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• W3130103116 abstract "Chertack et al's recent article1 outlines their approach to assuaging sociodemographic factors' negative influence on testicular cancer (TCa) health outcomes. By coordinating care between facilities within a health care system, they found that one's zip code does not have to dictate one's health status. This was encouraging to read because the disparities in TCa outcomes between sociodemographic groups are ever widening. The following is a summary of our thoughts on Chertack et al's piece as well as a critique of the generalizability of such an approach. TCa is a treatable and highly survivable disease. Furthermore, some of the biggest barriers to TCa treatment include knowledge and awareness of the issue, access to health care/insurance, and stigma. Minority males have poorer access to quality health care and are at higher risk of living in disadvantaged neighborhoods than their White/Caucasian counterparts.2 They are also at high risk to be uninsured/underinsured, to live in a health care desert, and/or to have lower knowledge/awareness of the disease. It is not surprising that Chertack et al1 indicate that the males coming to their safety net hospital (primarily minority males) are presenting with later stages of TCa. Chertack et al's study1 is of clinical importance because current data indicate that there has been a significant increase in TCa cases among minority males, particularly Latinos. As demographics continue to change over the next few decades, minority males will represent a larger share of TCa incidence. Therefore, providing effective treatment is paramount, particularly as TCa outcome disparities worsen. Although Chertack et al1 provide evidence that standardizing care across in-network facilities is effective in reducing disparate TCa outcomes, there is a glaring limitation (to which they readily admit): generalizability. Standardizing care within a network provides a uniformity in the quality of treatment that can equalize TCa outcomes. However, not all systems are created equal. We know that different options for treatment, the quality of those treatments, and even physician/staff expertise and skillsets differ between systems.3 We cannot, therefore, assume that all networks could execute this approach, particularly for a rare disease such as TCa. Tandstad et al4 poignantly state that “few institutions have substantial and sustained experience in expert management of GCTs [germ cell tumors],” and this produces an effect by which “most patients are diagnosed and treated in low-experience environments” (p 3525). All things considered, replicating Chertack et al's approach in most systems may prove impossible. In summary, although Chertack et al1 have showcased that zip code does not have to determine health outcomes, it becomes complicated when we discuss scaling up this method. An approach by Zengerling et al,5 however, outlines a German national program in which less experienced, low-volume facilities can consult with a second-opinion network. The purpose of this pipeline is to improve the implementation of research into practice. Similarly to the United States, Zengerling et al explain how the German health care system is also decentralized and treats only a very limited number of TCa cases per year. Furthermore, they were also in need of an integrated patient care network to bring best practices to all facilities, not just a few elite hospital systems. It appears that their approach is successful in the sense that they are getting better evidence into clinical practice. Could the United States use the German model as a guide to reform its approach to TCa treatment? Perhaps. We recommend the following: First, we believe in a regionalized, not national, approach in which systems specializing in TCa treatment and aftercare should function as regional nodes and serve a given geographic area as a second-opinion pipeline. The US system is too large to manage at the macroscale of the German system. Second, we advocate that all facilities treating TCa should demonstrate outcomes comparable to those of the contemporary International Germ Cell Cancer Collaborative Group, or they should either form multidisciplinary-group consultive agreements or transfer care for patients with TCa to those regional centers that do. What is most important is ensuring that the quality of care an individual receives is the most effective and comprehensive possible, regardless of zip code. We believe that this approach could help to bring that vision into fruition. Although logistics and resources would be factors in its implementation, this regional collaboration of combining TCa patient care with highly experienced teams may prove to be one possible answer to not just the TCa outcome disparity question but also what is best for all patients. No specific funding was disclosed. The authors made no disclosures." @default.
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• W3130103116 date "2021-02-17" @default.
• W3130103116 modified "2023-10-17" @default.
• W3130103116 title "So, now what?: Reflections on socioeconomic factors, testicular cancer, and health care accessibility" @default.
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• W3130103116 doi "https://doi.org/10.1002/cncr.33375" @default.
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