Delays in receipt of neoadjuvant chemotherapy in patients with localized muscle-invasive bladder cancer.

e13538 Background: Delay in time from muscle invasive bladder cancer (MIBC) diagnosis to neoadjuvant chemotherapy (NACT) > 60 days, can negatively impact cancer related outcomes. Identifying patients at highest risk for treatment delays may inform targeted interventions. We evaluated clinical and system-level factors associated with delays in NACT initiation. Methods: We conducted a retrospective cohort study using the National Cancer Database. Eligibility included age ≥18 years, diagnosis of MIBC stages II-IIIB between 1/1/2010 – 12/31/2022 who were treated with NACT followed by surgery. Time to NACT was recorded for each patient in days and > 60 days was categorized as delay. Multivariate logistic regression was used to identify demographic, socioeconomic, and tumor characteristics associated with delay. Linear regression was used in a restricted cohort of patients over 70 years of age to investigate the relationship of age on time to chemotherapy initiation. Results: We identified 5260 eligible patients. The median age of the cohort was 67 years of age (IQR: 60-74). Across the cohort, 83.7% of patients had cT2-T4aN0 disease while 16.3% had cT2-T4aN1-3 disease. Urothelial carcinoma histology accounted for 92% of the cohort. Patients who were White made up 88% of the cohort and 3792 (72%) were male. Median time from diagnosis to initiation of NACT was 50 days (IQR: 11-121) and 48.4% had a delay to initiation of NACT. In an adjusted logistic regression, patients who were Black (OR 1.43 95% CI 1.15-1.79), Hispanic (OR 1.64 95% CI 1.21-2.23), insured with Medicaid (OR 1.62 95% CI 1.30-2.02), resided in the lowest income bracket by zip code (OR 1.61 95% CI 1.32-1.96), male (OR 1.13 95% CI 1.00-1.28), Northeast region (OR 1.73 95% CI 1.44-2.08), treated at an academic facility (OR 1.50 95% CI 1.16-1.93) were more likely to be delayed. Tumor T and N stage and Charlson comorbidity score were not significantly associated with treatment delay. In an adjusted linear regression for a restricted cohort of patients older than 70 years of age, each additional year of age was associated with a 0.82-day decrease in time to treatment (p = 0.005). Conclusions: Among patients with MIBC, patients who were Black, Hispanic, and non-commercially insured had nearly a 50% increase in odds of a delay in NACT initiation. These findings will inform future studies and system-level interventions to reduce treatment delays and promote equitable cancer care.