One in every 270 men will get testicular cancer, the most common malignancy for men between the ages of 20 and 40, according to Johns Hopkins . A cancer diagnosis is never something a person wants to receive. There are so many questions, and at the top of the list is “Will I get the best care?”
New research from the University of Texas Southwestern found that the type of facility at which you receive treatment, whether a tertiary care or safety net hospital, may not matter as much as the experience of the team that is treating you.
The difference between hospitals
Let’s start with some definitions. A tertiary care hospital provides healthcare from specialists, after referral from the providers of primary care and secondary care. Specialized cancer centers are an example of tertiary care.
A safety net hospital is one that is bound legally or according to its mission statement to provide care to all patients, regardless of their ability to pay. When treating cancer patients, they might not have the special facilities of a tertiary care center.
A team of doctors at University of Texas Southwestern found themselves in a natural experiment. The same multidisciplinary team of oncologists, urologists and pathologists worked at both UT Southwestern Medical Center, a tertiary care center, and at Parkland Memorial Hospital, a public and safety net hospital in Dallas.
“It’s pretty obvious when you walk in the door and just work at these places that they’re very different patient populations,” said Aditya Bagrodia, MD, in an interview with Medical Daily. Dr. Bagrodia is a urologist and part of the multidisciplinary team at the heart of the study.
The clinicians compared notes on patients with testicular cancer who were treated at the two centers, as well as their outcomes. “Not unexpectedly certain demographic factors, lack of insurance, lack of education, lack of health literacy, minority status are associated with worse clinical outcomes in many different areas,” Dr. Bagrodia explained. “The idea was, [if] we’re really doing the exact same thing for these very different patient populations, are we able to level the playing field by offering high volume expert care?”
About the patients and their outcomes
The study, published in the journal Cancer, looked at 201 men; 106 men from Parkland Memorial and 95 from UT Southwestern. The Parkland group was more likely to be Hispanic and less likely to be insured. They were also more likely to have advanced cancer and waited twice as long (about 65 days) before seeing a doctor. Dr. Bagrodia theorized that lack of insurance, worries about immigration status, inability to get time off work, or childcare issues could delay patients from seeking help. “All we can do in the short term is give them the best possible care when they come to see us and they walk in the door,” he explained.
Despite these differences, the patients generally received the same care. The Parkland group had less time between diagnosis and surgery, averaging a day. The UT Southwestern group waited an average of 4 days.
Four men in the Parkland group died, but all had advanced cancer when diagnosed, and for 3, the cancer that had spread to the brain. Around 400 men die each year from testicular cancer.
Differences in care
“Sometimes you have to do a surgery to remove lymph nodes that have metastatic cancer cells,” Dr. Bagrodia explained. “Those types of things are done regardless of whether you’re having your surgery at Parkland or UT Southwestern.” Where there may be differences is in lifestyle issues. Prosthetics, sperm banking, and reproductive assistance are used more often by UT Southwestern patients, but they are not medically mandatory and not always covered by insurance, so patients with limited means are unlikely to have access.
For patients, the findings are a good thing. You don’t necessarily need to be treated at the hospital with the most resources to get good care. What is more important is that you get care early and that you have a team of experts.