Disparities in Pre-Orchiectomy Sperm Cryopreservation Among Testicular Cancer Patients at a Public Safety Net Hospital and a Private Tertiary Care Center



      To compare pre-orchiectomy sperm cryopreservation use in testicular cancer patients at a private tertiary care academic center and an affiliated public safety-net hospital.


      This was a retrospective cohort study of patients who underwent radical orchiectomy for testicular cancer at a private tertiary-care hospital, which cared primarily for patients with private health insurance, and at a public “safety-net” facility, which cared for patients regardless of insurance status. Clinical and demographic predictors of cryopreservation use prior to orchiectomy were determined by chart review.


      A total of 201 patients formed the study cohort, 106 (53%) at the safety-net hospital and 95 (47%) at the private hospital. Safety net patients were more likely to be non-White (82% vs 15%, P < 0.001), uninsured (80% vs 12%, P < 0.001), Spanish speaking (38% vs 5.6%, P < 0.001), and to reside in areas in the bottom quartile of income (41% vs 5.6%, P < 0.001). On multivariable analysis, treatment at the private tertiary care center was strongly associated with use of cryopreservation (OR 5.60, 95% CI 1.74 - 20.4, P = 0.005, though the effects of specific demographic factors could not be elucidated due to collinearity.


      Among patients with testicular cancer, disparities exist in use of sperm cryopreservation between the private and safety-net settings. Barriers to the use of cryopreservation in the safety-net population should be sought and addressed.
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        • Manecksha RP
        • Fitzpatrick JM
        Epidemiology of testicular cancer.
        BJU Int. 2009; 104: 1329-1333
        • Albers P
        • Albrecht W
        • Algaba F
        • et al.
        Guidelines on testicular cancer: 2015 update.
        Eur Urol. 2015; 68: 1054-1068
        • Djaladat H
        • Burner E
        • Parikh PM
        • Beroukhim Kay D
        • Hays K
        The association between testis cancer and semen abnormalities before orchiectomy: a systematic review.
        J Adolesc Young Adult Oncol. 2014; 3: 153-159
        • Hanson HA
        • Anderson RE
        • Aston KI
        • Carrell DT
        • Smith KR
        • Hotaling JM
        Subfertility increases risk of testicular cancer: evidence from population-based semen samples.
        Fertil Steril. 2016; 105: 322-328
        • Rives N
        • Perdrix A
        • Hennebicq S
        • et al.
        The semen quality of 1158 men with testicular cancer at the time of cryopreservation: results of the French National CECOS Network.
        J Androl. 2012; 33: 1394-1401
        • Crestani A
        • Esperto F
        • Rossanese M
        • Giannarini G
        • Nicolai N
        • Ficarra V
        Andrological complications following retroperitoneal lymph node dissection for testicular cancer.
        Minerva Urol e Nefrol. 2017; 69: 209-219
        • Howell S
        • Shalet S
        Gonadal damage from chemotherapy and radiotherapy.
        Endocrinol Metab Clin North Am. 1998; 27: 927-943
        • Dohle GR
        Male infertility in cancer patients: review of the literature.
        Int J Urol. 2010; 17: 327-331
        • Stoehr B
        • Schachtner L
        • Pichler R
        • et al.
        Influence of achieved paternity on quality of life in testicular cancer survivors.
        BJU Int. 2013; 111
        • Gilbert K
        • Nangia AK
        • Dupree JM
        • Smith JF
        • Mehta A
        Fertility preservation for men with testicular cancer: is sperm cryopreservation cost effective in the era of assisted reproductive technology?.
        Urol Oncol. 2018; 36: 921-929
        • Loren AW
        • Mangu PB
        • Beck LN
        • et al.
        Fertility preservation for patients with cancer: american society of clinical oncology clinical practice guideline update.
        J Clin Oncol. 2013; 31: 2500-2510
        • Stephenson A
        • Eggener SE
        • Bass EB
        • et al.
        Diagnosis and treatment of early stage testicular cancer: AUA Guideline.
        J Urol. 2019; 202: 272-281
        • Sonnenburg DW
        • Brames MJ
        • Case-Eads S
        • Einhorn LH
        Utilization of sperm banking and barriers to its use in testicular cancer patients.
        Support Care Cancer. 2015; 23: 2763-2768
        • Popescu I
        • Fingar KR
        • Cutler E
        • Guo J
        • Jiang HJ
        Comparison of 3 safety-net hospital definitions and association with hospital characteristics.
        JAMA Netw Open. 2019; 2: 1-13
        • Sun M
        • Abdollah F
        • Liberman D
        • et al.
        Racial disparities and socioeconomic status in men diagnosed with testicular germ cell tumors: a survival analysis.
        Cancer. 2011; 117: 4277-4285
        • Richardson LC
        • Neri AJ
        • Tai E
        • Glenn JD
        Testicular cancer: a narrative review of the role of socioeconomic position from risk to survivorship.
        Urol Oncol. 2012; 30: 95-101
        • Lerro CC
        • Robbins AS
        • Fedewa SA
        • Ward EM
        Disparities in stage at diagnosis among adults with testicular germ cell tumors in the national cancer data base.
        Urol Oncol. 2014; 32: 23.e15-23.e21
        • Gray PJ
        • Lin CC
        • Sineshaw H
        • Paly JJ
        • Jemal A
        • Efstathiou JA
        Management trends in stage i testicular seminoma: impact of race, insurance status, and treatment facility.
        Cancer. 2015; 121: 681-687
        • Markt SC
        • Lago-Hernandez CA
        • Miller RE
        • et al.
        Insurance status and disparities in disease presentation, treatment, and outcomes for men with germ cell tumors.
        Cancer. 2016; 122: 3127-3135
        • Macleod LC
        • Cannon SS
        • Ko O
        • et al.
        Disparities in access and regionalization of care in testicular cancer.
        Clin Genitourin Cancer. 2018; 16: e785-e793
        • Woldu SL
        • Aydin AM
        • Rao AV
        • et al.
        Differences at presentation and treatment of testicular cancer in Hispanic men: institutional and national hospital-based analyses.
        Urology. 2018; 112: 103-111
        • Chertack N
        • Ghandour RA
        • Singla N
        • et al.
        Overcoming sociodemographic factors in the care of patients with testicular cancer at a safety net hospital.
        Cancer. 2020; 126: 4362-4370
        • Quinn GP
        • Vadaparampil ST
        • Lee JH
        • et al.
        Physician referral for fertility preservation in oncology patients: a national study of practice behaviors.
        J Clin Oncol. 2009; 27: 5952-5957
        • Shnorhavorian M
        • Harlan LC
        • Smith AW
        • et al.
        Fertility preservation knowledge, counseling, and actions among adolescent and young adult patients with cancer: a population-based study.
        Cancer. 2015; 121: 3499-3506
        • Mehta A
        • Nangia AK
        • Dupree JM
        • Smith JF
        Limitations and barriers in access to care for male factor infertility.
        Fertil Steril. 2016; 105: 1128-1137
        • Simon CM
        • Zyzanski SJ
        • Durand E
        • Jimenez X
        • Kodish ED
        Interpreter accuracy and informed consent among spanish-speaking families with cancer.
        J Health Commun. 2006; 11: 509-522
        • Diamond LC
        • Tuot DS
        • Karliner LS
        The use of spanish language skills by physicians and nurses: policy implications for teaching and testing.
        J Gen Intern Med. 2012; 27: 117-123
        • Roter DL
        • Gregorich SE
        • Diamond L
        • et al.
        Loss of patient centeredness in interpreter-mediated primary care visits.
        Patient Educ Couns. 2020; 103: 2244-2251