Impact of insurance status on testicular cancer outcomes: A single-institution, dual-site study

Our aim was to examine a diverse patient population to identify any sociodemographic factors, specifically lack of health care coverage, that may worsen aggressiveness of disease on presentation and negatively impact outcomes in testicular germ cell tumors (TGCT).

Patients who were diagnosed and treated for TGCT at both a SNH (Safety-Net Hospital) and TCH (Tertiary Care Hospital) covered by the same institution and physicians were retrospectively reviewed to assess any disparities in outcomes. We evaluated whether insurance coverage affected the severity of disease on presentation based on International Germ Cell Collaborative Group (IGCCCG) prognostic classification.

Between January 2009 and December 2020, 144 patients were considered underinsured compared to 82 patients that were fully insured. Underinsured patients were more likely to be treated at SNH (85.4% vs. 7.3% P < 0.01), more likely to be Hispanic (73.6% vs. 17.1%, P < 0.01) and more likely to present with advanced disease (P = 0.01). IGCCG risk at presentation was worse for underinsured vs. insured including 19 patients (23.8%) vs. 3 patients (8.1%) with intermediate risk disease and 22 patients (27.5%) vs. 5 patients (13.5%) with poor risk disease (P < 0.01). Although recurrence after first line chemotherapy was similar between underinsured and insured (P = 0.38), the CSS outcomes were worse in those patients without insurance (P = 0.02). Patients with worse presentation of disease (IGCCCG risk group) also demonstrated worse CSS outcomes (P < 0.01).

Insurance status can be associated with a worse prognostic disease presentation of TGCT and may have implications on treatment options and survival. These findings underscore the necessity of community outreach and educational interventions targeting populations in SNHs to improve earlier access to care or increase availability of salvage options in rare cases to mitigate these disparities.