SUO 2017: Muscle-invasive Bladder Cancer Patients Who Did Not Receive Radical Cystectomy: Treatment Decisions, Alternative Treatments, And Opportunities For Care Improvement

Washington, DC ( Introduction: Radical cystectomy (RC), along with neoadjuvant chemotherapy (NAC), is the gold standard for treatment of muscle invasive bladder cancer (MIBC). However, a substantial number of MIBC patients do not receive RC, with no clear reasons. The authors aimed to determine these reasons and identify alternative treatments used within a large, integrated delivery system.

Methods: The authors performed a retrospective study of all patients diagnosed with MIBC, without distant metastases, between 2007- 2015 within the data of Kaiser Permanente Southern California (KPSC). We compared baseline characteristics between those who did and did not undergo RC.

Results: Of 910 MIBC patients potentially eligible for RC, 402 did not have a RC within a year of diagnosis. Patients who did not undergo RC were similar to those who had RC with respect to race (p=0.35) and sex (p=0.27), but were older (p<0.0001) and had more comorbidities (p<0.0001). Patient refusal (40%) and poor surgical candidacy (35%) were the two most common reasons for ultimately rejecting RC. Patient refusal was based on factors that included quality of life and, in some cases, requests for hospice care. In about 25% of cases in which RC was initially considered, it was unclear why it was not performed. Alternative treatments to RC included chemotherapy (36%), radiation therapy (26%), and/or repeat endoscopic resections (30%).

Conclusion: Over 40% of KPSC patients in this MIBC cohort did not receive RC despite its established curative role. Patient refusal and poor surgical candidacy were the two major reasons identified.. This study highlights opportunities to improve potential care gaps in the treatment of MIBC. Further study of the reason(s) for patient refusal and provider treatment recommendations is merited.

Presented by: Kim Danforth, Southern California Permanente Medical Group, San Diego, CA, USA

Written by: Hanan Goldberg, MD, Urologic Oncology Fellow (SUO), University of Toronto, Princess Margaret Cancer Centre, @GoldbergHanan, at the 18th Annual Meeting of the Society of Urologic Oncology, November 29-December 1, 2017 – Washington, DC