The following is a summary of “Analysis of treatment of muscle invasive bladder cancer using the national cancer database: Factors associated with receipt of aggressive therapy,” published in the November 2023 issue of Urology by Moon, et al.
For a study, researchers sought to describe the treatments muscle-invasive bladder cancer (MIBC) patients receive, look at how they are used based on sociodemographic, clinical, pathologic, and facility factors, and find ways to improve care, keeping in mind that patients with MIBC have a disease that could kill them, but they often don’t get treatments that are in line with guidelines and could cure them. They examined 102,119 people confirmed with MIBC from 2009 to 2018 using the National Cancer Data Base (NCDB). Some of the treatments were cystectomy, radiation, chemotherapy (CT), or just watching. Aggressive therapy (AT) included treatments like cystectomy or radiation (RT) of 50 Gy or more. Using SAS version 9.4, a multivariate generalized estimating equation model was used to determine how the independent factors affected getting AT.
Most people were 73 years old, 72.9% were men, 84.3% were white, and 7.1% were black. 59.4% were in stage II, 23.0% were in stage III, and 17.6% were in stage IV. Overall, 55.2% of people got AT, 41.1% did not, and 26.6% were just watched after having a bladder tumor removed transurethrally. As the primary treatment, 45.4% had a cystectomy, 9.8% had RT, and 12.8% had CT. Notably, more than 30% of people aged 50 to 70 did not get intensive treatment. Age over 70 (OR < 0.79, P < 0.0001), being Black (OR 0.70, P < 0.0001), not having enough health insurance (OR 0.62, P < 0.0001), having a lot of other health problems (OR 0.74, P < 0.0001), and getting treatment at a low volume (OR 0.72, P < 0.0001) or nonacademic cancer program (OR 0.54, P < 0.0001) were all linked to not getting AT.
Chemoradiation (5.4% in 2009 to 8.8% in 2018; P < 0.001) and post-CT (17.5% in 2009 to 46.7% in 2018) were both used more and more over the long term. When Cox regression analysis was used to remove any potentially confusing factors, it was found that intense therapy was linked to a higher total mortality rate. Over a third of patients with MIBC did not get AT, even though many of them seemed qualified based on their age and other health problems. Prospective studies were needed to determine why these people don’t get AT. Getting a better sense of what affects patients, their access to care, and providers will help focus efforts to improve care for MIBC patients.
Source: sciencedirect.com/science/article/abs/pii/S1078143923002648