PD02-05 SURVIVAL AMONG PATIENTS WITH UROLOGIC MALIGNANCIES TREATED AT SAFETY NET CANCER CENTERS

Abstract

You have accessJournal of UrologyGeneral & Epidemiological Trends & Socioeconomics: Quality Improvement & Patient Safety I1 Apr 2016PD02-05 SURVIVAL AMONG PATIENTS WITH UROLOGIC MALIGNANCIES TREATED AT SAFETY NET CANCER CENTERS Lindsey Herrel, Sandra Wong, and David Miller Lindsey HerrelLindsey Herrel More articles by this author , Sandra WongSandra Wong More articles by this author , and David MillerDavid Miller More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2016.02.2079AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Safety net facilities are a critical source of care for vulnerable populations with urologic malignancies. To better understand care and outcomes for underserved patients with urologic cancers, we compared readmissions and mortality following major urological cancer surgery for patients treated at safety net and non-safety net cancer centers. METHODS Using the National Cancer Database, we performed a retrospective cohort study of patients with urologic malignancies (i.e., bladder, prostate, kidney, penile, testis and ureteral) between 1998 and 2011. We defined the safety net burden for each cancer center based on the proportion of uninsured and Medicaid patients treated at each facility. We examined the distribution of urologic cancers at safety net (cancer centers in the highest quartile of safety net burden) versus non-safety net centers (lowest quartile). We used Kaplan-Meier curves to compare survival in safety net versus non-safety net centers. For each urologic malignancy, we fit multivariable regression models to examine the likelihood of readmission (30-day) and mortality (30-day, 90-day, 5-year) for patients treated with surgery at safety net versus non-safety net facilities, after adjusting for age, race, stage, education and comorbidities. RESULTS Among 2,090,581 patients diagnosed between 1998 and 2011, safety net centers saw higher proportions of kidney, testis and penile cancers (p<0.001). Kaplan-Meier analysis showed lower 5-year overall survival at safety net centers (Figure, log rank p<0.001). On multivariable analysis we found no differences in readmissions, 30-day or 90-day mortality for each of the six cancers examined. We observed significant differences in 5-year mortality on multivariable Cox regression, with higher rates of mortality at safety net cancer centers for prostate (1.16 HR, 95% CI 1.14-1.18), bladder (1.09 HR, 95% CI 1.07-1.11), kidney (1.11 HR, 95% CI 1.08-1.13), penile (1.14 HR, 95% CI 1.01-1.30) and testis cancers (1.49 HR, 95% CI 1.32-1.68). CONCLUSIONS Readmissions and early mortality are not impacted by cancer center safety net status for patients with urologic malignancies. However, treatment in safety net facilities is associated with lower five-year overall survival. Understanding drivers of long-term survival will be imperative to reducing this disparity. © 2016FiguresReferencesRelatedDetails Volume 195Issue 4SApril 2016Page: e52 Advertisement Copyright & Permissions© 2016MetricsAuthor Information Lindsey Herrel More articles by this author Sandra Wong More articles by this author David Miller More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...