MP2-01 TREATMENT PATTERNS IN PATIENTS WITH RECURRENT HIGH-RISK BLADDER CANCER

Abstract

You have accessJournal of UrologyGeneral & Epidemiological Trends & Socioeconomics: Evidence-based Medicine & Outcomes II1 Apr 2014MP2-01 TREATMENT PATTERNS IN PATIENTS WITH RECURRENT HIGH-RISK BLADDER CANCER Karim Chamie, Eric Ballon-Landa, Jeffrey C. Bassett, Timothy J. Daskivich, Julie Lai, Jan M. Hanley, Badrinath R. Konety, Mark S. Litwin, and Christopher S. Saigal Karim ChamieKarim Chamie More articles by this author , Eric Ballon-LandaEric Ballon-Landa More articles by this author , Jeffrey C. BassettJeffrey C. Bassett More articles by this author , Timothy J. DaskivichTimothy J. Daskivich More articles by this author , Julie LaiJulie Lai More articles by this author , Jan M. HanleyJan M. Hanley More articles by this author , Badrinath R. KonetyBadrinath R. Konety More articles by this author , Mark S. LitwinMark S. Litwin More articles by this author , and Christopher S. SaigalChristopher S. Saigal More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2014.02.159AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Patients with high-risk bladder cancer are apt to develop multiple recurrences. Since the association of recurrences with subsequent aggressive treatment in individuals with recurrent high-grade bladder cancer has not been quantified, we sought to determine whether increasing number of recurrences correlates with higher treatment rates. METHODS Using linked SEER-Medicare data, we identified subjects with recurrent high-grade, non-muscle-invasive disease diagnosed in 1992–2002 and followed until 2007. Using propensity score and competing-risks regression analyses, we quantified the incidence of radical cystectomy, radiotherapy, and systemic chemotherapy after each recurrence. We further restricted our analyses of treatment in auspicious environments, defined as those patients with characteristics most suited for aggressive intervention: age <70, Charlson 0, and undifferentiated T1 tumors treated at academic cancer centers. RESULTS Of 4521 subjects, (59.6%) 2694 had more than one recurrence within initial two years of diagnosis. Compared with patients who only had one recurrence, those with ≥4 recurrences were less likely to undergo radical cystectomy (9.7% vs 12.1%, p-value=0.03), more likely to undergo radiotherapy (18.0% vs 12.1%, p-value<0.01), and more likely to undergo systemic chemotherapy (6.7% vs 4.2%, p-value<0.01). For patients with ≥4 recurrences, only 25% were treated with curative intent, while 43% were similarly treated in auspicious environments. CONCLUSIONS Only 25% of patients high-risk bladder cancer who recur ≥4 times undergo treatment for curative intent. Increasing recurrences do not appear to alter the treatment course as patients and their doctors may be unable or unwilling to proceed with aggressive treatment despite mounting risk of disease progression. Table 1. Probability of treatment after each recurrence after adjusting for patient and tumor characteristics using multinomial inverse probability treatment weights. Radical Cystectomy Radiotherapy Systemic Chemotherapy Probability p-value Probability p-value Probability p-value 1 Recurrence 12.2% Referent 12.1% Referent 4.2% Referent 2 Recurrences 11.8% 0.78 14.7% 0.04 3.9% 0.71 3 Recurrences 12.3% 0.94 15.9% 0.02 4.3% 0.91 ≥ 4 Recurrences 9.7% 0.03 18.0% < 0.01 6.7% < 0.01 © 2014FiguresReferencesRelatedDetails Volume 191Issue 4SApril 2014Page: e24 Advertisement Copyright & Permissions© 2014MetricsAuthor Information Karim Chamie More articles by this author Eric Ballon-Landa More articles by this author Jeffrey C. Bassett More articles by this author Timothy J. Daskivich More articles by this author Julie Lai More articles by this author Jan M. Hanley More articles by this author Badrinath R. Konety More articles by this author Mark S. Litwin More articles by this author Christopher S. Saigal More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...