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Predictive Factors of Diagnostic Delay and Effect on Treatment Patterns in Testicular Germ Cell Tumor Patients - Beyond the Abstract

Testis germ cell tumor (GCT) is the most common cancer in young men between 15 and 35 years of age. With early diagnosis, the survival rate nears 100%.1  However, a portion of the population presents to a physician long after the development of a testicular mass, which can worsen disease. In our study, we sought to assess what sociodemographic factors affect the time from symptom onset to diagnosis (termed diagnostic delay); we also assessed how diagnostic delay (DD) impacts clinical stage (CS) at diagnosis and subsequent adjuvant treatment. Our institution is unique in that we are a high-volume testis cancer center that consists of a safety net county hospital and a tertiary care academic center. As a result, we were able to capture sociodemographic data from a diverse patient population between 2006 and 2018.

We looked at variables such as age, race/ethnicity, primary language, employment status, marital status, insurance, presentation to the emergency department vs. clinic, zipcode median income, and year of presentation for 201 patients. We were also interested in studying whether the Patient Protection and Affordable Care Act (PPACA) impacted DD.

While the median DD was 38 days, the DD data had a right-skewed distribution. The only factor associated with increased DD on multivariable analysis was presentation before 2014. Because the PPACA went into effect that year, we postulate that patients may have had decreased DD after 2014 due to the health insurance mandate.

As for the impact of diagnostic delay on the clinical stage of disease, we found that the presence of metastatic disease (CS II-III) was associated with increased DD (76 days vs. 31 days; p < 0.001). Patients with DD >38 days were more likely to have CS III disease compared to those with DD <38 days (p < 0.001). CS I seminoma patients had a greater DD than CS I non-seminoma patients (p = 0.006), which is likely due to the slower growth of seminomas leading to increased DD. A higher portion of patients with increased DD received adjuvant treatment. When comparing patients with DD <38 days with those with DD >38 days, we found that those in the higher DD group had a 1.33x increased receipt of adjuvant therapy (p = 0.001).

In summary, early diagnosis of testicular cancer can prevent the progression of disease. Increased DD leads to advanced stage at presentation and use of adjuvant treatment. Over the last few years, DD of testicular cancer has decreased. The implementation of the PPACA may have played a role in this trend.

Written by: 

  • Rohit R Badia, BS, Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX
  • Aditya Bagrodia, MD, FACS, Associate Professor, Department of Urology, Disease Team Co-Leader Genitourinary Oncology, UC San Diego Health, La Jolla, CA

References:

  1. Baird DC, Meyers GJ, Hu JS. Testicular Cancer: Diagnosis and Treatment. Am Fam Physician. Feb 15 2018;97(4):261-268.

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