79 WOMEN ARE LESS LIKELY TO RECEIVE EVIDENCE-BASED PROCESSES OF CARE FOR SURGICAL TREATMENT OF BLADDER CANCER COMPARED TO MEN

Abstract

You have accessJournal of UrologyGeneral & Epidemiological Trends & Socioeconomics: Evidence-Based Medicine & Outcomes (II)1 Apr 201379 WOMEN ARE LESS LIKELY TO RECEIVE EVIDENCE-BASED PROCESSES OF CARE FOR SURGICAL TREATMENT OF BLADDER CANCER COMPARED TO MEN Christopher Anderson, Joann Alvarez, Tatsuki Koyoma, David Penson, and Daniel Barocas Christopher AndersonChristopher Anderson Nashville, TN More articles by this author , Joann AlvarezJoann Alvarez Nashville, TN More articles by this author , Tatsuki KoyomaTatsuki Koyoma Nashville, TN More articles by this author , David PensonDavid Penson Nashville, TN More articles by this author , and Daniel BarocasDaniel Barocas Nashville, TN More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2013.02.1457AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Although women are less likely to be diagnosed with bladder cancer, they experience a disproportionally high rate of cancer-specific mortality compared to men. Underuse of evidence-based processes of care in women may contribute to this difference in the mortality-to-incidence ratio. Thus, we sought to explore gender variation in the utilization of two important processes of care in patients with bladder cancer: radical cystectomy (RC) compared with partial cystectomy (PC), and pelvic lymphadenectomy (PLND) among those undergoing RC. METHODS We used data from three states within the Healthcare Cost and Utilization Project's State Inpatient Databases (NY, MD and FL). These are comprehensive administrative datasets that are comprised of patient and hospital characteristics from every non-Federal discharge within participating states. We identified all patients with bladder cancer who underwent either RC or PC from 1996-2009 by ICD-9 diagnosis and procedure codes (n=16,864). The effect of gender on use of RC, as compared to PC, and use of PLND among patients who underwent RC was analyzed using logistic regression models allowing for clustering of outcomes within hospital and controlling for age, race, comorbidity, state, year, payer and hospital and surgeon volume. RESULTS Of our cohort, 81% were men and 19% were women. The majority of patients were white, had ≤1 comorbidity and lived in a metropolitan area. Median patient age was 70 years old. As compared to men, a lower percentage of women received an RC (79.5% vs. 86.2%, p<0.001) and PLND (46% vs. 54.5%, p<0.001). Multivariable analyses showed women had 36% lower odds of undergoing RC (OR 0.64, 95% CI 0.57-0.73) and 25% lower odds of undergoing PLND (OR 0.75, 95% CI 0.68-0.83) as compared to men. When accounting for surgeon and hospital volume, women treated by surgeons and at hospitals in the highest volume decile still had a 31% lower odds of RC (OR 0.69, 95% CI 0.62-0.77) and 20% lower odds of PLND (OR 0.80, 95% CI 0.72-0.88). CONCLUSIONS Women were less likely to receive processes of care known to favorably impact survival outcomes, even when treated by high volume surgeons and at high volume hospitals. Gender variation in adherence to evidence-based processes of care may contribute to the inferior bladder cancer outcomes observed in women. Our findings suggest that an opportunity exists for improving quality of care for women with bladder cancer. © 2013 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 189Issue 4SApril 2013Page: e33 Advertisement Copyright & Permissions© 2013 by American Urological Association Education and Research, Inc.MetricsAuthor Information Christopher Anderson Nashville, TN More articles by this author Joann Alvarez Nashville, TN More articles by this author Tatsuki Koyoma Nashville, TN More articles by this author David Penson Nashville, TN More articles by this author Daniel Barocas Nashville, TN More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...