Discrepancies in staging, treatment, and delays to treatment may explain disparities in bladder cancer outcomes: An update from the National Cancer Data Base (2004–2013)

Adam B. Weiner, Mary Kate Keeter, Adarsh Manjunath, Joshua J. Meeks*

*Corresponding author for this work

Research output: Contribution to journalArticle

10 Citations (Scopus)

Abstract

Introduction: We sought to characterize national disparities in the diagnosis of advanced stage bladder cancer. Among patients with advanced disease, we explored disparities in overall survival, treatment, and time to treatment. Methods and materials: We queried the National Cancer Data Base for patients diagnosed with bladder urothelial carcinoma. We used multivariable logistic regression to assess the association between covariates and diagnosis of advanced disease (AJCC stage III–IV). We used Kaplan-Meier, log-rank, and Cox proportional analyses to evaluate disparities in overall survival for patients with advanced disease. Receipt of treatment and delays to treatment were compared between subgroups. Results: Among our cohort of 328,560 patients, 7.6% were diagnosed with advanced disease. Female sex, black race, Hispanic ethnicity, and living in a region of lower income and education were all associated with increased odds of advanced disease. Female sex (HR = 1.16; 95% CI: 1.12–1.20; P<0.001), black race (HR = 1.10; 95% CI: 1.04–1.18; P = 0.002), and lower regional income levels (fourth quartile compared to first: HR = 1.08; 95% CI: 1.02–1.16; P = 0.016) portended worse overall survival. Chemotherapy (HR = 0.55, 95% CI: 0.53–0.57; P<0.001) and radical cystectomy (HR = 0.61; 95% CI: 0.59–0.64, P<0.001) improved survival. Females, black patients, and patients from regions of lower income and education were less likely to receive treatment and less likely to receive treatment within 12 weeks of diagnosis. Conclusion: There are several disparities in the diagnosis and treatment of advanced bladder cancer. Overall survival for certain groups may benefit from earlier diagnosis and improved timely access to potentially life prolonging treatment.

Original languageEnglish (US)
Pages (from-to)237.e9-237.e17
JournalUrologic Oncology: Seminars and Original Investigations
Volume36
Issue number5
DOIs
StatePublished - May 2018

Fingerprint

Urinary Bladder Neoplasms
Databases
Neoplasms
Survival
Therapeutics
Education
Cystectomy
Hispanic Americans
Early Diagnosis
Urinary Bladder
Logistic Models
Carcinoma
Drug Therapy

Keywords

  • Cystectomy
  • Epidemiology
  • Healthcare disparities
  • Survival
  • Therapeutics
  • United States
  • Urinary bladder neoplasms

ASJC Scopus subject areas

  • Oncology
  • Urology

Cite this

@article{acc1aee020724daf9b0fa3dfce29aa45,
title = "Discrepancies in staging, treatment, and delays to treatment may explain disparities in bladder cancer outcomes: An update from the National Cancer Data Base (2004–2013)",
abstract = "Introduction: We sought to characterize national disparities in the diagnosis of advanced stage bladder cancer. Among patients with advanced disease, we explored disparities in overall survival, treatment, and time to treatment. Methods and materials: We queried the National Cancer Data Base for patients diagnosed with bladder urothelial carcinoma. We used multivariable logistic regression to assess the association between covariates and diagnosis of advanced disease (AJCC stage III–IV). We used Kaplan-Meier, log-rank, and Cox proportional analyses to evaluate disparities in overall survival for patients with advanced disease. Receipt of treatment and delays to treatment were compared between subgroups. Results: Among our cohort of 328,560 patients, 7.6{\%} were diagnosed with advanced disease. Female sex, black race, Hispanic ethnicity, and living in a region of lower income and education were all associated with increased odds of advanced disease. Female sex (HR = 1.16; 95{\%} CI: 1.12–1.20; P<0.001), black race (HR = 1.10; 95{\%} CI: 1.04–1.18; P = 0.002), and lower regional income levels (fourth quartile compared to first: HR = 1.08; 95{\%} CI: 1.02–1.16; P = 0.016) portended worse overall survival. Chemotherapy (HR = 0.55, 95{\%} CI: 0.53–0.57; P<0.001) and radical cystectomy (HR = 0.61; 95{\%} CI: 0.59–0.64, P<0.001) improved survival. Females, black patients, and patients from regions of lower income and education were less likely to receive treatment and less likely to receive treatment within 12 weeks of diagnosis. Conclusion: There are several disparities in the diagnosis and treatment of advanced bladder cancer. Overall survival for certain groups may benefit from earlier diagnosis and improved timely access to potentially life prolonging treatment.",
keywords = "Cystectomy, Epidemiology, Healthcare disparities, Survival, Therapeutics, United States, Urinary bladder neoplasms",
author = "Weiner, {Adam B.} and Keeter, {Mary Kate} and Adarsh Manjunath and Meeks, {Joshua J.}",
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volume = "36",
pages = "237.e9--237.e17",
journal = "Urologic Oncology",
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TY - JOUR

T1 - Discrepancies in staging, treatment, and delays to treatment may explain disparities in bladder cancer outcomes

T2 - An update from the National Cancer Data Base (2004–2013)

AU - Weiner, Adam B.

AU - Keeter, Mary Kate

AU - Manjunath, Adarsh

AU - Meeks, Joshua J.

PY - 2018/5

Y1 - 2018/5

N2 - Introduction: We sought to characterize national disparities in the diagnosis of advanced stage bladder cancer. Among patients with advanced disease, we explored disparities in overall survival, treatment, and time to treatment. Methods and materials: We queried the National Cancer Data Base for patients diagnosed with bladder urothelial carcinoma. We used multivariable logistic regression to assess the association between covariates and diagnosis of advanced disease (AJCC stage III–IV). We used Kaplan-Meier, log-rank, and Cox proportional analyses to evaluate disparities in overall survival for patients with advanced disease. Receipt of treatment and delays to treatment were compared between subgroups. Results: Among our cohort of 328,560 patients, 7.6% were diagnosed with advanced disease. Female sex, black race, Hispanic ethnicity, and living in a region of lower income and education were all associated with increased odds of advanced disease. Female sex (HR = 1.16; 95% CI: 1.12–1.20; P<0.001), black race (HR = 1.10; 95% CI: 1.04–1.18; P = 0.002), and lower regional income levels (fourth quartile compared to first: HR = 1.08; 95% CI: 1.02–1.16; P = 0.016) portended worse overall survival. Chemotherapy (HR = 0.55, 95% CI: 0.53–0.57; P<0.001) and radical cystectomy (HR = 0.61; 95% CI: 0.59–0.64, P<0.001) improved survival. Females, black patients, and patients from regions of lower income and education were less likely to receive treatment and less likely to receive treatment within 12 weeks of diagnosis. Conclusion: There are several disparities in the diagnosis and treatment of advanced bladder cancer. Overall survival for certain groups may benefit from earlier diagnosis and improved timely access to potentially life prolonging treatment.

AB - Introduction: We sought to characterize national disparities in the diagnosis of advanced stage bladder cancer. Among patients with advanced disease, we explored disparities in overall survival, treatment, and time to treatment. Methods and materials: We queried the National Cancer Data Base for patients diagnosed with bladder urothelial carcinoma. We used multivariable logistic regression to assess the association between covariates and diagnosis of advanced disease (AJCC stage III–IV). We used Kaplan-Meier, log-rank, and Cox proportional analyses to evaluate disparities in overall survival for patients with advanced disease. Receipt of treatment and delays to treatment were compared between subgroups. Results: Among our cohort of 328,560 patients, 7.6% were diagnosed with advanced disease. Female sex, black race, Hispanic ethnicity, and living in a region of lower income and education were all associated with increased odds of advanced disease. Female sex (HR = 1.16; 95% CI: 1.12–1.20; P<0.001), black race (HR = 1.10; 95% CI: 1.04–1.18; P = 0.002), and lower regional income levels (fourth quartile compared to first: HR = 1.08; 95% CI: 1.02–1.16; P = 0.016) portended worse overall survival. Chemotherapy (HR = 0.55, 95% CI: 0.53–0.57; P<0.001) and radical cystectomy (HR = 0.61; 95% CI: 0.59–0.64, P<0.001) improved survival. Females, black patients, and patients from regions of lower income and education were less likely to receive treatment and less likely to receive treatment within 12 weeks of diagnosis. Conclusion: There are several disparities in the diagnosis and treatment of advanced bladder cancer. Overall survival for certain groups may benefit from earlier diagnosis and improved timely access to potentially life prolonging treatment.

KW - Cystectomy

KW - Epidemiology

KW - Healthcare disparities

KW - Survival

KW - Therapeutics

KW - United States

KW - Urinary bladder neoplasms

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