MP24-03 UNDERSTANDING THE PRODROME OF BLADDER CANCER AND MISSED OPPORTUNITIES FOR EARLIER DIAGNOSES

Abstract

You have accessJournal of UrologyBladder Cancer: Epidemiology & Evaluation I (MP24)1 Apr 2020MP24-03 UNDERSTANDING THE PRODROME OF BLADDER CANCER AND MISSED OPPORTUNITIES FOR EARLIER DIAGNOSES Justin Drobish*, Aaron Miller, Alan Arakkal, Philip Polgreen, Paul Gellhaus, and Bradley Erickson Justin Drobish*Justin Drobish* More articles by this author , Aaron MillerAaron Miller More articles by this author , Alan ArakkalAlan Arakkal More articles by this author , Philip PolgreenPhilip Polgreen More articles by this author , Paul GellhausPaul Gellhaus More articles by this author , and Bradley EricksonBradley Erickson More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000000857.03AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Bladder cancer carries high mortality and a delay in treatment after diagnosis has been shown to affect survival in patients with muscle invasive disease. Less is known about the incidence and impact of diagnostic delay itself. The purpose of this study is to investigate patterns of healthcare utilization in the two years leading up to the diagnosis of bladder cancer. During this period, we hypothesized to find an increase in healthcare utilization for diagnoses symptomatically similar to bladder cancer METHODS: We conducted a retrospective case study using the Truven Health Analytics Commercial Claims and Encounters Database from 2001-2017. First, we identified index visits where a diagnosis of bladder cancer first appears. Next, we identified encounters where symptomatically-similar diagnoses (SSD) were noted. We then performed a change-point analysis to identify the time window prior to the index bladder cancer diagnosis where diagnostic opportunities first appeared. Finally, we used a simulation model to estimate the likelihood that SSDs represented missed opportunities for an earlier bladder cancer diagnosis. RESULTS: The study cohort included 157,968 patients with bladder cancer (112,265 (71.1%) males; 45,703 (28.9%) females). Based on a rapid increase in the number of SSD visits plotted over time (Figure), we estimate that the mean time prior to bladder cancer diagnosis that diagnostic opportunities existed was 106 (102-111) days. Within this window, 374,861 visits (70.6% of patients) had at least 1 SSD, the most common being hematuria (66.6%), urinary tract infection (50.5%) and urinary symptoms (26.3%). Of these visits, we estimate that 191,762 visits (CI 187,358-197,016), among 69,015 patients (CI 68,328-69,758), represent a diagnostic delay, the median duration being 31.3 days. Approximately 27% experienced a delay of > 50 days and 9% > 70 days. On average, patients with diagnostic delay had 2.78 (CI 2.74-2.83) visits with SSDs prior to diagnosis of bladder cancer. CONCLUSIONS: In this insured population of patients, bladder cancer patients began to present with SSDs on average 106 days prior to formal diagnosis. Utilizing simulation models, we estimate that many of these patients had diagnostic delay. Future work will quantify the impact of these delays and ways to ameliorate. Source of Funding: none © 2020 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 203Issue Supplement 4April 2020Page: e347-e348 Advertisement Copyright & Permissions© 2020 by American Urological Association Education and Research, Inc.MetricsAuthor Information Justin Drobish* More articles by this author Aaron Miller More articles by this author Alan Arakkal More articles by this author Philip Polgreen More articles by this author Paul Gellhaus More articles by this author Bradley Erickson More articles by this author Expand All Advertisement PDF downloadLoading ...