Mp24-14 Social Vulnerability and Urinary Diversion Technique in Patients Undergoing Radical Cystectomy for Bladder Cancer

You have accessJournal of UrologyHealth Services Research: Practice Patterns, Quality of Life and Shared Decision Making II (MP24)1 May 2024MP24-14 SOCIAL VULNERABILITY AND URINARY DIVERSION TECHNIQUE IN PATIENTS UNDERGOING RADICAL CYSTECTOMY FOR BLADDER CANCER Sarosh Irani, Lindsey Herrel, and Rishi Sekar Sarosh IraniSarosh Irani , Lindsey HerrelLindsey Herrel , and Rishi SekarRishi Sekar View All Author Informationhttps://doi.org/10.1097/01.JU.0001008860.46052.c4.14AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: After radical cystectomy (RC), there are two commonly pursued types of urinary diversion: the ileal conduit and the orthotopic neobladder. Beyond clinicopathologic factors, patient-level factors have been shown to affect the type of urinary diversion received. Previous studies have shown patients with higher income are more likely to receive neobladders, while patients on Medicaid were more likely to receive ileal conduits. Adverse social determinants of health (SDOH) may underlie these disparities. In this study, we evaluate the association between community-level SDOH and urinary diversion technique. METHODS: We queried our institutional database for patients with bladder cancer treated with RC between 2000 and 2022. SVI, assessed at the county level, was assigned to each patient using their zip code of residence. Patients were then grouped into quintiles of SVI (i.e., least vulnerable to most vulnerable). Demographics, clinicopathologic characteristics, and type of urinary diversion were compared across SVI quintiles. Multivariable logistic regression analysis was performed to evaluate the association between SVI quintile and type of urinary diversion. RESULTS: We identified 1,661 patients that underwent RC, of which 1,147 (69.1%) received an ileal conduit and 514 (30.9%) received a continent diversion. A greater proportion of patients residing in the most vulnerable communities were of minority status (9.1%, p=0.01), but otherwise were similar in terms of age, race, sex, and cancer stage. On multivariable logistic regression analysis, all quintiles of SVI had similar odds of receiving a continent diversion (highest versus lowest quintile of SVI, OR 1.0, 95% CI 0.7 – 1.5). Increasing age and cancer T stage were associated with significantly decreased odds of receiving a continent diversion (all, p<0.05). CONCLUSIONS: We found similar rates of continent urinary diversion across quintiles of SVI, suggesting that population-level SDOH may not contribute to determination of urinary diversion technique. Further study into the influence of patient, provider, and community-level factors is necessary to ensure patients with bladder cancer undergoing radical cystectomy have equitable access to urinary diversion options which can have considerable impact on survivorship. Download PPT Source of Funding: Rishi Sekar received research support from the National Cancer Institute institutional training grant T32-CA-236621 © 2024 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 211Issue 5SMay 2024Page: e398 Advertisement Copyright & Permissions© 2024 by American Urological Association Education and Research, Inc.Metrics Author Information Sarosh Irani More articles by this author Lindsey Herrel More articles by this author Rishi Sekar More articles by this author Expand All Advertisement PDF downloadLoading ...