Do Learning Disabilities Affect Testicular Cancer Survival: A National Cohort Study Between 2001 and 2015

Abstract Background Some 1.5 million people in the UK have a learning disability (LD). This vulnerable group derives less benefit from population-based education programs. They are prone to underenrolment in screening programs and may lack the ability to perform self-examination. Objective To identify patients with LD in England and assess their testicular cancer (TC) survival in comparison to the general population. Design, setting, and participants Patient records were identified from the Hospital Episode Statistics database. All patients resident in England with a diagnosis of mental debility, "developmental disorder of scholastic skills", or attending under the specialty of LD between April 1, 2001 and June 30, 2015 were included. Outcome measurements and statistical analysis We measured survival outcomes according to the Kaplan-Meier method and used log-rank tests to assess survival difference between demographic groups. Results and limitations Of 158138 male patients with LD, 331 had TC and 32 died of cancer. LD patients had a poorer prognosis, with 10-yr TC-specific survival of 88.4% (95% confidence interval [CI] 84.5–92.4%) in the LD group versus 96.8% (95% CI 96.6–97.1%) in the non-LD group. LD patients also had lower all-cause survival rates. The 10-yr survival rate was 77.6% (95% CI 72.2–83.3%) for LD patients versus 89.9% (95% CI 89.4–90.3%) for non-LD patients, while the corresponding 5-yr rates were 84% (95% CI 79.9–88.4%) versus 92.2% (95% CI 91.8–92.5%). Conclusions Education regarding self-examination for TC must be provided in a format suitable for those with LD. Carers for male patients with LD should be informed about testicular examination and sinister signs. Patient summary Testicular cancer patients who also have a learning disability (LD) have a one in nine chance of dying, compared to a one in 36 chance for testicular cancer patients without LD. This is because patients with LD are less likely to detect the disease at an earlier stage.