Mp22-06 Income Disparities in Survival and Receipt of Neoadjuvant Chemotherapy and Lymph Node Dissection for Muscle-Invasive Bladder Cancer

You have accessJournal of UrologyBladder Cancer: Invasive II (MP22)1 May 2024MP22-06 INCOME DISPARITIES IN SURVIVAL AND RECEIPT OF NEOADJUVANT CHEMOTHERAPY AND LYMPH NODE DISSECTION FOR MUSCLE-INVASIVE BLADDER CANCER Ryan M. Antar, Vincent E. Xu, Arthur Drouaud, Olivia F. Gordon, Sarah Azari, Briana Goddard, Sean Tafuri, and Michael J. Whalen Ryan M. AntarRyan M. Antar , Vincent E. XuVincent E. Xu , Arthur DrouaudArthur Drouaud , Olivia F. GordonOlivia F. Gordon , Sarah AzariSarah Azari , Briana GoddardBriana Goddard , Sean TafuriSean Tafuri , and Michael J. WhalenMichael J. Whalen View All Author Informationhttps://doi.org/10.1097/01.JU.0001008608.50694.4b.06AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Muscle-invasive bladder cancer (MIBC) has a poor prognosis, particularly for low-income patients, as evident in other cancers. While the adoption of neoadjuvant cisplatin-based chemotherapy (NAC) followed by radical cystectomy (RC) and pelvic lymph node dissection (LND) has improved outcomes, these standard-of-care treatments may be underutilized in lower-income patients. We sought to investigate the economic disparities in NAC and LND receipt and survival outcomes in MIBC. METHODS: The National Cancer Database was queried from 2004-2019 for cT2-4N0-3M0 BCa patients with urothelial histology alone who underwent RC. Primary endpoints included overall survival (OS) and NAC+LND receipt (≥1 LNs removed). Income was dichotomized into upper and lower-income. OS between low and high-income patients was compared with Kaplan-Meier method. Multivariate logistic regression identified significant predictors of NAC+LND receipt. Multivariate Cox Proportional Hazards model estimated the influence of NAC+LND on OS, accounting for age, sex, insurance, Charlson-Comorbidity Index, tumor stage, nodal involvement, year of diagnosis, and facility type. RESULTS: A total of n=25,823 patients were included, of whom 90.9% received LND, 45.5% received LND≥15 LNs, 35.1% received NAC, and only 6.5% received both NAC+LND. Lower-income patients had significantly worse OS than higher-income patients (Median 55.9 vs. 68.2 months, p<0.001) and were less likely to receive LND (OR=0.905 0.829-0.989, p=0.027) or NAC+LND (OR=0.794 0.749-0.841, p<0.001). Patients were more likely to receive NAC+LND if diagnosed after 2011 (OR=3.376 3.164-3.603, p<0.001) or treated at an academic facility (OR=1.353 1.281-1.430, p<0.001). Private insurance (HR=0.928 0.886-0.973, p=0.002) and higher income (HR=0.915 0.882-0.949, p<0.001) were associated with significantly reduced adjusted mortality risk. CONCLUSIONS: NAC+LND is underutilized in lower-income MIBC patients, beyond expectations of medical ineligibility for NAC. Without these standard-of-care modalities, OS is negatively impacted. Our findings identify an opportunity to improve the quality of care for lower-income MIBC patients through concerted efforts to regionalize multi-modal urologic oncology care. Download PPT Source of Funding: No source of funding to disclose © 2024 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 211Issue 5SMay 2024Page: e343 Advertisement Copyright & Permissions© 2024 by American Urological Association Education and Research, Inc.Metrics Author Information Ryan M. Antar More articles by this author Vincent E. Xu More articles by this author Arthur Drouaud More articles by this author Olivia F. Gordon More articles by this author Sarah Azari More articles by this author Briana Goddard More articles by this author Sean Tafuri More articles by this author Michael J. Whalen More articles by this author Expand All Advertisement PDF downloadLoading ...