Weiner AB, et al. - Physicians designed this study to characterize national disparities in the diagnosis of advanced stage bladder cancer. They further investigated disparities in overall survival, treatment, and time to treatment among patients with advanced disease. Several disparities were noted in the diagnosis and treatment of advanced bladder cancer. For certain groups, overall survival could benefit from earlier diagnosis and improve timely access to potentially life-prolonging treatment.

Methods

• The National Cancer Data Base was queried for patients diagnosed with bladder urothelial carcinoma.
• Multivariable logistic regression was used to evaluate the association between covariates and diagnosis of advanced disease (AJCC stage III–IV).
• To assess disparities in overall survival for patients with advanced disease, Kaplan-Meier, log-rank, and Cox proportional analyses were used.
• The physicians compared receipt of treatment and delays to treatment between subgroups.

Results

• Advanced disease was observed in 7.6% patients among this cohort of 328,560 patients.
• Factors associated with increased odds of advanced disease were female sex, black race, Hispanic ethnicity, and living in a region of lower income and education.
• Overall worse survival was noted in association with female sex (HR = 1.16; 95% CI: 1.12–1.20; P < 0.001), black race (HR = 1.10; 95% CI: 1.04–1.18; P=0.002), and lower regional income levels (fourth quartile compared to first: HR = 1.08; 95% CI: 1.02-1.16; P=0.016).
• Improved survival was obtained with chemotherapy (HR = 0.55, 95% CI: 0.53–0.57; P < 0.001) and radical cystectomy (HR = 0.61; 95% CI: 0.59–0.64, P < 0.001).
• Treatment and treatment within 12 weeks of diagnosis were less frequently observed among females, black patients, and patients from regions of lower income and education.