Introduction:
Management of high-risk non-muscle invasive bladder cancer (NMIBC) represents a clinical challenge due to high failure rates despite prior bacillus Calmette-Guérin (BCG) therapy. Blacks patients have worse bladder cancer outcomes than any other race. We describe real-world bladder cancer outcomes as a function of race among high-risk NMIBC patients managed in the largest equal access setting in the United States (US): The Veterans Affairs (VA) Health System.
Methods:
We retrospectively identified a sample of 412 high-risk NMIBC patients from 63,139 patients diagnosed with bladder cancer that received ≥ 1 dose of BCG within VA centers across the US from January 1, 2000, to December 31, 2015. Adequate induction BCG included at least 5 of 6 installations, and adequate BCG therapy was at least 7 installations, respectively. We used the Kaplan-Meier method to estimate outcomes including event-free survival and Cox regression to determine association between race and recurrence, progression, disease-specific survival and overall survival outcomes.
Results:
Follow-up was 2,694 person-years. Out of 412 patients, 50 (12%) and 345 (84%) were Black and White, respectively. There was no difference in age, sex, smoking status, and Charlson Comorbidity Index by race. Black patients had lower socioeconomic status (SES) with greater percentage of patients living below the poverty level than White (50% vs. 21%, p<0.001) patients, respectively. A total of 392 (95%) patients received adequate induction BCG and 152 (37%) patients received adequate BCG therapy. There was no significant difference in adequate induction BCG or adequate BCG therapy according to race. There was no significant difference in recurrence (Hazard Ratio (HR) 1.43; 0.65-3.18), progression (HR 0.87; 0.40-1.91), disease-specific survival (HR 1.21; 0.36-4.06), and overall survival (HR 1.38; 0.69-1.89) according to Black vs. White race, respectively.
Conclusion:
In an equal access setting, we found despite Black patients more likely to have lower SES, there was no difference in receipt of adequate BCG nor any differences in recurrence, progression or death from bladder cancer. If our results are confirmed on a larger scale, these data would support the potential importance of equal access to healthcare in reducing racial disparities in bladder cancer care.
Funding: This study was conducted with the support of a Department of Defense Peer Reviewed Cancer Research Program (PRCRP) Career Development Award (W81XWH1710576) (SBW).
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Understanding the Impact of Race on Outcomes Among BCG-treated High-Risk Non-Muscle Invasive Bladder Cancer Patients in an Equal Access Setting
Category
Bladder Cancer > Non-Muscle Invasive Bladder Cancer
Description
Poster #33
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Presented By: Stephen Williams
Authors:
Stephen Williams
Lin Gu
Lauren Howard
Corinne Lawler
Brandee Branch
Emily Wiggins
Aditya Srinivasan
Meagan L. Foster
Zachary Klaassen
Amanda M. De Hoedt
Stephen J. Freedland