Treatment patterns in patients with recurrent high-risk bladder cancer.

Abstract

303 Background: Patients with high-risk bladder cancer are apt to develop multiple recurrences. Since the association of recurrences with aggressive treatment in individuals with recurrent high-grade disease has not been quantified, we sought to determine whether increasing number of recurrences correlates with higher treatment rates. Methods: Using linked SEER-Medicare data, we identified subjects with recurrent high-grade, non-muscle-invasive disease diagnosed in 1992–2002 and followed until 2007. Using propensity score and competing-risks regression analyses, we quantified the incidence of radical cystectomy, radiotherapy, and systemic chemotherapy after each recurrence. We further restricted our analyses of treatment in auspicious environments, defined as those patients most suited for aggressive intervention: age <70, Charlson 0, and undifferentiated T1 tumors treated at academic cancer centers. Results: Of 4,521 subjects, (59.6%) 2,694 recurred more than once within two years of diagnosis. Compared with patients who only had one recurrence, those with ≥4 recurrences were less likely to undergo radical cystectomy (9.7% vs 12.1%, p value=0.03), but more likely to undergo radiotherapy (18.0% vs 12.1%, p value<0.01) and systemic chemotherapy (6.7% vs 4.2%, p value<0.01). For patients with ≥4 recurrences, only 25% were treated with curative intent, while 43% were similarly treated in auspicious environments. Conclusions: Only 25% of patients with high-risk bladder cancer who recur ≥4 times undergo treatment for curative intent. Increasing recurrences do not appear to alter the treatment course, as patients and their doctors may be unable or unwilling to proceed with aggressive treatment despite mounting risk of disease progression. [Table: see text]