Discrepancies in staging, treatment, and delays to treatment may explain disparities in bladder cancer outcomes: An update from the National Cancer Data Base (2004–2013)

Abstract

IntroductionWe sought to characterize national disparities in the diagnosis of advanced stage bladder cancer. Among patients with advanced disease, we explored disparities in overall survival, treatment, and time to treatment. Methods and materialsWe queried the National Cancer Data Base for patients diagnosed with bladder urothelial carcinoma. We used multivariable logistic regression to assess the association between covariates and diagnosis of advanced disease (AJCC stage III–IV). We used Kaplan-Meier, log-rank, and Cox proportional analyses to evaluate disparities in overall survival for patients with advanced disease. Receipt of treatment and delays to treatment were compared between subgroups. ResultsAmong our cohort of 328,560 patients, 7.6% were diagnosed with advanced disease. Female sex, black race, Hispanic ethnicity, and living in a region of lower income and education were all associated with increased odds of advanced disease. Female sex (HR = 1.16; 95% CI: 1.12–1.20; P<0.001), black race (HR = 1.10; 95% CI: 1.04–1.18; P = 0.002), and lower regional income levels (fourth quartile compared to first: HR = 1.08; 95% CI: 1.02–1.16; P = 0.016) portended worse overall survival. Chemotherapy (HR = 0.55, 95% CI: 0.53–0.57; P<0.001) and radical cystectomy (HR = 0.61; 95% CI: 0.59–0.64, P<0.001) improved survival. Females, black patients, and patients from regions of lower income and education were less likely to receive treatment and less likely to receive treatment within 12 weeks of diagnosis. ConclusionThere are several disparities in the diagnosis and treatment of advanced bladder cancer. Overall survival for certain groups may benefit from earlier diagnosis and improved timely access to potentially life prolonging treatment.