MP22-18 A CONTEMPORARY ANALYSIS OF TREATMENT OF MUSCLE INVASIVE BLADDER CANCER USING THE NATIONAL CANCER DATABASE: FACTORS ASSOCIATED WITH RECEIPT OF NON-AGGRESSIVE THERAPY

Abstract

You have accessJournal of UrologyCME1 Apr 2023MP22-18 A CONTEMPORARY ANALYSIS OF TREATMENT OF MUSCLE INVASIVE BLADDER CANCER USING THE NATIONAL CANCER DATABASE: FACTORS ASSOCIATED WITH RECEIPT OF NON-AGGRESSIVE THERAPY Sol Moon, Vishruti Pandya, Andrew McDonald, Arnab Basu, Sejong Bae, and James Ferguson Sol MoonSol Moon More articles by this author , Vishruti PandyaVishruti Pandya More articles by this author , Andrew McDonaldAndrew McDonald More articles by this author , Arnab BasuArnab Basu More articles by this author , Sejong BaeSejong Bae More articles by this author , and James FergusonJames Ferguson More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003247.18AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Patients with muscle-invasive bladder cancer (MIBC) face a potentially lethal disease, yet often do not receive potentially curative therapies. This study aims to characterize the treatments received by patients with MIBC, analyze their use according to sociodemographic, clinical, pathologic, and facility measures, and to identify possibilities for improvement in care for patients with MIBC METHODS: Using the NCDB, we analyzed 102,119 patients with non-metastatic muscle invasive bladder cancer diagnosed between 2009-2018. Treatments included cystectomy, radiation, chemotherapy, or observation. Treatments which included cystectomy or radiotherapy >50 Gy were considered aggressive therapy (AT). A multivariable generalized estimating equation model was used to assess the relationship of the independent variables with receiving AT. Statistical analysis was conducted using SAS version 9.4. RESULTS: The median age was 73 years, with 72.9% male, 84.3% White, and 7.1% Black. Stage distribution included 59.4% stage II, 23.0% (III), and 17.6% (IV). Overall, 55.2% of patients received AT, while 41.1% did not, with 26.6% receiving observation alone. 45.4% of patients received cystectomy, 9.8% underwent definitive radiotherapy, and 12.8% underwent chemotherapy as primary treatment. Notably, over 30% of patients between ages of 50 and 70 did not receive aggressive therapy (Figure 1). On multivariate analysis, factors associated with lack of aggressive therapy included age >70 (OR <0.79, p<0.0001), Black race (OR 0.70, p<0.0001), Medicaid and underinsured status (OR 0.62, p<0.0001), Charlson score > 2 (OR 00.74, p<0.0001), and low volume (OR 0.72 p<0.0001), non-academic cancer program (OR 0.54, p<0.0001). Utilization of perioperative chemotherapy and chemoradiotherapy increased over time. CONCLUSIONS: Over a third of patients do not receive aggressive therapy for MIBC, with many of these patients seemingly eligible by age and comorbidity status. Prospective studies are needed to determine exactly why these patients do not receive aggressive therapy. A better understanding of patient vs access to care vs provider factors would help to focus efforts to improve care for patients with MIBC. Source of Funding: VA RDA award to JEF © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e304 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Sol Moon More articles by this author Vishruti Pandya More articles by this author Andrew McDonald More articles by this author Arnab Basu More articles by this author Sejong Bae More articles by this author James Ferguson More articles by this author Expand All Advertisement PDF downloadLoading ...