Introduction: Over the last several years, the surgical care for bladder cancer has become increasingly centralized. We sought to examine trends in overall and bladder-cancer specific mortality for both surgical and nonsurgical care during this time period.
Methods: Using Surveillance, Epidemiology, and End Results (SEER)-Medicare data, we identified patients diagnosed with at least muscle-invasive bladder cancer between 2004-2013. We further identified whether patients were treated with surgical (cystectomy) or nonsurgical (radiation, chemotherapy) care. Patients with metastatic disease were included in the cohort and separate analyses were done for this population. Our primary outcome was 1-year overall mortality and our secondary outcome was 1-year bladder cancer-specific mortality. We used multilevel linear probability models with hospital-level random effects, adjusted for several patient and tumor characteristics.
Results: We identified all patients who underwent radical cystectomy (n=6,756[YJG1] ), radiation (n=5,832), and chemotherapy (n=7,730) between 2004-2013. The 1-year adjusted overall mortality for cystectomy patients decreased from 34.0% (95% CI, 31.7-36.2) in 2004 to 29.4% (95% CI, 27.1-31.7) in 2013 (p=0.01) (Figure). Overall mortality remained stable for radiation and trended down for chemotherapy. The 1-year adjusted bladder-cancer specific mortality for cystectomy patients decreased from 21.9% (95% CI, 20.2-23.7) to 19.9% (95% CI, 17.9-21.9), but did not reach statistical significance (p=0.16). Bladder-cancer specific mortality remained stable for radiation and decreased for chemotherapy from 22.0% (95% CI, 19.9-24.1) to 18.5% (95% CI, 16.9-20.2) (p=0.03).
Conclusions: In the era of centralized surgical care for bladder cancer patients, there has been a general trend in decreasing mortality for bladder cancer patients receiving surgery and chemotherapy, even after adjusting for patient and tumor characteristics. Source of
Funding: Supported in part by P30CA047904 from the National Cancer Institute, the Henry L. Hillman Foundation, and the Shadyside Hospital Foundation
