Pd05-04 Investigating the Role of Access to Quality Care for Muscle-Invasive Bladder Cancer in the Disparate Outcomes for Sociodemographically Disadvantaged Patients in the State of Kentucky

You have accessJournal of UrologyDiversity, Equity & Inclusion: Health Equity & Outcomes I (PD05)1 May 2024PD05-04 INVESTIGATING THE ROLE OF ACCESS TO QUALITY CARE FOR MUSCLE-INVASIVE BLADDER CANCER IN THE DISPARATE OUTCOMES FOR SOCIODEMOGRAPHICALLY DISADVANTAGED PATIENTS IN THE STATE OF KENTUCKY Joon Kyung Kim, Feitong Lei, Seth Teplitsky, Eric Wahlstedt, Jate Bernard, Derek Allison, Zin Myint, Stephen Strup, Bin Huang, and Patrick Hensley Joon Kyung KimJoon Kyung Kim , Feitong LeiFeitong Lei , Seth TeplitskySeth Teplitsky , Eric WahlstedtEric Wahlstedt , Jate BernardJate Bernard , Derek AllisonDerek Allison , Zin MyintZin Myint , Stephen StrupStephen Strup , Bin HuangBin Huang , and Patrick HensleyPatrick Hensley View All Author Informationhttps://doi.org/10.1097/01.JU.0001008624.07191.ab.04AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: The reference standard of care (SOC) for non-metastatic muscle-invasive bladder cancer (MIBC) is neoadjuvant chemotherapy (NAC) followed by radical cystectomy (RC) or trimodal therapy (TMT) with maximal transurethral resection of bladder tumor followed by chemoradiation. However, half of MIBC patients do not receive potential curative therapy for MIBC. Socioeconomic disparities are an increasingly recognized factors in receipt of quality bladder cancer care. The state of Kentucky has the 15th highest age-adjusted incidence rate for bladder cancer but 3rd highest death rate, which is disproportionately seen in the Appalachian region. We sought to investigate how social, demographic, and clinical factors influence receipt of SOC for MIBC, and how substandard care influences survival outcomes within the state of Kentucky. METHODS: Patients diagnosed with cT2-4 N0-2 M0 MIBC from 2004-2020 were identified from the Kentucky Cancer Registry population-based database. Sociodemographic and clinical variables were examined as predictors of receiving SOC management, defined as either NAC/RC or TMT. Kaplan-Meier, log-rank, and Cox regression analysis was performed for survival, and univariate and multivariable logistic regression analysis was performed for receipt of SOC. RESULTS: Of the 1846 patients included, 28% received SOC (NAC/RC in 340 patients and TMT in 177 patients). The most common substandard treated regimen was RC alone (271 patients, 15%). Factors associated with poor survival include sub-SOC management (p<0.001), old age (p<0.001), low income (p=0.046), Appalachian status (p=0.02), lack of insurance (p<0.001), and advanced TNM stage (p<0.001). On multivariate analysis, age (p=0.003) and insurance status (p<0.001) were associated with receipt of sub-SOC. Notably, income, and Appalachian residency were not independent predictors of receipt of SOC, nor were they associated with delays to definitive treatment, type of urinary diversion, or receipt of adjuvant chemotherapy. CONCLUSIONS: In the state of Kentucky, less than a third of patients with MIBC received SOC management. While sociodemographic factors such as Appalachian status and low income did not impact receipt of SOC therapy, they were each independent predictors of poor survival. These data suggest that disparate outcomes in these underserved patient populations are not primarily driven by receipt of quality or timely care and may reflect unmeasured confounders which need further investigation. Source of Funding: None © 2024 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 211Issue 5SMay 2024Page: e90 Advertisement Copyright & Permissions© 2024 by American Urological Association Education and Research, Inc.Metrics Author Information Joon Kyung Kim More articles by this author Feitong Lei More articles by this author Seth Teplitsky More articles by this author Eric Wahlstedt More articles by this author Jate Bernard More articles by this author Derek Allison More articles by this author Zin Myint More articles by this author Stephen Strup More articles by this author Bin Huang More articles by this author Patrick Hensley More articles by this author Expand All Advertisement PDF downloadLoading ...