Disparities in the Prescription Patterns of Intravesical Therapies in Treatment of Non-Muscle Invasive Bladder Cancer
Mentor 1
Kourosh Ravvaz
Mentor 2
John Weissert
Location
Union Wisconsin Room
Start Date
5-4-2019 1:30 PM
End Date
5-4-2019 3:30 PM
Description
Introduction: Last year in the United States, bladder cancer was diagnosed in about 81,000 patients resulting in nearly 17,000. Intravesical therapy including Postoperative single dose intravesical chemotherapy (PSDIVC) and Bacillus Calmette-Guerin (BCG) immunotherapy is guideline recommended therapy in patients with Non-Muscle Invasive Bladder Cancer (NMIBC). In this study, we aimed determine if there were any unexpected disparities in the utilization of PSDIVC and BCG. Methods: Using the National Cancer Database Participant User File (PUF) we conducted a retrospective nationwide cross-sectional observational study from 2004-2014 to evaluate unexpected disparities (i.e. not guideline recommended) in the use of PSDIVC and BCG following surgical intervention. Patients with age > 40 years old, tumor stage Ta, T1 or Tis, and one lifetime cancer diagnosis were included. Outcomes were the receipt of PSDVIC or BCG treatment. Stepwise regression was used to identify variables, which were unique not significantly correlated with each other. Then, Binomial logistic regression was used to identify patient characteristics significantly (p<0.05) associated with differential odds ratios of receiving therapy compared to not receiving treatment. Results: We identified 484,367 patients diagnosed with NMIBC and met our analysis inclusion criteria. 209004 (43.15%) of the patients received BCG and/or PSDIVC treatments. Of the variables tested facility type, facility location, age, sex, and ethnicity were significantly associated with not receiving BCG. Additionally, we found that facility type, facility location, age, income, education attainment, and urban versus rural were significantly associated with not receiving PSDIVC. Conclusion: In a nationwide cohort of patients with NMIBC, significant unexpected disparities in the utilization of intravesical therapy exist. It is critical that patients and physicians are aware of such disparities so that all patients have the opportunity for high quality guideline based NMIBC therapy.
Disparities in the Prescription Patterns of Intravesical Therapies in Treatment of Non-Muscle Invasive Bladder Cancer
Union Wisconsin Room
Introduction: Last year in the United States, bladder cancer was diagnosed in about 81,000 patients resulting in nearly 17,000. Intravesical therapy including Postoperative single dose intravesical chemotherapy (PSDIVC) and Bacillus Calmette-Guerin (BCG) immunotherapy is guideline recommended therapy in patients with Non-Muscle Invasive Bladder Cancer (NMIBC). In this study, we aimed determine if there were any unexpected disparities in the utilization of PSDIVC and BCG. Methods: Using the National Cancer Database Participant User File (PUF) we conducted a retrospective nationwide cross-sectional observational study from 2004-2014 to evaluate unexpected disparities (i.e. not guideline recommended) in the use of PSDIVC and BCG following surgical intervention. Patients with age > 40 years old, tumor stage Ta, T1 or Tis, and one lifetime cancer diagnosis were included. Outcomes were the receipt of PSDVIC or BCG treatment. Stepwise regression was used to identify variables, which were unique not significantly correlated with each other. Then, Binomial logistic regression was used to identify patient characteristics significantly (p<0.05) associated with differential odds ratios of receiving therapy compared to not receiving treatment. Results: We identified 484,367 patients diagnosed with NMIBC and met our analysis inclusion criteria. 209004 (43.15%) of the patients received BCG and/or PSDIVC treatments. Of the variables tested facility type, facility location, age, sex, and ethnicity were significantly associated with not receiving BCG. Additionally, we found that facility type, facility location, age, income, education attainment, and urban versus rural were significantly associated with not receiving PSDIVC. Conclusion: In a nationwide cohort of patients with NMIBC, significant unexpected disparities in the utilization of intravesical therapy exist. It is critical that patients and physicians are aware of such disparities so that all patients have the opportunity for high quality guideline based NMIBC therapy.
