Login to Access Video or Poster Abstract: MP04-09
Sources of Funding: None

Introduction

Bladder cancer (BCa) is one of the top ten most common cancers in the world. However, very few studies have reported on health disparities involving advanced BCa. The objective of this study was to identify disparities in treatment and survival for patients with metastatic bladder cancer.

Methods

Patients with metastatic BCa diagnosed between 1991 and 2014 were identified through the California Cancer Registry. Included in the analysis were age at diagnosis, sex, race/ethnicity, area-based socioeconomic status (SES), first course of treatment, and survival time. Predictors of treatment were identified using logistic regression, and cause-specific survival was analyzed using Cox regression.

Results

A total of 3,073 cases of metastatic BCa were identified. Among these cases, 67.39% were male, and 32.61% were female. The race distribution was 74.78% non-Hispanic (NH) white, 6.25% NH black, 12.46% Hispanic and 5.96% NH Asian/Pacific Islander (Asian/PI). Among all patients presenting with metastatic bladder cancer, 45.6% received chemotherapy. Of those receiving chemotherapy, 42% underwent additional local treatment (radical cystectomy or radiotherapy). Patients over age 65, female patients and those residing in all but the wealthiest census tracts were less likely to receive chemotherapy with or without local treatment. NH black patients also were slightly less likely to be treated. Patients diagnosed between 2003 and 2014 were 32% more likely to receive chemotherapy than those diagnosed between 1991 and 2002 (p<.001). Overall and cause-specific survival for the entire cohort was 11.1% and 14.5%, respectively. A smaller proportion of NH black patients survived two years after diagnosis (6.5% versus 14.4% NH white, 18.3% Hispanic, and 15.4% Asian/PI). After adjustment for other factors, patients aged 80 and older were more likely to die from bladder cancer (HR=1.2, 95% CI=1.0-1.3) as were black patients (HR=1.2, 95% CI=1.0-1.5). Patients residing in poorer census tracts were slightly more likely to die of bladder cancer although results were not statistically significant. Patients who received no chemotherapy had more than twice the risk of death. There was no evidence that overall survival improved in the most recent time period.

Conclusions

Non-Hispanic blacks and patients who were not treated with chemotherapy experienced poorer survival than other groups. There had been no improvement in this heath disparity or in overall survival over the last two decades.

Funding

None