BACKGROUND: Despite its lethal potential, many patients with muscle-invasive bladder cancer (MIBC) do not receive aggressive, potentially curative therapy consistent with established practice standards. OBJECTIVE: To characterize the treatments received by patients with MIBC and analyze their use according to sociodemographic, clinical, pathologic, and facility measures. DESIGN, SETTING, AND PARTICIPANTS: Using the National Cancer Data Base, we analyzed 28 691 patients with MIBC (stages II-IV) treated between 2004 and 2008, excluding those with cT4b tumors or distant metastases. Treatments included radical or partial cystectomy with or without chemotherapy (CT), chemoradiotherapy (CRT), radiation therapy (RT), or CT alone and observation following biopsy. Aggressive therapy (AT) was defined as radical or partial cystectomy or definitive RT/CRT (total dose ≥ 50 Gy). OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: AT use and correlating variables were assessed by multivariable, generalized estimating equation models adjusted for facility clustering. RESULTS AND LIMITATIONS: According to the database, 52.5% of patients received AT; 44.9% were treated surgically, 7.6% received definitive CRT or RT, and 25.9% of patients received observation only. AT use decreased with advancing age (odds ratio [OR]: 0.34 for age 81-90 yr vs ≤ 50 yr; p<0.001). AT use was also lower in racial minorities (OR: 0.74 for black race; p<0.001), the uninsured (OR: 0.73; p<0.001), Medicaid-insured patients (OR: 0.81; p=0.01), and at low-volume centers (OR: 0.64 vs high-volume centers; p<0.001). Use of AT was higher with increasing tumor stage (OR: 2.23 for T3/T4a vs T2; p<0.001) and nonurothelial histology (OR: 1.25 and 1.43 for squamous and adenocarcinoma, respectively; p<0.001). Study limitations include retrospective design and lack of information about patient and provider motivations regarding therapy selection. CONCLUSIONS: AT for MIBC appears underused, especially in the elderly and in groups with poor socioeconomic status. These data point to a significant unmet need to inform policy makers, payers, and physicians regarding appropriate therapies for MIBC.
BACKGROUND: Despite its lethal potential, many patients with muscle-invasive bladder cancer (MIBC) do not receive aggressive, potentially curative therapy consistent with established practice standards. OBJECTIVE: To characterize the treatments received by patients with MIBC and analyze their use according to sociodemographic, clinical, pathologic, and facility measures. DESIGN, SETTING, AND PARTICIPANTS: Using the National Cancer Data Base, we analyzed 28 691 patients with MIBC (stages II-IV) treated between 2004 and 2008, excluding those with cT4b tumors or distant metastases. Treatments included radical or partial cystectomy with or without chemotherapy (CT), chemoradiotherapy (CRT), radiation therapy (RT), or CT alone and observation following biopsy. Aggressive therapy (AT) was defined as radical or partial cystectomy or definitive RT/CRT (total dose ≥ 50 Gy). OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: AT use and correlating variables were assessed by multivariable, generalized estimating equation models adjusted for facility clustering. RESULTS AND LIMITATIONS: According to the database, 52.5% of patients received AT; 44.9% were treated surgically, 7.6% received definitive CRT or RT, and 25.9% of patients received observation only. AT use decreased with advancing age (odds ratio [OR]: 0.34 for age 81-90 yr vs ≤ 50 yr; p<0.001). AT use was also lower in racial minorities (OR: 0.74 for black race; p<0.001), the uninsured (OR: 0.73; p<0.001), Medicaid-insured patients (OR: 0.81; p=0.01), and at low-volume centers (OR: 0.64 vs high-volume centers; p<0.001). Use of AT was higher with increasing tumor stage (OR: 2.23 for T3/T4a vs T2; p<0.001) and nonurothelial histology (OR: 1.25 and 1.43 for squamous and adenocarcinoma, respectively; p<0.001). Study limitations include retrospective design and lack of information about patient and provider motivations regarding therapy selection. CONCLUSIONS: AT for MIBC appears underused, especially in the elderly and in groups with poor socioeconomic status. These data point to a significant unmet need to inform policy makers, payers, and physicians regarding appropriate therapies for MIBC.
Authors: John M Sung; Jeremy W Martin; Francis A Jefferson; Daniel A Sidhom; Keyhan Piranviseh; Melissa Huang; Nobel Nguyen; Jenny Chang; Argyrios Ziogas; Hoda Anton-Culver; Ramy F Youssef Journal: Clin Genitourin Cancer Date: 2019-05-31 Impact factor: 2.872
Authors: Felix V Chen; Tulay Koru-Sengul; Feng Miao; Joshua S Jue; Mahmoud Alameddine; Devina J Dave; Sanoj Punnen; Dipen J Parekh; Chad R Ritch; Mark L Gonzalgo Journal: Urol Oncol Date: 2019-08-14 Impact factor: 3.498
Authors: Jean V Joseph; Ralph Brasacchio; Chunkit Fung; Jay Reeder; Kevin Bylund; Deepak Sahasrabudhe; Shu Yuan Yeh; Ahmed Ghazi; Patrick Fultz; Deborah Rubens; Guan Wu; Eric Singer; Edward Schwarz; Supriya Mohile; James Mohler; Dan Theodorescu; Yi Fen Lee; Paul Okunieff; David McConkey; Hani Rashid; Chawnshang Chang; Yves Fradet; Khurshid Guru; Janet Kukreja; Gerald Sufrin; Yair Lotan; Howard Bailey; Katia Noyes; Seymour Schwartz; Kathy Rideout; Gennady Bratslavsky; Steven C Campbell; Ithaar Derweesh; Per-Anders Abrahamsson; Mark Soloway; Leonard Gomella; Dragan Golijanin; Robert Svatek; Thomas Frye; Seth Lerner; Ganesh Palapattu; George Wilding; Michael Droller; Donald Trump Journal: Bladder Cancer Date: 2018-10-03
Authors: Nilay M Gandhi; Alexander Baras; Enrico Munari; Sheila Faraj; Leonardo O Reis; Jen-Jane Liu; Max Kates; Mohammad Obaidul Hoque; David Berman; Noah M Hahn; Mario Eisenberger; George J Netto; Mark P Schoenberg; Trinity J Bivalacqua Journal: Urol Oncol Date: 2015-03-23 Impact factor: 3.498