title: Insurance Status and Differences in Treatment and Survival of Testicular Cancer Patients.
abstract: OBJECTIVE
  To explore the relationship between insurance status and differences in treatment and survival of testicular cancer patients. The Surveillance, Epidemiology, and End Results (SEER) database was utilized for this study.
  
  
  METHODS
  Between 2007 and 2011, 5986 testicular cancer patients were included in the SEER database. Patients were classified into nonseminoma and seminoma groups. We compared mortality rates, metastasis (M+) at diagnosis, and rates of adjuvant treatments between the uninsured (UI) and insured (I) populations.
  
  
  RESULTS
  Overall, 2.64% of UI vs 1.36% of I died from testicular cancer (P = .025) and 16.73% of UI vs 10.52% of I had M+ at diagnosis (P <.0001). In the nonseminoma group, 4.19% of UI vs 2.79% of I died from testicular cancer (P = .326) and 25.92% of UI vs 18.46% of I had M+ at diagnosis (P = .0007). Also 17.28% of UI vs 20.88% of I had retroperitoneal lymph node dissection (RPLND; P = .1). In the seminoma group, 1.06% of UI vs 0.33% of I died from testicular cancer (P = .030) and 7.43% of UI vs 4.81% of I had M+ at diagnosis (P = .029). Also 34.75% of UI vs 48.4% of I received adjuvant radiation (P = .0083). The lack of health insurance predicted poor survival after adjusting for tumor stage, receiving adjuvant radiation or RPLND.
  
  
  CONCLUSIONS
  UI testicular cancer patients present with more advanced cancer stages and have higher mortality rates than I patients. UI seminoma patients received less adjuvant radiation. This may be related to lack of access to care or more advanced cancer stage at diagnosis.
authors.affiliation: Department of Urology, University of Arkansas for Medical Sciences, Little Rock, AR.
authors.forename: Mohamed H
authors.initials: MH
authors.lastname: Kamel
authors.affiliation: Department of Epidemiology, University of Arkansas for Medical Sciences, Little Rock, AR.
authors.forename: Mohammed
authors.initials: M
authors.lastname: Elfaramawi
authors.affiliation: Department of Epidemiology, University of Arkansas for Medical Sciences, Little Rock, AR.
authors.forename: Supriya
authors.initials: S
authors.lastname: Jadhav
authors.affiliation: Department of Urology, Aswan University, Aswan, Egypt.
authors.forename: Ahmed
authors.initials: A
authors.lastname: Saafan
authors.affiliation: Department of Urology, University of California, San Diego, San Diego, CA.
authors.forename: Omer A
authors.initials: OA
authors.lastname: Raheem
authors.affiliation: Department of Urology, Ain Shams University, Cairo, Egypt. Electronic address: rdavis@uams.edu.
authors.forename: Rodney
authors.initials: R
authors.lastname: Davis
mesh_terms: D000328:Adult; D003131:Combined Modality Therapy / Q000191:economics; D017281:Cost of Illness; D006801:Humans; D019458:Insurance Coverage; D008297:Male; D008484:Medicaid / Q000191:economics*; D008875:Middle Aged; D058991:Patient Protection and Affordable Care Act / Q000191:economics*; D012189:Retrospective Studies; D018426:SEER Program; D015996:Survival Rate / Q000639:trends; D013736:Testicular Neoplasms / Q000191:economics / Q000401:mortality / Q000628:therapy*; D014481:United States / Q000453:epidemiology; D055815:Young Adult