MP19-03 IMPACT OF SOCIAL VULNERABILITY ON RECEIPT OF NEOADJUVANT CHEMOTHERAPY IN PATIENTS UNDERGOING RADICAL CYSTECTOMY FOR BLADDER CANCER

Abstract

You have accessJournal of UrologyCME1 Apr 2023MP19-03 IMPACT OF SOCIAL VULNERABILITY ON RECEIPT OF NEOADJUVANT CHEMOTHERAPY IN PATIENTS UNDERGOING RADICAL CYSTECTOMY FOR BLADDER CANCER Rishi Sekar, Avinash Maganty, Jeff Montgomery, and Lindsey Herrel Rishi SekarRishi Sekar More articles by this author , Avinash MagantyAvinash Maganty More articles by this author , Jeff MontgomeryJeff Montgomery More articles by this author , and Lindsey HerrelLindsey Herrel More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003244.03AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Neoadjuvant chemotherapy (NAC) prior to radical cystectomy (RC) is standard- of-care in patients with muscle-invasive bladder cancer (MIBC); however, utilization remains suboptimal. Social determinants of health (SDOH) may impact access to NAC leading to disparities in cancer outcomes. We evaluated the association between a comprehensive community-level measure of SDOH, the CDC Social Vulnerability Index (SVI), and receipt of NAC. METHODS: We queried our institutional database for patients with localized MIBC treated with RC between 2000 and 2022. Patients with contraindications to platinum-based NAC were excluded. SVI, assessed at the county level, was assigned to each patient using their zip code of residence. Patients were then grouped by quintiles of SVI (i.e., least vulnerable to most vulnerable). Demographics, clinicopathologic characteristics, and receipt of NAC were compared across SVI quintiles. Multivariable logistic regression analysis was performed to evaluate the association between SVI quintile and receipt of NAC. A sub-analysis was performed evaluating the association between subthemes of SVI (socioeconomic status, household composition/disability, race/ethnicity/language, and housing/transportation) and receipt of NAC. RESULTS: Of the total cohort (n=878), 51.4% received NAC, with increasing rates over the study period. A greater proportion of patients living in the highest SVI quintile counties were of minority status (9.1%), underwent open RC (82.4%), and did not receive NAC (57.1%, all p<0.05). On multivariable logistic regression analysis, highest SVI quintile was associated with significantly decreased odds of receiving NAC (OR 0.56, 0.35–0.90). Analysis of subthemes of SVI demonstrated this association was predominantly driven by socioeconomic status (OR 0.53, 0.33–0.84) and household composition and disability (OR 0.56, 0.31–1.00). CONCLUSIONS: Patients living in communities with the highest social vulnerability had significantly decreased odds of receiving NAC prior to RC, mostly driven by socioeconomic status and household composition/disability. Adverse community-level SDOH may contribute to disparities in complex oncologic care and should be addressed towards achieving equitable care. Source of Funding: NA © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e264 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Rishi Sekar More articles by this author Avinash Maganty More articles by this author Jeff Montgomery More articles by this author Lindsey Herrel More articles by this author Expand All Advertisement PDF downloadLoading ...