Disparity in education and disease stage in patients with testicular germ cell tumors.

person Michal Chovanec Department of Oncology, Faculty of Medicine, Comenius University and National Cancer Institute, Bratislava, Slovakia info_outline Michal Chovanec, Rateb Alzeer, Nikola Hapakova, Katarina Kalavska, Peter Lesko, Jana Obertova, Zuzana Orszaghova, Patrik Palacka, Katarina Rejlekova, Daniela Svetlovska, Zuzana Sycova-Mila, Lucia Vasilkova, Michal Mego

Authors person Michal Chovanec Department of Oncology, Faculty of Medicine, Comenius University and National Cancer Institute, Bratislava, Slovakia info_outline Michal Chovanec, Rateb Alzeer, Nikola Hapakova, Katarina Kalavska, Peter Lesko, Jana Obertova, Zuzana Orszaghova, Patrik Palacka, Katarina Rejlekova, Daniela Svetlovska, Zuzana Sycova-Mila, Lucia Vasilkova, Michal Mego Organizations Department of Oncology, Faculty of Medicine, Comenius University and National Cancer Institute, Bratislava, Slovakia, Comenius University, Bratislava, Slovakia, Klenová 1, Bratislava, Slovakia, Translation Research Unit, Comenius University and National Cancer Institute, Bratislava, Slovakia, National Cancer Institute, Bratislava, Slovakia, Comenius University and National Cancer Institute, Bratislava, Slovakia Abstract Disclosures Research Funding APVV Background: Disparities may result in delayed staging and worse outcomes in cancer patients. Testicular germ cell tumors (GCTs) have excellent prognosis. However, disparities in education may have detrimental effect on early diagnosis and treatment. This study evaluated differences in staging and disease burden based on education in GCT patients treated at National Cancer Institute in Slovakia. Methods: Our institutional database was searched for GCT patients treated at National Cancer Institute in Slovakia between 1984 and 2023. Educational status was categorized as: basic/high-school and university. Educational status was correlated with disease stage, IGCCCG risk group, non-metastatic vs metastatic disease and size of retroperitoneal lymph nodes. Methods of descriptive statistics Chi-squared test and logistic regression were used for statistical analysis. Results: This retrospective study included 232 patients treated for stage I or metastatic GCT. Of the patients, 7 (3%), 114 (49%) and 111 (48%) had basic, high-school and university education, respectively. 46 patients (20%) had stage I disease and 186 patients (80%) were treated for metastatic disease. Patients who had basic/high-school education were diagnosed with metastatic disease more commonly compared to patients with university degree (p = 0.01). The Odds ratio for higher risk in patients without university education was 4.6 (95% CI 1.4-15.1). IGCCCG risk group, nodal stage or presence of non-pulmonary visceral metastases did not correlate with educational status (all p>0.05). Conclusions: GCT patients with basic- and/or high-school education are diagnosed with metastatic disease more frequently than those with university education. Our study may suffer from referral bias. Raising awareness in schools is imperative for early diagnosis of GCTs.