Studies Evaluate Racial Variations, Cost, and Influence of Access to Care in the Management and Treatment of Testicular Cancer


Key Points

  • Testicular self-examination was determined to be cost-effective, with study results demonstrating a 3:1 cost/benefit ratio for early detected testicular cancer vs advanced-stage disease.
  • Unfavorable presentations and outcomes in testicular cancer were seen in non-Caucasian men. African American men are at particular risk of advanced-stage disease at presentation and death.
  • Adherence to testicular cancer clinical practice guidelines is variable and is associated with nonclinical, access-related features including hospital type and geographic location.

A series of studies evaluating the cost-effectiveness, risks, and outcomes associated with detecting, diagnosing, and treating testicular cancer were presented at a press conference during the 2014 Annual Scientific Meeting of the American Urological Association in Orlando, Florida.

Although testicular cancer is not common, it is the most prevalent cancer in young men between the ages of 20 and 35. The risk of developing testicular cancer is about 1 in 270, and the risk of mortality is very low, about 1 in 5,000.

Cost Analysis of Testicular Self-Examination

Based on repeated recommendations against testicular self-examinations by the U.S. Preventive Services Task Force, researchers from the University of Kansas set out to perform a testicular self-examination cost evaluation to highlight the significant medical morbidity or fiscal cost of treating missed advanced-stage cancer (Abstract MP10-11). Using Medicare reimbursements as an estimate for a national cost standard, the average cost of treatment for a missed advanced-state (seminomatous and nonseminomatous) testicular tumor was compared to the average cost of six scenarios (four malignant and two benign) involving the workup of a testicular mass felt during self-examination.

Results showed that the total treatment cost for an advanced-stage testicular seminoma is $48,877, whereas the total treatment cost for an advanced-stage testicular nonseminoma is $51,592. These costs are equal to 313 benign office visits ($156), 180 office visits with scrotal ultrasound ($272), 79 office visits with serial scrotal ultrasounds and labs ($621), 6 office visits resulting in radical inguinal orchiectomy for benign pathology ($7,686), and 3 office visits resulting in detection, treatment, and surveillance of an early-stage testicular cancer ($19,438 seminoma; $26,190 nonseminoma)

Researchers demonstrated a 3:1 cost/benefit ratio for early detected testicular cancer vs advanced-stage disease, thus concluding that testicular self-examination is a cost-effective consideration, which should be promoted and not discouraged.

Influence of Race on Outcomes in Testicular Cancer

African American males have an increased risk of being diagnosed with a higher-stage testicular cancer or dying of the disease than Caucasian patients, according to researchers from Virginia Mason Medical Center, Seattle; University of Southern California Norris Cancer Center, Los Angeles; Oregon Health and Sciences University, Portland; and British Columbia Cancer Agency, Vancouver (Abstract MP10-05).

Utilizing population-based data from the National Cancer Data Base (NCDB), researchers evaluated and aggregated racial/ethnic characteristics and social demographic features of nearly 76,000 men with testicular cancer. Overall survival was available on more than 48,500 patients.

Results showed that African American males had the lowest overall testicular cancer survival rates when compared to Asian, Caucasian, and Hispanic males. African American males were twice as likely to die from testicular cancer as Caucasian males with similar stage at presentation.

At presentation, stage III disease was seen in 15.5% of African American males vs 13.9% of Asian and 10.9% of Caucasian males; however Hispanic males presented with the highest rate of stage III testicular cancer at 17.2%.

Influence of Access to Care on Guideline Adherence

Physician use of the National Comprehensive Cancer Network (NCCN) Clinical Practice Guidelines for testicular cancer varies based on access-related patient features such as hospital type and geographic location, according to researchers at Vanderbilt University Medical Center, Nashville, and University of Chicago Medical Center, Chicago (MP10-03)

Measurement of preorchiectomy serum tumor markers in patients with suspected testicular cancer and use of radiation therapy for clinical stage IS seminoma are recommended processes of care in the NCCN Guidelines. However based on patient data gathered and analyzed from the National Cancer Data Registry, results showed that of the 6,462 patients with orchiectomy-proven testicular seminoma and nonseminoma, 75% had preorchiectomy serum tumor markers drawn. Use of radiation therapy for clinical stage IS seminoma occurred in slightly more than half of patients.

Physician-use of preorchiectomy serum tumor markers in comprehensive or academic cancer facilities and for lower-income patients or younger males showed a significant increase between 2004 and 2011, while geographic location in the South or Midwest was negatively associated with the use of preorchiectomy serum tumor markers. For patients diagnosed between 2010 and 2011, utilization of radiation therapy for clinical stage IS seminoma was less likely to occur than for those diagnosed prior to 2006.

“Most testicular cancers can be found at an early stage, and many physicians agree self-exams are fundamental to early diagnosis,” said Benjamin J. Davies, MD, of the University of Pittsburgh School of Medicine, who moderated the session. “Health-care access, inherent biologic differences, and cultural perceptions may be important factors in patient diagnosis, treatment, and survival variances; however, further research is needed to understand more about the causes of this disease. This improved understanding will lead to even more individualized and effective diagnosis and treatment options.”

The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.