Low Socioeconomic Status is a Risk Factor for Delay to Treatment and Mortality of Testicular Cancer Patients in Hungary. A Prospective Study

Abstract

Background. In Hungary, the mortality rate for testicular germ cell cancer (TGCC) is 7.6% which is significantly higher than the EU average. We prospectively evaluated the effect of socioeconomic status on patient delay, doctor’s delay, and therapy outcomes.Methods: Questionnaires on subjective (MacArthur Subjective Status Scale), objective (wealth, education, and housing data) social status, and on patient’s and doctors’ delays were completed by newly diagnosed TGCC patients.Results: Patients belonged to a relatively high socioeconomic class, a university degree was double the Hungarian average, Cancer-specific mortality in the highest social quartile was 1.56% while in the lowest social quartile 13.09% (p=0.02). In terms of patient delay, 57.2% of deceased patients waited more than a year before seeking help, while this number for the surviving patients was 8.0% (p=0.0000). Longer patient delay was associated with a more advanced stage in non-seminoma but not in seminoma, the correlation coefficient for non-seminoma was 0.321 (p<0.001). For patient delay, the most important variables were the mother’s and patient’s education levels (r=-0.21, p=0.0003, and r=-0.20, p=0.0005), respectively. Since the patient delay was correlated with the social quartile and resulted in a more advanced stage in non-seminoma, the lower social quartile resulted in higher mortality in non-seminoma patients (p=0.005) but not in seminoma patients (p=0.36) where the patient delay was not associated with a more advanced stage.Conclusions: Based on our result, we conclude that to improve survival, we should promote testicular cancer awareness, especially among the most deprived populations, and their health care providers.