Presentation Authors: Yaw Nyame*, Sarah Holt, Brian Winters, Sarah Psutka, Atreya Dash, George Schade, Daniel Lin, Evan Yu, John Gore, Jonathan Wright, Seattle, WA
Introduction: Neoadjuvant cisplatin-based chemotherapy (NAC) is associated with improved overall survival in patients with muscle-invasive bladder cancer (MIBC). Over the past decade, the use of NAC has increased to approximately 20% of patients with MIBC; however, little is known about the impact of socioeconomic status (SES) and ethnicity on NAC utilization. We investigated patterns of NAC and appropriateness of cisplatin-based regimen utilization using cancer registry data.
Methods: This is an analysis of linked SEER-Medicare data for patients diagnosed from 2004-2011. Patients with cT2-4N0-1 bladder cancer undergoing cystectomy were identified. Specific chemotherapy drugs administered were identified using pharmacy records. The cohort was stratified into three groups, standard of care (SOC: appropriate cisplatin-based regimen), non-SOC, and no NAC. Descriptive statistics were performed to compare each group and multivariate logistic regression performed to determine factors associated with receiving any NAC (model 1) and SOC NAC (model 2).
Results: We identified 4534 patients undergoing cystectomy of whom 15.3% received NAC. Among those receiving NAC, 345/694 (49.7%) received a non-SOC regimen. 4.3% and 4.5% of patients in the cohort self-identified as black or Latino, respectively. On multivariate analysis, being married (OR 1.4, 95% CI 1.1-1.6) and having high SES (OR 1..4, 95% CI 1.2-1.6) were associated with increased odds of NAC utilization (model 1). Moderate/severe renal dysfunction (OR 0.5, 95% CI 0.3-0.8) was associated with decreased odds of receiving cisplatin-based NAC (model 2). Race/ethnicity was not associated with SOC NAC (OR 0.85, 95% CI 0.36-2.01 among black participants; OR 0.5, 95% CI 0.2-1.1 among Latino participants; model 2).
Conclusions: The receipt of NAC is influenced by socioeconomic status in patients with MIBC. Nearly half of the patients receiving NAC were given a non-SOC regimen, which was driven by renal dysfunction. These results highlight the importance of understanding the role of SES, race/ethnicity, and health status in the providing appropriate NAC or early cystectomy in the management of MIBC.