MP59-08: Disparities in the Prevalence and Management of High-Risk Non-Muscle Invasive Bladder Cancer

Angela Estevez*, Sumedh Kaul, Aaron Fleishman, Ruslan Korets, Peter Chang, Andrew Wagner, Joaquim Bellmunt, Aria Olumi, Heidi Rayala, Boris Gershman, Boston , MA

Introduction: Substantial variation exists in the management of non-muscle-invasive bladder cancer (NMIBC) despite strong clinical practice guidelines. We hypothesized that socioeconomic disparities may be associated with variation in the management of NMIBC, and utilized a nationwide oncology dataset to examine this question.

Methods: We identified adult patients aged 18-89 years with Ta, T1, or Tis urothelial carcinoma of the bladder diagnosed from 2006-2016 in the NCDB. We then examined the associations of patient and socioeconomic characteristics with the guidelines-based management of high-risk NMIBC using multivariable logistic regression.

Results: A total of 163,949 patients were included in the study cohort, including 64% with Ta, 32% with T1, and 4% with Tis disease. Among those diagnosed with bladder cancer, male (OR 1.24, 95%CI 1.21-1.27), uninsured (OR 1.10, 95%CI 1.01-1.19 vs private), and non-White (OR 1.34, 95%CI 1.28-1.41 for Black; OR 1.10; 95%CI 1.03-1.18 for Other versus White) patients were more likely to be diagnosed with high-risk (HGT1 or Tis) disease, as well as patients from lower education level areas. Among those with high-risk NMIBC, patients who were older, non-White, Hispanic, uninsured or insured with Medicaid were less likely to receive intravesical BCG, while those residing in rural and higher education level areas were more likely to receive BCG (Table 1). When examining non-guidelines based use of radiotherapy for HGT1 disease, older age (OR 1.06; 95% CI 1.04-1.07) and VA/Military insurance (OR 2.73; 95%CI 0.93-6.36 vs private) were associated with radiotherapy use.

Conclusions: There are strong disparities in the prevalence and management of high-risk NMIBC. These observations represent an important target for future efforts to identify interventions to reduce such healthcare disparities.

Source of Funding: None