Racial and insurance-based disparities in muscle-invasive bladder cancer (MIBC) have been well documented. However, little is known whether these disparities are affected by the type of treatment facility. We aimed to investigate the impact of treatment in academic facilities on disparities in patients with MIBC.
We queried the National Cancer Database (NCDB) for patients with muscle-invasive non-metastatic bladder cancer (cT2-T4/M0) between 2004 and 2015. Patients were stratified according to treatment facility type (community cancer program, comprehensive cancer program, academic research program and integrated network). Sociodemographic, clinical and treatment pattern variables were assessed among different groups. Kaplan-Meier survival curves and Cox proportional hazards model were fitted to evaluate overall survival (OS) as a function of race, insurance status and facility type after adjusting for confounding variables.
A total of 73,780 patients with stage cT2-T4/M0 MIBC were identified. Of whom 27,227(37%) were treated at academic centers(AC) and 46,553(63%) were treated at non-academic centers(Non-AC). Overall, Medicare patients had lower overall survival(OS) when compared to the privately insured(HR1.73, CI1.69–1.7, p<0.001), and African Americans(AA) compared to whites(HR1.16, CI1.12–1.20, p<0.001). Notably, patients treated at Non-AC had lower survival compared to AC(HR1.25, CI1.23–1.28, p<0.001). When stratified by facility type, in Non-AC group, overall survival was significantly diminished for AA compared to whites(HR1.18, CI1.10–1.27, p<0.001). Similarly, uninsured and Medicaid patients had worse OS compared to privately insured patients(HR1.23, CI1.09–1.39, p=0.001 and 1.38, 1.25–1.52, p<0.001; respectively). Adjusted subgroup analysis of patients treated at AC revealed persistence of racial disparities. AA showed persistently worse survival compared to whites(HR1.22, CI1.13–1.32, p<0.001). Likewise, insurance-based disparities persisted with uninsured and Medicaid patients showing worse OS compared to private insurance(HR1.2, CI1.04–1.38, p=0.014 and 1.23, 1.11–1.36, p<0.001, respectively).
Treatment at academic research facilities did not mitigate racial and insurance-based disparities. AA race and uninsured/Medicaid status were consistently associated with worse overall survival even in AC.
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DOES TREATMENT IN ACADEMIC CENTERS DECREASE RACIAL AND INSURANCE-BASED DISPARITIES IN PATIENTS WITH MUSCLE-INVASIVE BLADDER CANCER?
Bladder Cancer > Muscle Invasive Bladder Cancer
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Wednesday, Dec 1
1:00 p.m. - 2:00 p.m.
Presented By: Ahmad O. Hadri
Ahmad O. Hadri