Proportion of elderly patients with advanced bladder cancer receiving cisplatin-based chemotherapy: A large Medicare database study.

Abstract

276 Background: The frequency of employment of cisplatin-based chemotherapy in elderly patients presenting with advanced (unresectable or metastatic) bladder cancer is unclear. We examined the use and pattern of chemotherapy in Medicare fee-for-service elderly patients with newly diagnosed advanced bladder cancer (ABC). Methods: SEER-Medicare linked data were used to identify incident ABC patients presenting with the following stages of bladder cancer: T4b, N0, M0; Any T, N1–N3, M0; Any T, Any N, M1) between 2004 and 2007, with claims data until 2009. Outpatient and inpatient Medicare claims data were queried for receipt and type of chemotherapy used. The descriptive analyses were performed to examine associations between receiving chemotherapy and patient demographics, and clinical characteristics. Results: A total of 1,031 Medicare FFS elderly patients with ABC met inclusion criteria. The median age was 74 years, 69.8% were men. 40.1% were T4bN0M0, 55.3% were any N1-3M0 and 4.6% were any T, any N, M1. Overall use of chemotherapy occurred in 51.6% of the study patients. Of these patients receiving chemotherapy, carboplatin accounted for 50.6% in the initial treatment, followed by cisplatin in 39.7% and other agents in 9.8%. 37.5% of patients received chemotherapy within 6 months, 14.1% after 6 months, and 48.4% had not receive any chemotherapy over the study period. There were no statistical differences according to gender, race, and age. There were variations in receiving chemotherapy by stage: T4bN0M0 (51%), any T, N1-3, M0 (52.3%) or any T, any N, MI (48.9%), p<0.05. Conclusions: Among elderly patients presenting with ABC in the SEER-Medicare linked database, only 51.6% received chemotherapy and of these only 39.7% received cisplatin. Drug development for this population should focus on chemotherapy-ineligible and cisplatin-ineligible patients. Further analysis will explore practice patterns in prescribing chemo regiments in the initial treatment of ABC and its impacts on patient outcomes.