(UroToday.com) The 2024 Southeastern Section of the AUA (SESAUA) annual meeting featured a bladder cancer session and a presentation by Dr. Joon Kyung Kim discussing the role of access to quality care for muscle-invasive bladder cancer in the disparate outcomes among sociodemographically disadvantaged patients in Kentucky.
The reference standard of care for non-metastatic muscle-invasive bladder cancer is neoadjuvant chemotherapy followed by radical cystectomy or trimodal bladder-preservation therapy with maximal transurethral resection of bladder tumor followed by chemoradiation. However, half of muscle-invasive bladder cancer patients do not receive potentially curative therapy for their muscle-invasive disease. Socioeconomic disparities are an increasingly recognized factor in receipt of quality bladder cancer care. The state of Kentucky has the 15th highest age-adjusted incidence rate for bladder cancer but the 3rd highest death rate, which is disproportionately seen in the Appalachian region. Dr. Kim and colleagues thus sought to investigate how social, demographic, and clinical factors influence receipt of standard of care for muscle-invasive bladder cancer, and how substandard care influences survival outcomes within the state of Kentucky.
In this study, patients diagnosed with cT2-4 N0-2 M0 muscle-invasive bladder cancer from 2004-2020 were identified from the Kentucky Cancer Registry population-based database. Sociodemographic and clinical variables were examined as predictors of receiving standard of care management, defined as either neoadjuvant chemotherapy followed by radical cystectomy or trimodal bladder-preservation therapy. Kaplan-Meier, log-rank, and Cox regression analysis was performed for survival, and univariate and multivariable logistic regression analysis was performed for receipt of standard of care.
Among 1,846 patients included in the study, 28% received standard of care: neoadjuvant chemotherapy/radical cystectomy in 340 patients and trimodal bladder-preservation therapy in 177 patients. The most common substandard treated regimen was radical cystectomy alone (271 patients, 15%).
On multivariate analysis, age (p = 0.003) and insurance status (p < 0.001) were associated with receipt of sub-standard of care. Notably, income and Appalachian status were not independent predictors of receipt of standard of care, nor were they associated with delays to definitive treatment, type of urinary diversion, or receipt of adjuvant chemotherapy.
Factors associated with poor survival included:
- Sub-standard of care management (p < 0.001)
- Old age (p < 0.001)
- Low income (p = 0.046)
- Appalachian status (p = 0.02)
- Lack of insurance (p < 0.001)
- Advanced TNM stage (p < 0.001)
The Kaplan Meier survival analysis stratified by Appalachian status and median household income are as follows:
Dr. Kim concluded his presentation discussing the role of access to quality care for muscle-invasive bladder cancer in the disparate outcomes among socio-demographically disadvantaged patients in Kentucky with the following summary statements:
- In the state of Kentucky, less than a third of patients with muscle-invasive bladder cancer received standard of care management
- While sociodemographic factors such as Appalachian status and low income did not impact receipt of standard of care therapy, they were each independent predictors of poor survival
- These data suggest that disparate outcomes in these underserved patient populations are not primarily driven by receipt of quality or timely care and may reflect unmeasured confounders which need further investigation
Presented by: Joon Kyung Kim, MD, University of Kentucky, Lexington, KY
Written by: Zachary Klaassen, MD, MSc – Urologic Oncologist, Associate Professor of Urology, Georgia Cancer Center, Wellstar MCG Health, @zklaassen_md on Twitter during the 2024 Southeastern Section of the American Urological Association (SESAUA) Annual Meeting, Austin, TX, Wed, Mar 20 – Sat, Mar 23, 2024.