Presentation Authors: Dennis Robins*, Nicholas Suss, Viktor Flores, Matthew Smith, Jeffrey Weiss, Brian McNeil, Andrew Winer, Brooklyn, NY
Introduction: Neoadjuvant chemotherapy (NAC) combined with radical cystectomy (RC) and urinary diversion is the standard of care in the treatment of urothelial muscle invasive bladder cancer (MIBC) as it confers a survival benefit to RC alone. To date, NAC is under-utilized despite level 1 evidence of its efficacy. Using the National Cancer Database (NCDB), we investigated disparities in the utilization of NAC for patient&[prime]s of different race and socioeconomic status that received RC and identified predictors of NAC administration prior to RC.
Methods: 6167 patients from 2004-2015 were identified with clinical stage T2-T4a, N0, M0, urothelial MIBC that received RC, and were NAC eligible. Of those, 1887 received NAC+RC and 4280 had RC alone. Patients were considered to have received NAC if chemotherapy was administered between time of diagnosis of MIBC and time of radical cystectomy. NAC eligible patients had a Charlson-Deyo score less than 2. Multivariate regression analysis was performed to identify independent predictors of receiving NAC.
Results: Patients in the highest income quartile were more likely to receive NAC than the lowest income quartile (OR 1.534, CI 1.198-1.966, p < 0.01). Patients in integrated cancer centers or academic institutions were more likely to receive NAC than community hospitals (OR 1.665, CI 1.344-2.064, p < 0.01 and 1.421, CI 1.236-1.632, p < 0.01, respectively). Patients in east south central (OR 0.470, CI 0.339-0.660, p < 0.01), west south central (OR 0.475, CI 0.340-0.680, p < 0.01), pacific (OR 0.744,CI 0.564-0.995), p < 0.04), and mountain regions (OR 0.640, CI 0.459-0.927, p < 0.013) of the US were less likely to receive NAC than patients in New England. Patients traveling distances greater than 11 miles to treatment were more likely to receive NAC than patients traveling shorter distances (p < 0.05). Race, gender, and insurance type did not influence NAC administration.
Conclusions: Wealth, location and treatment center type influence NAC administration in this patient population, while race, gender and insurance do not. An understanding of these influences may help clinicians to minimize disparities in cancer care.