MP10-03 THE INFLUENCE OF ACCESS TO CARE ON ADHERENCE TO CLINICAL PRACTICE GUIDELINES FOR TESTIS CANCER

Abstract

You have accessJournal of UrologyPenis/Testis: Benign & Malignant Disease II1 Apr 2014MP10-03 THE INFLUENCE OF ACCESS TO CARE ON ADHERENCE TO CLINICAL PRACTICE GUIDELINES FOR TESTIS CANCER C.J. Stimson, Zachary Reardon, Sanjay Patel, Harras Zaid, Samuel Kaffenberger, Daniel Barocas, Matthew Resnick, and Sam Chang C.J. StimsonC.J. Stimson More articles by this author , Zachary ReardonZachary Reardon More articles by this author , Sanjay PatelSanjay Patel More articles by this author , Harras ZaidHarras Zaid More articles by this author , Samuel KaffenbergerSamuel Kaffenberger More articles by this author , Daniel BarocasDaniel Barocas More articles by this author , Matthew ResnickMatthew Resnick More articles by this author , and Sam ChangSam Chang More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2014.02.459AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Measurement of pre-orchiectomy serum tumor markers (pSTM) in patients with suspected testis cancer (TC) and use of radiation therapy (RT) for clinical Stage IS (cIS) seminoma are recommended processes of care in the National Comprehensive Cancer Network (NCCN) guidelines. We assessed whether factors that influence patient access to care are associated with adherence to these guidelines. METHODS We analyzed all patients with orchiectomy-proven non-seminomatous (NSGCT) and seminomatous (SGCT) germ cell tumors diagnosed between 2004-2011 from the National Cancer Database registry. Separate logistic regression models were fit to determine whether access-related factors predicted pSTM measurement among all TC patients, and use of RT among patients with cIS SGCT. RESULTS 6462 patients met our inclusion criteria, of which 4851/6462 (75%) had pSTM drawn. The cIS SCGT cohort included 527 patients, of which 270/527 (51.2%) received primary RT. While controlling for other clinical and demographic factors, multivariate analysis showed a statistically significant increase in use of pSTM with younger age, treatment at a comprehensive or academic cancer facility, and lower income, while geographic location in the South or Midwest was negatively associated with use of pSTM (Table 1). With regards to utilization of RT for cIS SGCT, patients diagnosed between 2010 and 2011 were less likely to receive RT than those diagnosed prior to 2006 (p<0.05). CONCLUSIONS Evidence-based clinical guidelines recommend pSTM for patients with suspected TC and treatment with primary RT for cIS SGCT. Adherence to these guidelines is variable and is associated with non-clinical, access-related patient features including hospital type and geographic location. Multivariate Analysis: Predictors of Pre-Orchiectomy Tumor Marker Measurement Covariate Odds Ratio 95% Confidence Interval p-value Age 0.99 0.99-1.00 < 0.01 Race White Referent Black 0.88 0.63-1.21 0.43 Other 1.09 0.77-1.55 0.61 Insurance Status Insured Referent Uninsured 1.10 0.93-1.33 0.26 Income < $30,000 Referent $30,000-$34,999 0.80 0.63-1.02 0.08 $35,000-$45,999 0.74 0.58-0.95 0.02 > $45,999 0.72 0.56-0.94 0.02 % of County Residents without High School Degree < 14% Referent 14-19.9% 0.99 0.79-1.23 0.90 20-28.9% 1.09 0.86-1.37 0.48 > 29% 1.23 0.97-1.60 0.09 Geographic Location Northeast Referent South 0.82 0.69-0.99 0.04 Midwest 0.77 0.65-0.90 < 0.01 West 1.01 0.84-1.23 0.85 Distance from Hospital Same zip code Referent < 60 miles 1.21 0.89-1.65 0.22 60-120 miles 0.87 0.56-1.35 0.54 > 120 miles 0.77 0.49-1.21 0.26 Rurality Metro Referent Urban 1.12 0.93-1.36 0.23 Rural 1.53 0.91-2.70 0.11 Hospital Type Community Referent Comprehensive Community 1.34 1.11-1.62 < 0.01 Academic 2.25 1.83-2.77 < 0.01 Charlson Comorbidity Index 0 Referent 1 1.25 0.96-1.64 0.10 > 1 2.29 0.89-5.94 0.89 © 2014FiguresReferencesRelatedDetails Volume 191Issue 4SApril 2014Page: e115 Advertisement Copyright & Permissions© 2014MetricsAuthor Information C.J. Stimson More articles by this author Zachary Reardon More articles by this author Sanjay Patel More articles by this author Harras Zaid More articles by this author Samuel Kaffenberger More articles by this author Daniel Barocas More articles by this author Matthew Resnick More articles by this author Sam Chang More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...