Association of diagnosing physician and hospital characteristics with the use of radical cystectomy among patients with muscle-invasive bladder cancer.

Abstract

6576 Background: Only one out of five muscle-invasive bladder cancer patients receive radical cystectomy, a guideline-recommended treatment. Prior studies evaluated patient characteristics associated with radical cystectomy use. We aimed to determine bladder cancer diagnosing physician and hospital characteristics associated with the use of radical cystectomy. Methods: This cohort study used linked SEER-Medicare Data from 2002 to 2011. We included older adults (age>65 years) diagnosed with muscle-invasive bladder cancer. For each patient, a urologist who performed transurethral resection of bladder tumor was assigned as a diagnosing physician. The diagnosing physician was assigned to one hospital based on where he/she performed more than half of all urologic surgeries. Two-level hierarchical model (patients nested within hospitals) were constructed to determine the association of patient, physician and hospital characteristics with radical cystectomy use. Results: A total of 7,097 patients were diagnosed by 4601 physicians who were affiliated with 822 hospitals. Overall, the radical cystectomy utilization rate was 26.5%. Only 4.8% of the variation in radical cystectomy was attributed to the hospital level. In the two-level hierarchical model, patients diagnosed by female physicians were more likely to undergo radical cystectomy (32.8% vs. 25.8%; OR=1.63, 95% CI=1.31-2.02). Higher radical cystectomy volume by diagnosing physicians and hospitals increased the radical cystectomy use (Table). Diagnosing physician characteristics (age, years in practice, employment status), and hospital characteristics (teaching states, location, type of hospital) were not associated with radical cystectomy use. Patient characteristics such as age, male, higher comorbidity burden were associated with lower likelihood of radical cystectomy use. Conclusions: Physician and hospital factors do not largely contribute to the receipt of radical cystectomy. Radical cystectomy volume by diagnosing physicians and hospital drives radical cystectomy use.[Table: see text]