You have accessJournal of UrologyBladder Cancer: Invasive (I)1 Apr 20131444 ACCESS TO CARE INFLUENCES ADHERENCE TO GUIDELINES FOR MANAGEMENT OF MUSCLE-INVASIVE BLADDER CANCER C.J. Stimson, Sanjay G. Patel, Harras B. Zaid, Sam S. Chang, Matthew J. Resnick, Samuel D. Kaffenberger, Michael S. Cookson, and Daniel A. Barocas C.J. StimsonC.J. Stimson Nashville, TN More articles by this author , Sanjay G. PatelSanjay G. Patel Nashville, TN More articles by this author , Harras B. ZaidHarras B. Zaid Nashville, TN More articles by this author , Sam S. ChangSam S. Chang Nashville, TN More articles by this author , Matthew J. ResnickMatthew J. Resnick Nashville, TN More articles by this author , Samuel D. KaffenbergerSamuel D. Kaffenberger Nashville, TN More articles by this author , Michael S. CooksonMichael S. Cookson Nashville, TN More articles by this author , and Daniel A. BarocasDaniel A. Barocas Nashville, TN More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2013.02.2798AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES National Comprehensive Cancer Network (NCCN) guidelines recommend radical cystectomy (RC) with pelvic lymph node dissection (PLND) as the standard of care for patients with muscle-invasive bladder cancer (MIBC). Using the National Cancer Database (NCDB), we sought to determine how health care access impacts adherence to this guideline. METHODS The NCDB captures approximately 70% of all cancer diagnoses from 1400 accredited hospitals in the US. We analyzed patients with stage cT2 or cT3/cN0/cM0 urothelial cell carcinoma, diagnosed from 1998-2010. We examined the relationship between clinical and socioeconomic variables and use of RC/PLND versus non-RC/PLND, which encompassed any other management (transurethral resection of bladder tumor [TURBT], radiation, chemotherapy, partial cystectomy, or combinations thereof) that did not include RC/PLND. We performed both univariate chi-squared and t-test analyses and multivariate logistic regression analysis to determine whether access-related factors influence use of RC/PLND. RESULTS 29115 patients met our inclusion criteria, 6413 (22.0%) had RC/PLND, while 667 (2.3%) had neoadjuvant chemotherapy with RC/PLND. On univariate analysis there were statistically significant associations between RC/PLND and age, race, year of diagnosis, insurance status, income, metro/urban/rural, distance from hospital, geographic location, Charlson Comorbidity Index, clinical stage, and tumor grade (p < 0.05 for each). These associations were preserved on multivariate analysis (Table). Stratifying by geographic region and altering the outcome to TURBT versus RC/PLND did not substantially change the results. An exploratory model with neoadjuvant chemotherapy plus RC/PLND as the outcome showed similar associations but with wide confidence intervals due to the small number of patients who received this combination. CONCLUSIONS A minority (22.0%) of patients with cT2 or cT3 BC were treated with RC/PLND. In addition to expected associations between clinical factors and treatment, factors influencing access to care, including race, income, insurance status, and distance from hospital, were associated with variation in adherence to treatment guidelines for MIBC. © 2013 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 189Issue 4SApril 2013Page: e591-e592 Advertisement Copyright & Permissions© 2013 by American Urological Association Education and Research, Inc.MetricsAuthor Information C.J. Stimson Nashville, TN More articles by this author Sanjay G. Patel Nashville, TN More articles by this author Harras B. Zaid Nashville, TN More articles by this author Sam S. Chang Nashville, TN More articles by this author Matthew J. Resnick Nashville, TN More articles by this author Samuel D. Kaffenberger Nashville, TN More articles by this author Michael S. Cookson Nashville, TN More articles by this author Daniel A. Barocas Nashville, TN More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...