Sex and Racial Disparities in the Treatment and Outcomes of Muscle-invasive Bladder Cancer.

MedStar author(s):
Citation: Urology. 151:154-162, 2021 05.PMID: 32810481Institution: MedStar Health Research Institute | MedStar Washington Hospital CenterDepartment: UrologyForm of publication: Journal ArticleMedline article type(s): Journal ArticleSubject headings: *Healthcare Disparities | *Urinary Bladder Neoplasms/mo [Mortality] | *Urinary Bladder Neoplasms/th [Therapy] | Aged | Databases, Factual | Female | Humans | Male | Neoplasm Invasiveness | Race Factors | Sex Factors | United States/ep [Epidemiology] | Urinary Bladder Neoplasms/pa [Pathology]Year: 2021ISSN:
  • 0090-4295
Name of journal: UrologyAbstract: METHODS: Using the National Cancer Database, we identified patients with muscle invasive bladder cancer from 2004-2014. Treatments analyzed included no treatment, cystectomy, neoadjuvant chemotherapy plus cystectomy ("optimal treatment"), cystectomy plus adjuvant chemotherapy, and chemoradiation. Propensity matching compared mortality outcomes between sexes. Logistic models evaluated predictors of receiving optimal treatment, as well as mortality.OBJECTIVE: To identify racial and sex disparities in the treatment and outcomes of muscle-invasive bladder cancer (MIBC) using a nationwide oncology outcomes database.RESULTS: 47229 patients were identified. Most patients were male (73.4%) and underwent cystectomy alone (69.0%). Propensity score matching demonstrated increased 90-day mortality in women vs. men (13.0% vs. 11.6%, p=0.009), despite adjusting for differences in treatments between sexes. Logistic regression models showed no difference in receipt of optimal treatment between sexes (OR 1.01, 95% CI 0.83-1.22) although black patients were less likely to receive optimal treatment (OR 0.15, 95% CI 0.05-0.48). Logistic regression models confirmed increased 90-day mortality in female (OR 1.17, CI 1.08-1.27, p<0.001) and black (OR 1.29, CI 1.11-1.50, p=0.001) patients. Females had a lower overall survival on Cox regression analysis (HR 0.92, 95% CI 0.87-0.97) CONCLUSIONS: While there do not appear to be significant treatment disparities between sexes, women experience higher 90-day mortality and lower overall survival. Black patients are less likely to receive optimal treatment and have a higher risk of 90-day mortality. Additional research is needed to determine the variables leading to worse outcomes in females and identify impediments to black patients receiving optimal treatment. Copyright (c) 2020. Published by Elsevier Inc.All authors: Carvalho F, Egan J, Hwang J, Kowalczyk K, Krasnow R, Lynch J, Marinaro J, Stamatakis L, Williams S, Zeymo AOriginally published: Urology. 2020 Aug 15Fiscal year: FY2021Fiscal year of original publication: FY2021Digital Object Identifier: Date added to catalog: 2020-09-02
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Journal Article MedStar Authors Catalog Article 32810481 Available 32810481

METHODS: Using the National Cancer Database, we identified patients with muscle invasive bladder cancer from 2004-2014. Treatments analyzed included no treatment, cystectomy, neoadjuvant chemotherapy plus cystectomy ("optimal treatment"), cystectomy plus adjuvant chemotherapy, and chemoradiation. Propensity matching compared mortality outcomes between sexes. Logistic models evaluated predictors of receiving optimal treatment, as well as mortality.

OBJECTIVE: To identify racial and sex disparities in the treatment and outcomes of muscle-invasive bladder cancer (MIBC) using a nationwide oncology outcomes database.

RESULTS: 47229 patients were identified. Most patients were male (73.4%) and underwent cystectomy alone (69.0%). Propensity score matching demonstrated increased 90-day mortality in women vs. men (13.0% vs. 11.6%, p=0.009), despite adjusting for differences in treatments between sexes. Logistic regression models showed no difference in receipt of optimal treatment between sexes (OR 1.01, 95% CI 0.83-1.22) although black patients were less likely to receive optimal treatment (OR 0.15, 95% CI 0.05-0.48). Logistic regression models confirmed increased 90-day mortality in female (OR 1.17, CI 1.08-1.27, p<0.001) and black (OR 1.29, CI 1.11-1.50, p=0.001) patients. Females had a lower overall survival on Cox regression analysis (HR 0.92, 95% CI 0.87-0.97) CONCLUSIONS: While there do not appear to be significant treatment disparities between sexes, women experience higher 90-day mortality and lower overall survival. Black patients are less likely to receive optimal treatment and have a higher risk of 90-day mortality. Additional research is needed to determine the variables leading to worse outcomes in females and identify impediments to black patients receiving optimal treatment. Copyright (c) 2020. Published by Elsevier Inc.

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