title: Penile cancer: an analysis of socioeconomic factors at a southeastern tertiary referral center.
abstract: BACKGROUND
  Penile cancer is rare, often presenting in later stages. We sought to determine if factors potentially related to access to care were associated with worse outcomes.
  
  
  METHODS
  We performed a retrospective review of all patients with the diagnosis of penile cancer over a 14 year period at the only tertiary referral center in the state. We collected data on multiple factors potentially associated with access to care.
  
  
  RESULTS
  Fifty-five patients with penile cancer were identified. The average age was 57 years. Of the 55 patients, 23 patients (42%) had private insurance carriers, 16 (29%) had Medicare/Medicaid, 13 (24%) had no insurance, one had VA benefits, and no data was available on two patients. Typically, 4% of patients seen at our institution are uninsured. Pathologic tumor stage distribution was Tis (n = 9), Ta (1), T1 (15), T2 (16), and T3 (4). Nodal disease was present in 11, four of whom (38%) were uninsured, and metastatic disease was present in three. Of the 55 patients, eight admitted to greater than two alcoholic drinks per day three, of whom 38% presented with advanced disease. School district graduation rate was also calculated and similar among all groups. Univariate and multivariate modeling revealed no factors associated with delay to care.
  
  
  CONCLUSIONS
  Patients presenting to a referral center in the southeastern United States with penile cancer more commonly lack health insurance. Additionally, patients who are heavy alcohol users or are uninsured present with advanced disease. These factors contribute to poorer prognosis in these patients.
authors.affiliation: Medical University of South Carolina, Charleston, USA.
authors.forename: Matthew
authors.initials: M
authors.lastname: McIntyre
authors.forename: Avi
authors.initials: A
authors.lastname: Weiss
authors.forename: Amy
authors.initials: A
authors.lastname: Wahlquist
authors.forename: Thomas
authors.initials: T
authors.lastname: Keane
authors.forename: Harry
authors.initials: H
authors.lastname: Clarke
authors.forename: Stephen
authors.initials: S
authors.lastname: Savage
mesh_terms: D000428:Alcohol Drinking; D057210:Delayed Diagnosis; D006297:Health Services Accessibility; D006801:Humans; D007348:Insurance, Health; D008297:Male; D008875:Middle Aged; D010412:Penile Neoplasms / Q000473:pathology*; D012189:Retrospective Studies; D012720:Severity of Illness Index; D012959:Socioeconomic Factors; D014481:United States