In:
Journal of Clinical Oncology, American Society of Clinical Oncology (ASCO), Vol. 39, No. 6_suppl ( 2021-02-20), p. 403-403
Abstract:
403 Background: The socioeconomic characteristics associated with the diagnosis and management of bladder cancer are not well described. Methods: We utilized the National Cancer Database (NCDB) to stratify cases of urothelial cell carcinoma of the bladder by the National Comprehensive Cancer Network (NCCCN) guidelines: early (Tis, Ta, T1), muscle invasive (T2-T3, N0), locally advanced (T4, N1-3), and metastatic. We then used multivariate binomial and multinomial logistic regression analyses to identify demographic characteristics associated with stage at diagnosis and receipt of cancer-directed therapies. Hazard ratios (HR) are reported with 95% confidence intervals. Results: After exclusions, we identified 331,714 early, 72,154 muscle invasive, 15,579 locally advanced, and 15,161 metastatic cases. Relative to diagnosis at early stage, the two strongest independent predictors of diagnosis at muscle invasive, locally advanced, and metastatic disease included black race (HR = 1.19 [1.15-1.23], HR = 1.49 [1.40-1.59] , HR = 1.66 [1.56-1.76], respectively), and female gender (HR = 1.21 [1.18-1.21] , HR = 1.16 [1.12-1.20], and HR = 1.34 [1.29-1.38] , respectively). Additional demographic factors associated with diagnosis at a more advanced stage on multivariable analysis included older age, treatment at an academic center (except for metastasis), Medicaid insurance, and patients from lower income/ less educated/more rural areas (all p 〈 0.01). The following demographic factors were less likely to receive cancer-directed therapies, signified by odds ratios, per multivariable binomial regression analysis: Additionalyl, female patients (HR = 1.03, 1.02-1.05) and black patients (HR = 1.13, 1.11-1.16) were the only demographic correlates of reduced survival in the entire cohort with multivariable cox regression analysis. Conclusions: In the largest study of its kind, we report that several socioeconomic, racial, and gender factors are associated with the diagnosis of bladder cancer at a later stage, as well as the use of less cancer-directed treatments. Further investigation is warranted to better characterize, and ultimately improve upon, health disparities in bladder cancer. Research Sponsor: None[Table: see text]
Type of Medium:
Online Resource
ISSN:
0732-183X
,
1527-7755
DOI:
10.1200/JCO.2021.39.6_suppl.403
Language:
English
Publisher:
American Society of Clinical Oncology (ASCO)
Publication Date:
2021
detail.hit.zdb_id:
2005181-5
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