Journal article
Impact of County Rurality and Urologist Density on the Practice of Inguinal Lymph Node Dissection and Mortality in Patients Diagnosed with Squamous Cell Carcinoma of the Penis
Annals of surgical oncology, Vol.25(1), pp.334-341
01/2018
DOI: 10.1245/s10434-017-6211-x
PMID: 29110272
Abstract
Inguinal lymphadenectomy (LND) is influential in reducing the mortality of squamous cell carcinoma of the penis (SCCP). We investigated the impact of urologic workforce density (UD) and rural residence (RR) on the practice of LND and mortality of SCCP (SCCP-RM).
UD was determined from the 2014 to 2015 Area Health Resource File data, while RR was determined using the 2003 rural-urban continuum codes. All cases of SCCP within the surveillance, epidemiology, and end results 18 registry with known county codes were used for analysis (n = 2863).
Overall, 48.69% of cases lived in a county with less than the mean UD, 8.38% lived in counties with no urologists, 14.60% lived in a rural county, and 19.2% (n = 550) had LND performed. UD and RR had no impact on the prevalence of LND, number of lymph nodes examined, or the mean number of lymph nodes positive for SCCP (all p > 0.05). Adjusted analysis indicated that older patients and patients with regional stage of cancer were at a greater risk for post-LND SCCP-RM (hazard ratio [HR] 1.68, 95% confidence interval [CI] 1.28-2.21, and HR 4.32, 95% CI 3.09-6.06, respectively). There was no difference in the HR of SCCP-RM dependent on race, marital status, education, RR, UD, or LND.
While demand on the urologist workforce has increased in rural demographics, no impact of limited access to urologists on the practice of LND in SCCP could be identified in this study. In addition, there was no significant difference in the risk of SCCP-specific mortality related to lower UD or RR.
Details
- Title: Subtitle
- Impact of County Rurality and Urologist Density on the Practice of Inguinal Lymph Node Dissection and Mortality in Patients Diagnosed with Squamous Cell Carcinoma of the Penis
- Creators
- Michael Romanelli - Division of Urology, Department of Surgery, Southern Illinois University School of Medicine, Springfield, IL, USATariq Issa - Vanderbilt University, Nashville, TN, USAWhitney Zahnd - Division of Urology, Department of Surgery, Southern Illinois University School of Medicine, Springfield, IL, USADanuta Dynda - Division of Urology, Department of Surgery, Southern Illinois University School of Medicine, Springfield, IL, USAShaheen Alanee - Urologic Oncology, Department of Urology, Henry Ford Health System, Detroit, MI, USA. salanee1@hfhs.org
- Resource Type
- Journal article
- Publication Details
- Annals of surgical oncology, Vol.25(1), pp.334-341
- DOI
- 10.1245/s10434-017-6211-x
- PMID
- 29110272
- ISSN
- 1068-9265
- eISSN
- 1534-4681
- Language
- English
- Date published
- 01/2018
- Academic Unit
- Health Management and Policy
- Record Identifier
- 9984214710502771
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