(UroToday.com) The 2024 Southeastern Section of the AUA (SESAUA) annual meeting featured a bladder cancer session and a presentation by Dr. Ashley Foret discussing the impact of rural location on receipt of standard of care treatment and survival for locally advanced bladder cancer in Louisiana.
Bladder cancer is the sixth most common cancer in the United States, with ~30% of bladder cancer being muscle-invasive at the time of diagnosis. Stage at diagnosis, gender, and race are well-established independent predictors of cancer-specific outcomes. However, there remains a need to characterize additional factors that influence bladder cancer treatment and outcomes. Additionally, there are unique challenges for rural patients, including (i) limited access to specialized cancer centers, (ii) a shortage of local providers, and (iii) socioeconomic disparities. Dr. Foret and colleagues investigated the effect of region of residence (urban versus rural) on the odds of receiving standard of care treatment for locally advanced bladder cancer in Louisiana and its impact on survival outcomes. The hypotheses for this study were as follows:
- Individuals diagnosed with locally advanced (AJCC stage II or III) bladder cancer living in rural Louisiana would have worse cancer specific outcomes than individuals living in urban areas
- Patients living in rural locations are less likely to receive standard of care treatment
Using the Louisiana Tumor Registry, Dr. Foret identified AJCC stage II or III, microscopically confirmed bladder cancer diagnoses in Louisiana residents between 2010 and 2020. Treatment received was classified as standard or non-standard of care according to AUA guidelines. Location of residence (urban versus rural) was determined using Rural Urban Commuting Area-Tract-level 2010. Multivariate Cox proportional hazard analysis was performed to identify independent predictors of overall and cancer-specific mortality, and multivariable logistic regression analyses were conducted to assess the impact of variables on receiving standard of care treatment.
Among the 983 eligible patients, 85.6% lived in urban areas and 22.6% identified as non-Hispanic Black. Overall, only 37.5% received standard-of-care for the definitive management of locally advanced bladder cancer:
The median cancer specific survival for residents living in urban areas was 58.7 months compared to 26.9 months for those living in rural areas (p = 0.0049):
The median overall survival for residents living in urban areas was 27.7 months compared to 16.1 months for those living in rural areas (p = 0.0124):
Additionally, receipt of non-standard of care resulted in worse cancer specific and overall survival outcomes compared to those receiving standard of care:
Individuals living in rural areas (OR 0.53, 95% CI 0.31-0.91, p = 0.02) and Black individuals (OR 0.60, 95% CI 0.37-0.95, p = 0.03) were less likely to receive standard of care treatment.
Dr. Foret concluded her presentation discussing the impact of rural location on receipt of standard of care treatment and survival for locally advanced bladder cancer in Louisiana with the following summary statements:
- Most patients with locally advanced bladder cancer in Louisiana do not receive standard of care therapy
- Rural and Black residents are more likely to receive non-standard of care therapy
- Non-standard of care treatment and rural residence, but not race, are independently associated with worse survival outcomes
- Further work to improve access to standard of care treatment is needed, with particular focus on rural residents
Presented by: Ashley Foret, School of Medicine - LSU Health Science Center New Orleans, New Orleans, LA
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.