Study Finds Delayed Cystectomy for Bladder Cancer Associated with Unnecessary Mortality

Researchers may suggest specific timeframes in which cystectomy should be performed to best avoid unnecessary mortality due to delays, according to research published in a poster at the 21st Annual Meeting of the Society of Urologic Oncology (SUO).

In addition, inequities in health care delivery according to race, sex, insurance status, education, and treating hospital were identified as factors in delayed cystectomy for patients with muscle-invasive bladder cancer.

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

The researchers found an increased 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).

More, a univariate analysis determined that distance from a medical provider and insurance status were also associated with delayed cystectomy regardless of neoadjuvant chemotherapy status (P < .001).

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

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

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

Found through the National Cancer Database, the study consisted of 11,468 patients who were diagnosed with stage II-IV bladder urothelial carcinoma who previously underwent 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 need to examine inequities to health care delivery for patients with bladder cancer. More, an expedited referral system and timely transfer of medical services is needed to ultimately decrease latency to radical cystectomy.

“In conjunction with data suggesting African American patients are more likely to have worse outcomes after [radical cystectomy], our analysis indicates that greater attention is needed to ensure minority groups receive appropriate and timely care,” wrote the researchers. “Though our study is limited by its retrospective nature, we present important associations in the largest population-based study to date.”

Reference:

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