Background
Bladder cancer is the sixth most incident neoplasm in the United States. The 5-year survival rate is 77% versus 5% in metastatic disease. Uninsured patients with kidney cancer are more likely to present with advanced disease and less likely to receive treatment compared to privately insured patients. In the USA, homelessness increased by more than 12% in 2023. Homeless patients have elevated rates of cancer risk factors, delayed diagnoses, and increased rates of cancer death.
Case Discussion
A 51-year-old male with CAD, CABG, mitral/tricuspid valve replacement, and testicular cancer presented with chest pain and was found to have invasive urothelial carcinoma. Years prior, the patient had hematuria and a mass at the ureterovesical junction (UVJ). He was discharged to follow-up with urology. He had a ureteral biopsy with plans for nephro-ureterectomy. He could not afford the surgery as he lost his job, health insurance, and became homeless. Years later he presented with chest pain, hypertensive emergency, hematuria, and arm weakness. CT abdomen showed calcified mass at left UVJ, pelvic wall with extension into bladder and bilateral inguinal lymphadenopathy. The team advocated for inpatient nephro-ureterectomy. Pathology reported high grade invasive urothelial carcinoma. Charity medication and foley supplies were given, however the patient was lost to follow-up due to financial constraints.
Conclusion
Cancer is a leading cause of death among homeless individuals. This patient showed invasive high-grade carcinoma in his later admission. Considering his financial situation years ago may have changed his morbidity outcome. It is imperative that healthcare providers look at financial disparities as a comorbidity when treating patients. Although the medical team advocated for this patient’s treatment, there was failure to implement safety nets upon discharge. Healthcare professionals can impact vulnerable populations by increasing awareness of homelessness and healthcare resources, as well as advocating for better care.