The Surveillance, Epidemiology, and End Results (SEER)-Medicare database was used from January 1, 2001 through December 31, 2011, to identify 9224 patients aged 65-90 years, diagnosed with muscle-invasive bladder cancer. Concurrent chemotherapy use was identified in Medicare claims. Clinical and sociodemographic predictors of concurrent chemotherapy use were identified using generalized linear model. Cox proportional hazards model as used to test whether concurrent chemotherapy use was associated with improved overall Survival and cancer-specific survival.
Use of radiation therapy increased significantly to 15.9% in 2004, and remained stable at 16.2% from 2004 to 2011. However, only 62.4% of patients who received radiation therapy also underwent concurrent chemotherapy over the study period. Predictors significantly associated with decreased likelihood of receiving concurrent chemotherapy were increased Charlson comorbidity index (3 versus 0) (OR: 0.90, 95% CI 0.83-0.99, p=0.027) and radiation/oncologist ratio per 1,000,000 population 25+ vs. 0 (OR 0.88, 95% 0.781.00, p=0.049). Presence of chronic kidney disease was not associated with receipt of concurrent chemotherapy. Concurrent chemotherapy, compared with no curative treatment, was associated with a mortality reduction of approximately 30% for both overall survival and cancer-specific survival when analyzed using the multivariable model.
This analysis confirms a survival benefit from concurrent chemotherapy in older patients diagnosed with bladder cancer. However, concurrent chemotherapy was not optimally utilized among elderly bladder cancer patients who underwent radiation therapy. Further research is needed in addressing factors inherent to patient and provider treatment decision-making.
Presented by: Christopher Kosarek
Affiliation: The University of Texas Medical Branch, Galveston, United States
Written by: Hanan Goldberg, MD, Urologic Oncology Fellow (SUO), University of Toronto, Princess Margaret Cancer Centre.Twitter: @GoldbergHanan at the 37th Congress of Société Internationale d’Urologie - October 19-22, 2017- Lisbon, Portugal