral center experience.

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4 Background: Rural residence, educational status & longer travel distance are variably associated with suboptimal cancer treatment and outcomes. There are limited data on impact of these factors on treatment patterns & survival outcomes in penile cancer. Methods: Patients with a histological diagnosis of carcinoma penis during 2015 to 2019 were identified from the database of a large tertiary care center in India. Chart reviews were performed to retrieve demographic, clinicopathological and treatment details. Educational status was categorized as no formal education and any educational attainment, while travel distance was dichotomized at 500 km. Logistic regression analyses were performed to examine the associations with cancer treatments. Relapse free survival (RS) and overall survival (OS) were calculated by plotting Kaplan Meir curves and compared using log rank test. Multivariable Cox regression analysis were used to determine the associations of socioeconomic status and residence on survival outcomes. Results: A total of 100 patients were eligible for the current analysis. The median age was 56 (interquartile [IQR]range, 42-65) years. The median duration of symptoms was 6 (IQR, 4-12) months. Ulcero-proliferative growth (65%) was the most common presenting symptom followed by pain (57%) and dysuria (36%). Most patients had grade 2 tumor (60%), while stage was equally distributed from I-IV. Three-fourths of patients had clinically enlarged inguinal lymph nodes, while, 42 % were pathologically involved. Of all patients, 58% were from rural communities, 44% patient didn’t receive any formal education, and 36% had travelling distance of over 500 km from the hospital. Surgery, radiotherapy, and chemotherapy were administered in 53%, 42% and 24%, respectively. On multivariable logistic regression analysis, lower education, rural residence and longer travel distance were not associated with a lower likelihood of receiving any treatment. At a median follow-up of 50.7 months, median RFS and OS were 59.8 (95% CI, 15.8-NR) and 83.9 (95% CI, 29.2–NR) months, respectively. After adjusting for tumor stage, involvement of lymph nodes, PS, and grade, education status, primary residence (urban vs rural), and distance from the treatment center were not associated with RFS and OS. However, advanced stage was the only factor predictive of worse RFS and OS (Table). Conclusions: Rural residence, educational status and travel time were not associated with treatment administration and survival outcomes in patients with penile cancer treated in a publicly funded tertiary care center in India. [Table: see text]