Introduction: Penile squamous cell carcinoma, which accounts for 95% of all penile tumors, is an aggressive genitourinary malignancy with significant physical and psychological morbidity. Social determinants of health variables have been shown to be prognostic indicators for various genitourinary neoplasms. Therefore, investigating the association between penile squamous cell carcinoma survivorship based on insurance status holds considerable implication for reducing cancer burden and maximizing health equity in the varying social gradients.
Methods: Penile squamous cell carcinoma patients diagnosed between 2007 to 2015 were extracted from the Surveillance, Epidemiology, and End Results (SEER) national database to assess whether insurance status was associated with improved overall and penile cause-specific survival. Participants were categorized based on insurance status: non-Medicaid, Medicaid, and uninsured. Pearson’s chi-squared test assessed the distribution of observed frequencies between the social determinants, tumor characteristics, and surgical variables across the insurance types. Overall and penile cause-specific survival were estimated using a Kaplan-Meier survival analysis and a multivariate Cox hazards proportional model analysis.
Results: Kaplan-Meier curve log rank test showed that overall (p <.001) and penile cause-specific survival (p <.001) significantly different between insurance types. Multivariate Cox hazards proportional model showed that, compared to non-Medicaid insured patients, Medicaid patients had an increased risk for overall death (hazard ratio [HR]= HR 1.54; 95% CI, 1.12-2.07). For penile cause-specific mortality, Medicaid patients had an increased risk of death compared to non-Medicaid insured patients (HR 1.58; 95% CI, 1.11-2.25).
Conclusions: Medicaid does not mitigate the differences caused by social determinants of health for overall or penile cause-specific mortality. Lower Medicaid reimbursements and out-of-pocket costs lead to a narrow network of physicians, hospitals, and treatment modalities thus compromising care. Improving access to care and increasing awareness of social determinants of health can lead to better prognostic assessments by providers. Further research evaluating Medicaid playing a leadership role with public health agencies to ameliorate prognostic disparities and expanding access to care is needed.
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