DEMOGRAPHIC DISPARITIES IN PENILE CANCER IN APPALACHIA: A MULTI-INSTITUTIONAL, STATEWIDE REVIEW

• Published in: Urologic oncology Vol. 42; p. S66
• Main Authors: Zekan, David, Pettit, Andrea, Gish, Charles, Salisbury, Frances, Luchey, Adam, Hajiran, Ali, Novak, Mary, Deem, Samuel, Hale, Nathan, Haffar, Ahmad, Williams, Andrew
• Format: Journal Article
• Language: English
• Published: Elsevier Inc 01-03-2024
• ISSN: 1078-1439; 1873-2496
• DOI: 10.1016/j.urolonc.2024.01.190

Known disparities exist amongst HPV-related cancer outcomes in urban versus;rural populations, including squamous cell carcinoma (SCC) of the penis.; Appalachia as a whole, and West Virginia specifically, present a unique opportunity for analysis of penile cancer in underserved areas with few tertiary care centers and large distances and travel time;between centers.; The majority of patients in the state seek urologic oncology care at two tertiary centers.; This study seeks;to examine;differences in penile cancer presentation (including TNM stage,;grade, pertinent risk factors,;presenting symptoms and duration), treatment, and outcomes;between rural and urban populations in West Virginia.; Identification of disparities is crucial in detecting disease;to provide earlier intervention and improve outcomes in a traditionally underserved population.
Following approval from institutional review boards, 89;patients with biopsy-proven SCC of the penis treated at Charleston Area Medical Center (CAMC) and West Virginia University over a fourteen-year period (2007-2022) were studied via retrospective chart review.; Distance and travel time from the respective tertiary care centers were collected based on zip code, and patients were stratified into urban and rural groups according to county based on the US Census Burea defition of Census Places >10,000.; T-stage, clinical node positivity, grade, risk factors (circumcision, smoking), primary tumor size and location, and treatment modality (chemotherapy, radiation, local therapy vs. partial penectomy vs. radical penectomy) and timing (symptom duration and time from presentation to surgery);were analyzed.; Patients were also followed post-operatively to assess the endpoints of death from penile cancer and local/nodal/distant recurrence.; Appropriate statistical tests were performed using SPSS.
Patients;further from;tertiary care centers;(travel time) were more likely to undergo radical penectomy as primary therapy;(p=0.03), although advanced stage;(pT2 or greater) and clinical nodal status at diagnosis;did not increase;with travel time.; Those living;in counties classified as “urban”;had higher BMI on average (p=0.004) and were more likely to present with a lesion on the penile shaft (p=0.06).; No significant;difference exists in stage or grade at diagnosis, other risk factors;(smoking status, circumcision), primary tumor size,;clinically palpable lymph nodes, radiation and chemotherapy use, symptom duration, or timing of therapy based on distance or travel time or when stratified based on rural/urban county of residence.; Patients were followed for a mean 32.8 months post-operatively and 30% exhibited local/nodal recurrence and 42% mortality.; Disease burden and stage appears greater in West Virginia when compared nationally.
Penile cancer patients in West Virginia fare poorly when compared to allcomers in the US in terms of both disease at presentation, recurrence, and mortality.; Patients further from tertiary care center (travel time) are more likely to undergo radical penectomy as definitive therapy. This did not occur due to higher risk disease based on pT stage statistically, although anecdotally there does appear to be more disease >pT1b in rural populations. When stratified based on census definitions, rural patients had lower BMI and presented less often with disease of the penile shaft, suggesting they may opt for a definitive radical penectomy due to difficulties with healthcare access.