Female Sexual Function Following Radical Cystectomy in Bladder Cancer

Despite the high incidence of bladder cancer among males, women consistently present with more advanced disease, and experience worse post-operative and oncologic outcomes. The dichotomy of the disease that exists within bladder cancer has been investigated at the epidemiologic and multi-omics levels. Studies focusing on hormone receptor expression, tumor biology, and mutational burden, as well as exposure/metabolism of carcinogens and socioeconomic factors have all aimed to assess the mechanisms underlying this gender discrepancy.

The studies prior to our published analysis “The Impact of Race and Sex on Metastatic Bladder Cancer Survival” have all focused on localized bladder cancer, within the most common histopathologic variant (urothelial). This vastly ignores patients presenting with metastatic disease (about 10-15%). As such, the focus of the current study was to assess overall survival (OS) and cancer specific survival ( CSS) stratified by sex and race within metastatic setting.

While platinum-based chemotherapy remains the standard treatment for advanced bladder cancer, treatment options have changed dramatically since the U.S Food and Drug Administration approval of immune checkpoint agents. After years of disappointing trials in metastatic disease, ICI therapy has been associated with improved survival and quality of life.

With the introduction of many alternative treatment options in metastatic disease, we believe this study is timely.

Our study utilized the Surveillance, Epidemiology, and End Results Program Database (SEER) over 17 years and 17,783 patients. Our results highlighted the persistent disparities present within metastatic setting. Particularly, Black females experienced the lowest 5-year CSS as compared to all race/gender combinations within urothelial 4.3% (95% CI: 1.6-8.9), squamous 2.6% (95% CI: 0.2-11.8), and adenocarcinoma 6.4% (0.4%-25%) of the bladder. Even after adjusting for clinical and pathologic variables, Black females continued to experience 17-20% increased odds of dying from their disease. These numbers echo the disparities present within localized bladder cancer.

These differences can be attributed to many potential causes: biology, socioeconomic barriers, financial toxicity associated with new immunotherapies, as well as treatment access, and lack of adherence to guideline driven care. As minority and female patient access to clinical trials has been historically limited, we hope that this study can lay the foundation for the continued efforts aimed at clinical trial inclusion, as well as further investigation delineating opportunities to enhance the care of women with bladder cancer.

Written by: April Miller, BS,¹ Laura Bukavina MD, MPH²

Case Western Reserve School of Medicine, Cleveland, OH, USA
Fox Chase Cancer Center, Division of Urologic Oncology, Philadelphia, PA, USA

Read the Abstract

Login