The study finds a delayed cystectomy for bladder cancer associated with unnecessary mortality

Researchers can suggest specific time periods in which to perform the cystectomy to best avoid unnecessary mortality due to delays, according to research published in a poster at the Society of Urologic Oncology (SUO) 21st Annual Meeting.

Furthermore, inequalities in health care provision based on race, sex, insurance status, education, and hospital treatment have been identified as factors of delayed cystectomy for patients with muscle-invasive bladder cancer.

“Our results indicate that delaying cystectomy by just 60 days leads to increased mortality in those who do not receive [neoadjuvant chemotherapy]”, The researchers wrote.” In those they receive [neoadjuvant chemotherapy], cystectomy delays were not associated with increased mortality until [radical cystectomy] was delayed more than 210 days after diagnosis. “

Researchers found an increase in the mortality rate with delayed cystectomy beyond 60 days for the non-neoadjuvant chemotherapy cohort (HR, 1.06; 95% CI, 1.00-1.13) and 210 days for the neoadjuvant chemotherapy cohort. (HR, 1.20; 95% CI, 1.04-1.39).

Furthermore, a univariate analysis determined that distance to a doctor and insurance status were also associated with delayed cystectomy regardless of neoadjuvant chemotherapy status (P. <.001).

Notably, for the non-neoadjuvant chemotherapy cohort, a number of factors including increased age, Hispanic race, non-private insurance, surgery at an academic center, and higher Charlson scores were associated with cystectomy. delayed, while the female gender was associated with a timely cystectomy.

For the neoadjuvant chemotherapy cohort, higher cancer stage and non-private insurance were factors associated with delayed cystectomy, while the procedure at a comprehensive non-academic community center and residency in areas with the highest high school graduation rates they were associated with timely cystectomy.

“Interestingly, we found that care in an academic center was associated with [delayed cystectomy]”, The researchers wrote.” Receipt of [radical cystectomy] in academic centers it has been associated with a decrease in perioperative morbidity and mortality, suggesting that a more convenient referral system and timely transfer of medical services to these institutions is needed. Importantly, we found that the Hispanic race was associated with [delayed cystectomy], suggesting an important socio-economic disparity not described in the literature “.

Found through the National Cancer Database, the study consisted of 11,468 patients diagnosed with stage II-IV urothelial bladder cancer who had previously undergone radical cystectomy from 2004 to 2013. The researchers created 2 cohorts: those who received neoadjuvant chemotherapy (n = 3,348) and those who did not receive neoadjuvant chemotherapy (n = 8,120).

Looking ahead, the researchers suggest that future studies must examine inequalities in health care provision for bladder cancer patients. Additionally, a quick referral system and timely transfer of medical services are required to reduce latency to radical cystectomy.

Combined with data that suggests African American patients are more likely to have worse outcomes later [radical cystectomy], our analysis indicates that more attention is needed to ensure that minority groups receive adequate and timely care, “the researchers wrote.” Although our study is limited by its retrospective nature, we present important associations in the largest study based on population to date “.

Reference:

Dall CP, Egan J, Carvalho FLF, et al. Delays from diagnosis to radical cystectomy are associated with poorer survival in muscle-invasive bladder cancer. Presented at: 21st Annual Meeting of the Society of Urologic Oncology; December 3, 2020. Poster n. 19.