Bladder cancer care has been increasingly concentrated in high-volume metropolitan medical centers (i.e., "regionalization" of care). We aimed to assess the potential role of geographic factors, including facility region and distance to treatment center, as determinants of neoadjuvant chemotherapy (NAC) delivery in patients with non-metastatic urothelial muscle-invasive bladder cancer (MIBC) using nationally-representative data from the United States.
We queried the National Cancer Database to identify patients with cT2-cT4a, N0, M0 urothelial MIBC who underwent radical cystectomy from 2006-2015. Patients who received radiation therapy, single-agent chemotherapy, adjuvant chemotherapy, or systemic therapies other than multiagent chemotherapy were excluded. Multivariate logistic regression analysis was performed to identify independent predictors of receiving NAC.
A total of 5,986 patients met the criteria for inclusion, of whom 1,788 (29.9%) received NAC and 4,108 received RC alone. Younger age, increased Charlson-Deyo score, increased cT stage, increased annual income, increased distance from cancer treatment center, treatment at an Academic Research Program or Integrated Network Cancer Program, and a later year of diagnosis were independently predictive of NAC receipt. Older age, Medicare insurance, and treatment in the East South Central or West South Central regions were independently associated with decreased odds for NAC receipt.
Distance to treatment center and United States geographic region were found to affect the likelihood of NAC receipt independently of other established predictors of success in this quality-of-care metric. Access to transportation and related resources merits consideration as additional pertinent social determinants of health in bladder cancer care.
International journal of clinical practice. 2021 Apr 22 [Epub ahead of print]
Thomas F Monaghan, Dennis J Robins, Nicholas R Suss, Connelly D Miller, Viktor X Flores, Matthew T Smith, Jeffrey P Weiss, Brian K McNeil, Andrew G Winer
Department of Urology, SUNY Downstate Health Sciences University, Brooklyn, NY, USA.