Abstract: PD06-11
Sources of Funding: none

Introduction

Delay in radical cystectomy (RC) for urothelial bladder cancer has been associated with decreased overall survival (OS). However, this association was observed before the increased adoption of neoadjuvant chemotherapy (NAC). We sought to analyze the effect of delays in the NAC setting and the factors associated with delays using a large registry based cohort.

Methods

Using the National Cancer Database, we identified patients who underwent NAC and RC for muscle-invasive urothelial bladder cancer from 2006-2013. Patients with metastatic disease and prior treatment with immunotherapy were excluded. Time points for delays from diagnosis to initiation of NAC and from diagnosis to RC were tested for association with survival. Logistic regression was used to identify factors associated with delays in treatment. Cox-proportional hazards models were used to examine the relationship of delays to OS.

Results

Based on inclusion criteria, 2,034 patients were identified. Median time from diagnosis to initiation of NAC and diagnosis to RC were 39 and 155 days, respectively. Delays were defined as >10 weeks for diagnosis to NAC and >6 months for diagnosis to RC. On multivariate analysis, significant factors associated with delay to NAC included, black race (OR 2.20, 95% CI (1.17,3.48)), no insurance (OR 2.10, 95% CI (1.17, 3.78)), Medicaid insurance (OR 2.25, 95% CI (1.34, 3.80)), Medicare insurance (OR 1.51, 95% CI (1.16, 1.97)), reporting at academic hospital (OR 1.42, 95% CI (1.06, 1.91)), and diagnosis elsewhere than treatment hospital (OR 1.74, 95% CI (1.29, 2.34)). For delay to RC, significant independent factors were male gender (OR 1.36, 95% CI (1.06, 1.74)), black race (OR 1.64, 95% CI (1.06, 2.55)), no insurance (OR 1.89, 95% CI (1.14, 3.16)), Medicaid insurance (OR 1.84, 95% CI (1.16, 2.91)), Medicare insurance (OR 1.33, 95% CI (1.07, 1.65)), and diagnosis elsewhere than treatment hospital (OR 1.87, 95% CI (1.50, 2.33)). Delays in NAC or RC did not have a significant effect on OS, complete response (P0), or downstaging.

Conclusions

There are several factors associated with delays in treatment of muscle invasive bladder cancer, including race, insurance, and care transitions. In the setting of NAC, delays do not seem to have a significant effect on OS or pathological response. More studies are needed to determine the reasons for these socioeconomic differences in treatment times and if improvements can be made to improve access to care for invasive bladder cancer.

Funding

none