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01-01-2018 | Urologic Oncology

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

Authors: Michael Romanelli, MA, Tariq Issa, MA, Whitney Zahnd, MS, Danuta Dynda, MD, Shaheen Alanee, MD, MPH, MBA, AFACS

Published in: Annals of Surgical Oncology | Issue 1/2018

Abstract

Background

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).

Materials and Methods

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).

Results

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.

Conclusion

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.

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Title: 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
Authors: Michael Romanelli, MA
Tariq Issa, MA
Whitney Zahnd, MS
Danuta Dynda, MD
Shaheen Alanee, MD, MPH, MBA, AFACS
Publication date: 01-01-2018
Publisher: Springer International Publishing
Published in: Annals of Surgical Oncology / Issue 1/2018
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI: https://doi.org/10.1245/s10434-017-6211-x

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

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

Abstract

Background

Materials and Methods

Results

Conclusion

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Background

Materials and Methods

Results

Conclusion

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