PCN329 Utilising Public Health England Datasets to Establish a Standing Cohort of Patients with Metastatic Bladder Cancer: Initial Results and Algorithm Defining Disease Progression

Abstract

Bladder (i.e. urothelial) cancer is the tenth most common UK cancer with survival prospects that vary by disease stage. Late diagnosis and metastatic progression lead to significantly poorer prognosis. Disease pathways are rapidly evolving and real-world evidence on treatment of metastatic urothelial cancer (mUC) and respective health outcomes would enable better understanding of current NHS clinical management. This descriptive, non-interventional study established an open-ended and population-based standing cohort of patients with mUC using routine clinical datasets linked within Public Health England’s National Cancer Registration and Analysis Service (NCRAS). In total, 14,951 patients were diagnosed with UC between January 2016 and June 2017. Of these, 2,543 (17%) had metastases at diagnosis. Patients with metastasis had a mean age of 74 years (SD=11.1) and were predominantly male (64%) with a C67 diagnosis (76%) and a transitional cell morphology (73%). Hypertension (24%) and type-2 diabetes (9%) were the most common comorbidities. Within the first follow-up period, 19% of patients underwent a primary tumour site resection. Systemic therapy was received by 27% of patients with a median of 8 administrations (IQR=4.0-11.0) per patient, lasting a median 84 days (IQR=49.0-133.0). Median overall survival was 5.8 months (95%CI=5.4-6.3) with the most common cause of death being C679, ‘malignant neoplasm of bladder, unspecified’ (67%, n=1,355). Initial results provide insight into the management of patients with mUC who are already metastatic at diagnosis in England, and improve our understanding of both the disease pathway and the NCRAS datasets. Completeness of the mUC cohort will improve over time through refresh of linked and quality-assured data. Additionally, an algorithm for disease progression has been developed through collaboration between data analysts and clinical experts to enable the inclusion of patients diagnosed with UC who subsequently progress to mUC, as well as those with metastases at diagnosis.