1
|
Escott M, Yi Y, Foret A, Li T, Hsieh M, Delacroix SE, Wu X, Westerman ME. Impact of rural location on receipt of standard of care treatment and survival for locally advanced bladder cancer in Louisiana. Cancer Med 2024; 13:e7301. [PMID: 38923853 PMCID: PMC11199337 DOI: 10.1002/cam4.7301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Revised: 02/22/2024] [Accepted: 05/07/2024] [Indexed: 06/28/2024] Open
Abstract
OBJECTIVE We aim to determine the effect of region of residence (urban vs. rural) on the odds of receiving standard of care treatment for locally advanced BCa in Louisiana and its impact on survival outcomes. METHODS Using the Louisiana Tumor Registry, we identified American Joint Committee on Cancer (AJCC) stage II or III, BCa diagnoses in Louisiana residents between 2010 and 2020. Treatment received was classified as standard or non-standard of care according to American Urological Association (AUA) guidelines and location of residence was determined using Rural Urban Commuting Area-Tract-level 2010 (RUCA). Multivariable logistic regression analyses and multivariate cox proportional hazard analyses were performed. RESULTS Of 983 eligible patients, 85.6% (841/983) lived in urban areas. Overall, only 37.5% received standard-of-care (SOC) for the definitive management of locally advanced bladder cancer. Individuals living in rural areas (OR 0.53, 95% CI: 0.31-0.91, p = 0.02) were less likely to receive standard of care treatment. Both rural residence and receipt of non-standard of care therapy were associated with an increased risk of bladder cancer-specific (adj HR 1.53, 95% CI: 1.09-2.14, p = 0.01 and adj HR: 1.85, 95% CI: 1.43-2.39, <0.0001) and overall mortality (adj HR: 1.28, 95% CI: 1.01-1.61, p = 0.04 and adj HR: 1.73 95% CI: 1.44-2.07, p < 0.0001). CONCLUSIONS Most patients with locally advanced bladder cancer in Louisiana do not receive SOC therapy. Individuals living in rural locations are more likely to receive non-standard of care therapy than individuals in urban areas. Nonstandard of care treatment and rural residence are both associated with worse survival outcomes for Louisiana residents with locally advanced bladder cancer.
Collapse
Affiliation(s)
- Megan Escott
- School of MedicineLSU Health Science CenterNew OrleansLouisianaUSA
- Department of UrologyWake Forest University School of MedicineWinston‐SalemNorth CarolinaUSA
| | - Yong Yi
- Louisiana Tumor Registry and EpidemiologyNew OrleansLouisianaUSA
- School of Public HealthLSU Health Science CenterNew OrleansLouisianaUSA
| | - Ashley Foret
- School of MedicineLSU Health Science CenterNew OrleansLouisianaUSA
| | - TingTing Li
- Louisiana Tumor Registry and EpidemiologyNew OrleansLouisianaUSA
- School of Public HealthLSU Health Science CenterNew OrleansLouisianaUSA
| | - Mei‐Chin Hsieh
- Louisiana Tumor Registry and EpidemiologyNew OrleansLouisianaUSA
- School of Public HealthLSU Health Science CenterNew OrleansLouisianaUSA
| | | | - Xiao‐Cheng Wu
- Louisiana Tumor Registry and EpidemiologyNew OrleansLouisianaUSA
- School of Public HealthLSU Health Science CenterNew OrleansLouisianaUSA
| | - Mary E. Westerman
- Department of UrologyLSU Health Science CenterNew OrleansLouisianaUSA
| |
Collapse
|
2
|
Bree KK, Janes JL, Hensley PJ, Srinivasan A, De Hoedt AM, Das S, Freedland SJ, Williams SB. Racial disparities in stage at bladder cancer diagnosis in the US Veterans Affairs healthcare system. BJU Int 2024. [PMID: 38680113 DOI: 10.1111/bju.16380] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/01/2024]
Abstract
OBJECTIVE To describe patient characteristics and pathological stage at bladder cancer (BCa) diagnosis in a diverse population within a national, equal-access healthcare system. METHODS This retrospective cohort study identified 15 966 men diagnosed with BCa in the Veterans Affairs (VA) healthcare system from 2000 to 2020. The primary outcome was pathological stage at diagnosis, determined by index transurethral resection of bladder tumour. Logistic regression was used to assess the relationship between race and stage. Competing risk models tested the association between race and BCa-specific mortality with cumulative incidence estimates. RESULTS Of 15 966 BCa patients, 12 868 (81%), 1726 (11%), 493 (3%) and 879 (6%) were White, Black, Hispanic and Other race, respectively. Black patients had significantly higher muscle-invasive bladder cancer (MIBC) rates than White patients (35% vs 32%; P = 0.009). In multivariable analysis, the odds of presenting with MIBC did not differ significantly between Black and White patients (odds ratio [OR] 1.10, 95% confidence interval [CI] 0.98-1.22) or between Hispanic patients (OR 0.82, 95% CI 0.67-1.01) and White patients. Compared to White patients, Black patients had a similar risk of BCa-specific mortality (hazard ratio [HR] 0.89, 95% CI 0.75-1.06), whereas Hispanic patients had a lower risk (HR 0.56, 95% CI 0.38-0.82). CONCLUSIONS Black patients presented with the highest rates of de novo MIBC. However, in a large, equal-access healthcare system, this did not result in a difference in BCa-specific mortality. In contrast, Hispanic patients had lower risks of MIBC and BCa-specific mortality.
Collapse
Affiliation(s)
- Kelly K Bree
- Department of Urology, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Jessica L Janes
- Division of Urology, Durham Veterans Affairs Health Care System, Durham, NC, USA
| | - Patrick J Hensley
- Department of Urology, University of Kentucky College of Medicine, Lexington, KY, USA
| | - Aditya Srinivasan
- Division of Urology, Department of Surgery, University of Texas Medical Branch, Galveston, TX, USA
| | - Amanda M De Hoedt
- Division of Urology, Durham Veterans Affairs Health Care System, Durham, NC, USA
| | - Sanjay Das
- Division of Urology, Durham Veterans Affairs Health Care System, Durham, NC, USA
- Department of Urology, University of California-Los Angeles, Los Angeles, CA, USA
- Department of Urology, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Stephen J Freedland
- Division of Urology, Durham Veterans Affairs Health Care System, Durham, NC, USA
- Department of Urology, Cedars-Sinai Medical Center, Los Angeles, CA, USA
- Center for Integrated Research on Cancer and Lifestyle, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Stephen B Williams
- Division of Urology, Department of Surgery, University of Texas Medical Branch, Galveston, TX, USA
| |
Collapse
|
3
|
Ladi-Seyedian SS, Ghoreifi A, Konety B, Pohar K, Holzbeierlein JM, Taylor J, Kates M, Willard B, Taylor JM, Liao JC, Kaimakliotis HZ, Porten SP, Steinberg GD, Tyson MD, Lotan Y, Daneshmand S. Racial Differences in the Detection Rate of Bladder Cancer Using Blue Light Cystoscopy: Insights from a Multicenter Registry. Cancers (Basel) 2024; 16:1268. [PMID: 38610946 PMCID: PMC11011163 DOI: 10.3390/cancers16071268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2024] [Revised: 03/16/2024] [Accepted: 03/22/2024] [Indexed: 04/14/2024] Open
Abstract
The use of blue light cystoscopy (BLC) has been shown to improve bladder tumor detection. However, data demonstrating the efficacy of BLC across different races are limited. Herein, we aim to evaluate heterogeneity in the characteristics of BLC for the detection of malignant lesions among various races. Clinicopathologic information was collected from patients enrolled in the multi-institutional Cysview® registry (2014-2021) who underwent transurethral resection or biopsy of bladder tumors. Outcome variables included sensitivity and negative and positive predictive values of BLC and white light cystoscopy (WLC) for the detection of malignant lesions among various races. Overall, 2379 separate lesions/tumors were identified from 1292 patients, of whom 1095 (85%) were Caucasian, 96 (7%) were African American, 51 (4%) were Asian, and 50 (4%) were Hispanic. The sensitivity of BLC was higher than that of WLC in the total cohort, as well as in the Caucasian and Asian subgroups. The addition of BLC to WLC increased the detection rate by 10% for any malignant lesion in the total cohort, with the greatest increase in Asian patients (18%). Additionally, the positive predictive value of BLC was highest in Asian patients (94%), while Hispanic patients had the highest negative predictive value (86%). Our study showed that regardless of race, BLC increases the detection of bladder cancer when combined with WLC.
Collapse
Affiliation(s)
- Seyedeh-Sanam Ladi-Seyedian
- Department of Urology, Norris Cancer Center, University of Southern California, Los Angeles, CA 90033, USA; (S.-S.L.-S.); (A.G.)
| | - Alireza Ghoreifi
- Department of Urology, Norris Cancer Center, University of Southern California, Los Angeles, CA 90033, USA; (S.-S.L.-S.); (A.G.)
| | | | - Kamal Pohar
- Department of Urology, Ohio State University, Columbus, OH 43210, USA;
| | | | - John Taylor
- Department of Urology, University of Kansas, Kansas City, KS 66045, USA; (J.M.H.); (J.T.)
| | - Max Kates
- The James Buchanan Brady Urological Institute, Johns Hopkins Medical Institutions, Baltimore, MD 21224, USA;
| | | | - Jennifer M. Taylor
- Michael E. DeBakey VA Medical Center, Baylor College of Medicine, Houston, TX 77030, USA;
| | - Joseph C. Liao
- VA Palo Alto Health Care System, Palo Alto, CA 94304, USA;
| | | | - Sima P. Porten
- Department of Urology, University of California San Francisco, San Francisco, CA 94115, USA;
| | - Gary D. Steinberg
- Department of Urology, Allina Health Cancer Institute, University of Minnesota, Minneapolis, MN 55407, USA;
| | - Mark D. Tyson
- Department of Urology, Mayo Clinic Hospital, Phoenix, AZ 85054, USA;
| | - Yair Lotan
- UT Southwestern Medical Center, Dallas, TX 75390, USA;
| | - Siamak Daneshmand
- Department of Urology, Norris Cancer Center, University of Southern California, Los Angeles, CA 90033, USA; (S.-S.L.-S.); (A.G.)
| | | |
Collapse
|
4
|
Gul ZG, Sharbaugh DR, Ellimoottil C, Rak KJ, Yabes JG, Davies BJ, Jacobs BL. Telemedicine in urologic oncology care: Will telemedicine exacerbate disparities? Urol Oncol 2024; 42:28.e1-28.e7. [PMID: 38220521 DOI: 10.1016/j.urolonc.2023.10.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2023] [Revised: 09/15/2023] [Accepted: 10/16/2023] [Indexed: 01/16/2024]
Abstract
INTRODUCTION Disparities in prostate, bladder, and kidney cancer outcomes are associated with access to care. Telemedicine can improve access but may be underutilized by certain patient populations. Our objective was to determine if the patient populations who suffer worse oncologic outcomes are the same as those who are less likely to use telemedicine. METHODS Using an institutional database, we identified all prostate, bladder and kidney cancer encounters from March 14, 2020 to October 31, 2021 (n = 15,623; n = 4, 14; n = 3,830). Telemedicine was used in 13%, 8%, and 12% of these encounters, respectively. We performed random effects modeling analysis to examine patient and provider characteristics associated with telemedicine use. Adjusted odds ratios (OR) and 95% confidence intervals (CI) were reported as measures of association. RESULTS Among prostate, bladder, and kidney cancer patients, Black patients had lower odds of a telemedicine encounter (OR 0.51, 95% CI 0.37-0.69; OR 0.22, 95% CI 0.07-0.70; OR 0.46, 95% CI 0.24-0.86), and patients residing in small and isolated small rural towns areas had higher odds of a telemedicine encounter (OR 1.44, 95% CI 1.09-1.91; OR 2.12, 95% CI 1.14-3.94; OR 1.89, 95% CI 1.12-3.19). Compared to providers in practice ≤5 years, providers in practice for 6 to 15 years had significantly higher odds of a telemedicine encounter for prostate and bladder cancer patients (OR 4.10, 95% CI 1.4511.58; OR 3.42, 95% CI 1.09-10.77). CONCLUSION The lower rates of telemedicine use among Black patients could exacerbate pre-existing disparities in prostate, bladder, and kidney cancer outcomes.
Collapse
Affiliation(s)
- Zeynep G Gul
- Department of Surgery, Division of Urology, University of Washington in St. Louis, St. Louis, MO.
| | - Danielle R Sharbaugh
- Department of Urology, Division of Health Services Research, University of Pittsburgh, Pittsburgh, PA
| | - Chad Ellimoottil
- Department of Urology, University of Michigan, Ann Arbor, MI; Institute for Healthcare Policy and Innovation, Ann Arbor, MI
| | - Kimberly J Rak
- Department of Critical Care Medicine, Clinical Research, Investigation, and Systems Modeling of Acute Illness Center, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Jonathan G Yabes
- Department of Medicine, University of Pittsburgh, Pittsburgh, PA
| | - Benjamin J Davies
- Department of Urology, Division of Health Services Research, University of Pittsburgh, Pittsburgh, PA
| | - Bruce L Jacobs
- Department of Urology, Division of Health Services Research, University of Pittsburgh, Pittsburgh, PA
| |
Collapse
|
5
|
Sereda Y, Alarid-Escudero F, Bickell NA, Chang SH, Colditz GA, Hur C, Jalal H, Myers ER, Layne TM, Wang SY, Yeh JM, Trikalinos TA. Approaches to developing de novo cancer population models to examine questions about cancer and race in bladder, gastric, and endometrial cancer and multiple myeloma: the Cancer Intervention and Surveillance Modeling Network incubator program. J Natl Cancer Inst Monogr 2023; 2023:219-230. [PMID: 37947329 PMCID: PMC11009510 DOI: 10.1093/jncimonographs/lgad021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Revised: 07/10/2023] [Accepted: 07/19/2023] [Indexed: 11/12/2023] Open
Abstract
BACKGROUND We are developing 10 de novo population-level mathematical models in 4 malignancies (multiple myeloma and bladder, gastric, and uterine cancers). Each of these sites has documented disparities in outcome that are believed to be downstream effects of systemic racism. METHODS Ten models are being independently developed as part of the Cancer Intervention and Surveillance Modeling Network incubator program. These models simulate trends in cancer incidence, early diagnosis, treatment, and mortality for the general population and are stratified by racial subgroup. Model inputs are based on large population datasets, clinical trials, and observational studies. Some core parameters are shared, and other parameters are model specific. All models are microsimulation models that use self-reported race to stratify model inputs. They can simulate the distribution of relevant risk factors (eg, smoking, obesity) and insurance status (for multiple myeloma and uterine cancer) in US birth cohorts and population. DISCUSSION The models aim to refine approaches in prevention, detection, and management of 4 cancers given uncertainties and constraints. They will help explore whether the observed racial disparities are explainable by inequities, assess the effects of existing and potential cancer prevention and control policies on health equity and disparities, and identify policies that balance efficiency and fairness in decreasing cancer mortality.
Collapse
Affiliation(s)
- Yuliia Sereda
- Center for Evidence Synthesis in Health, Brown University School of Public Health, Providence, RI, USA
| | - Fernando Alarid-Escudero
- Department of Health Policy, School of Medicine, and Stanford Health Policy, Freeman-Spogli Institute for International Studies, Stanford University, Stanford, CA, USA
| | - Nina A Bickell
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Institute for Health Equity Research, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Su-Hsin Chang
- Division of Public Health Sciences, Department of Surgery, WA University School of Medicine, St Louis, MO, USA
| | - Graham A Colditz
- Division of Public Health Sciences, Department of Surgery, WA University School of Medicine, St Louis, MO, USA
| | - Chin Hur
- Department of Medicine, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, USA
| | - Hawre Jalal
- School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Evan R Myers
- Department of Obstetrics and Gynecology, Duke University School of Medicine, Durham, NC, USA
| | - Tracy M Layne
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Blavatnik Family Women’s Health Research Institute and Center for Scientific Diversity, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Shi-Yi Wang
- Department of Chronic Disease Epidemiology, Yale University School of Public Health, New Haven, CT, USA
- Cancer Outcomes, Public Policy, and Effectiveness Research Center, Yale University School of Medicine, New Haven, CT, USA
| | - Jennifer M Yeh
- Department of Pediatrics, Boston Children’s Hospital, Boston, MA, USA
| | - Thomas A Trikalinos
- Center for Evidence Synthesis in Health, Brown University School of Public Health, Providence, RI, USA
- Departments of Health Services, Policy, & Practice and of Biostatistics, Brown University School of Public Health, Providence, RI, USA
| |
Collapse
|
6
|
Jiang C, Perimbeti S, Deng L, Xing J, Chatta GS, Han X, Gopalakrishnan D. Medicaid expansion and racial disparity in timely multidisciplinary treatment in muscle invasive bladder cancer. J Natl Cancer Inst 2023; 115:1188-1193. [PMID: 37314971 DOI: 10.1093/jnci/djad112] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2023] [Revised: 05/03/2023] [Accepted: 06/04/2023] [Indexed: 06/16/2023] Open
Abstract
BACKGROUND Multidisciplinary cancer care (neoadjuvant chemotherapy followed by radical cystectomy or trimodality therapy) is crucial for outcome of muscle-invasive bladder cancer (MIBC), a potentially curable illness. Medicaid expansion through Affordable Care Act (ACA) increased insurance coverage especially among patients of racial minorities. This study aims to investigate the association between Medicaid expansion and racial disparity in timely treatment in MIBC. METHODS This quasi-experimental study analyzed Black and White individuals aged 18-64 years with stage II and III bladder cancer treated with neoadjuvant chemotherapy followed by radical cystectomy or trimodality therapy from National Cancer Database 2008-2018. Primary outcome was timely treatment started within 45 days following cancer diagnosis. Racial disparity is the percentage-point difference between Black and White patients. Patients in expansion and nonexpansion states were compared using difference-in-differences and difference-in-difference-in-differences analyses, controlling for age, sex, area-level income, clinical stage, comorbidity, metropolitan status, treatment type, and year of diagnosis. RESULTS The study included 4991 (92.3% White, n = 4605; 7.7% Black, n = 386) patients. Percentage of Black patients who received timely care increased following the ACA in Medicaid expansion states (54.5% pre-ACA vs 57.4% post-ACA) but decreased in nonexpansion states (69.9% pre-ACA vs 53.7% post-ACA). After adjusting covariates, Medicaid expansion was associated with a net 13.7 percentage-point reduction of Black-White patient disparity in timely receipt of MIBC treatment (95% confidence interval = 0.5% to 26.8%; P < .01). CONCLUSIONS Medicaid expansion was associated with statically significant reduction in racial disparity between Black and White patients in timely multidisciplinary treatment for MIBC.
Collapse
Affiliation(s)
- Changchuan Jiang
- Department of Medicine, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA
| | - Stuthi Perimbeti
- Department of Medicine, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA
| | - Lei Deng
- Department of Medicine, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA
| | - Jiazhang Xing
- Department of Medicine, Peking Union Medical College, Beijing, China
| | - Gurkamal S Chatta
- Department of Medicine, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA
| | - Xuesong Han
- Surveillance and Health Equity Science, American Cancer Society, Atlanta, GA, USA
| | | |
Collapse
|
7
|
Doshi B, Athans SR, Woloszynska A. Biological differences underlying sex and gender disparities in bladder cancer: current synopsis and future directions. Oncogenesis 2023; 12:44. [PMID: 37666817 PMCID: PMC10477245 DOI: 10.1038/s41389-023-00489-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Revised: 08/21/2023] [Accepted: 08/23/2023] [Indexed: 09/06/2023] Open
Abstract
Sex and gender disparities in bladder cancer have long been a subject of interest to the cancer research community, wherein men have a 4 times higher incidence rate than women, and female patients often present with higher-grade disease and experience worse outcomes. Despite the known differences in disease incidence and clinical outcomes between male and female bladder cancer patients, clinical management remains the same. In this review, we critically analyze studies that report on the biological differences between men and women and evaluate how these differences contribute to sex and gender disparities in bladder cancer. Distinct characteristics of the male and female immune systems, differences in circulating hormone levels and hormone receptor expression, and different genetic and epigenetic alterations are major biological factors that all likely contribute to disparate incidence rates and outcomes for male and female bladder cancer patients. Future preclinical and clinical studies in this area should employ experimental approaches that account for and consider sex and gender disparities in bladder cancer, thereby facilitating the development of precision medicine for the effective treatment of bladder cancer in all patients.
Collapse
Affiliation(s)
- Bhavisha Doshi
- Department of Pharmacology and Therapeutics, Roswell Park Comprehensive Cancer Center, Buffalo, NY, 14203, USA
| | - Sarah R Athans
- Department of Pharmacology and Therapeutics, Roswell Park Comprehensive Cancer Center, Buffalo, NY, 14203, USA
| | - Anna Woloszynska
- Department of Pharmacology and Therapeutics, Roswell Park Comprehensive Cancer Center, Buffalo, NY, 14203, USA.
| |
Collapse
|
8
|
Paster IC, Chipollini J. AUTHOR REPLY. Urology 2023; 178:113. [PMID: 37438240 DOI: 10.1016/j.urology.2023.03.055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/14/2023]
|
9
|
Paster IC, Zeng J, Recio-Boiles A, Chipollini J. Gender, Racial and Ethnic Differences in Pathologic Response Following Neoadjuvant Chemotherapy for Bladder Cancer Patients. Urology 2023; 178:105-113. [PMID: 37230271 DOI: 10.1016/j.urology.2023.03.053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Revised: 03/24/2023] [Accepted: 03/28/2023] [Indexed: 05/27/2023]
Abstract
OBJECTIVE To evaluate trends and racial variations of pathologic complete response (CR) in patients with muscle-invasive bladder cancer undergoing cystectomy. MATERIALS AND METHODS The National Cancer Database was queried for patients with non-metastatic muscle-invasive bladder cancer who underwent neoadjuvant chemotherapy and surgery. The primary endpoints, CR and mortality, were evaluated using the Cochran-Armitage test, multivariable regression, and Kaplan-Meier analyses. RESULTS The cohort comprised 9955 patients. Non-Hispanic Black (NHB) patients were younger (P < .001), had a higher clinical tumor (P < .001), and had higher clinical node (P = .029) stages at presentation. CR for non-Hispanic White (NHW), NHB, and Hispanic patients were 12.6%, 10.1%, and 11.8%, respectively (P = .030). There was a significant increase in CR trends for NHW patients (P < .001) and increases in NHB (P = .311) and Hispanic patients (P = .236). On multivariable analysis, NHW females had lower odds of achieving CR (odds ratio: 0.83, 95% CI: 0.71-0.97); however, NHB males (hazard ratio: 1.21, 1.01-1.44) and NHB females (hazard ratio: 1.25, 1.03-1.53) had higher overall mortality in adjusted analysis. Survival differences were not observed in patients who achieved CR, regardless of racial background; however, for those with residual disease, the 2-year survival probabilities were 60.7%, 62.5%, and 51.1% for NHW, HW, and NHB patients, respectively (log-rank P = .010). CONCLUSION Our findings revealed differences in chemotherapy response based on gender and race or ethnicity. The CR trends for all racial or ethnic groups increased over time. However, Black patients were found to have worse survival, particularly when residual disease was present. Clinical studies with more underrepresented minorities are needed to verify biological differences in response to neoadjuvant chemotherapy.
Collapse
Affiliation(s)
| | - Jiping Zeng
- Department of Urology, University of Arizona, Tucson, AZ
| | | | | |
Collapse
|
10
|
Lei B, Jiang X, Saxena A. TCGA Expression Analyses of 10 Carcinoma Types Reveal Clinically Significant Racial Differences. Cancers (Basel) 2023; 15:2695. [PMID: 37345032 DOI: 10.3390/cancers15102695] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Revised: 05/02/2023] [Accepted: 05/04/2023] [Indexed: 06/23/2023] Open
Abstract
Epidemiological studies reveal disparities in cancer incidence and outcome rates between racial groups in the United States. In our study, we investigated molecular differences between racial groups in 10 carcinoma types. We used publicly available data from The Cancer Genome Atlas to identify patterns of differential gene expression in tumor samples obtained from 4112 White, Black/African American, and Asian patients. We identified race-dependent expression of numerous genes whose mRNA transcript levels were significantly correlated with patients' survival. Only a small subset of these genes was differentially expressed in multiple carcinomas, including genes involved in cell cycle progression such as CCNB1, CCNE1, CCNE2, and FOXM1. In contrast, most other genes, such as transcriptional factor ETS1 and apoptotic gene BAK1, were differentially expressed and clinically significant only in specific cancer types. Our analyses also revealed race-dependent, cancer-specific regulation of biological pathways. Importantly, homology-directed repair and ERBB4-mediated nuclear signaling were both upregulated in Black samples compared to White samples in four carcinoma types. This large-scale pan-cancer study refines our understanding of the cancer health disparity and can help inform the use of novel biomarkers in clinical settings and the future development of precision therapies.
Collapse
Affiliation(s)
- Brian Lei
- Krieger School of Arts and Sciences, Johns Hopkins University, Baltimore, MD 21218, USA
- Biology Department, Brooklyn College, New York, NY 11210, USA
| | - Xinyin Jiang
- Department of Health and Nutrition Sciences, Brooklyn College, New York, NY 11210, USA
- Biology and Biochemistry Programs, CUNY Graduate Center, New York, NY 10016, USA
| | - Anjana Saxena
- Biology Department, Brooklyn College, New York, NY 11210, USA
- Biology and Biochemistry Programs, CUNY Graduate Center, New York, NY 10016, USA
| |
Collapse
|
11
|
Faraj KS, Sekar RR, Singhal U. EDITORIAL COMMENT. Urology 2023; 174:147-148. [PMID: 37030908 DOI: 10.1016/j.urology.2022.12.037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/10/2023]
Affiliation(s)
- Kassem S Faraj
- Department of Urology, Rogel Cancer Center, University of Michigan, Ann Arbor, MI
| | - Rishi R Sekar
- Department of Urology, Rogel Cancer Center, University of Michigan, Ann Arbor, MI
| | - Udit Singhal
- Department of Urology, Rogel Cancer Center, University of Michigan, Ann Arbor, MI; Department of Urology, Mayo Clinic, Rochester, MN
| |
Collapse
|
12
|
Bonner A, Herring B, Wang R, Gillis A, Zmijewski P, Lindeman B, Fazendin J, Chen H. The Association of Socioeconomic Factors and Well-Differentiated Thyroid Cancer. J Surg Res 2023; 283:973-981. [PMID: 36915026 PMCID: PMC10478758 DOI: 10.1016/j.jss.2022.11.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Revised: 11/08/2022] [Accepted: 11/11/2022] [Indexed: 12/13/2022]
Abstract
INTRODUCTION Well-differentiated thyroid cancer (WDTC) is the most common thyroid malignancy, and the worldwide incidence is increasing. Early stage disease is curable with surgery. We hypothesized that patients who live at greater distances from health care institutions or have complicating socioeconomic barriers may present with more advanced diseases and have worse outcomes. METHODS The National Cancer Database (NCDB) was used to identify patients who were diagnosed with WDTC between 2004 and 2018. Race, ethnicity, insurance status, income status, and distance from residence to health care clinic of diagnosis (great circle distance [GCD]) were analyzed with respect to the severity of disease at presentation (stage) and outcomes. Binary logistic regression and Cox regression were used to determine associations between socioeconomic variables and tumor stage or survival. RESULTS The Hispanic (OR: 1.49, CI: 1.45-1.54, P < 0.001) and Asian (OR: 1.49, CI: 1.43-1.55, P < 0.001) populations had higher odds of developing an advanced disease when compared to the White population separately. Patients without insurance displayed higher odds of developing an advanced disease at diagnosis compared to those with insurance (OR: 1.39, CI: 1.31-1.47, P < 0.001). Adjusted-Cox regression analysis of survival revealed that Black patients had detrimental survival outcomes when compared to White patients (HR: 1.24, P < 0.001), and patients with private insurance had improved survival outcomes when compared to those without insurance (HR: 0.58, P < 0.001). CONCLUSIONS Hispanic and Asian patients were found to be more likely to present with an advanced disease but also displayed greater overall survival when compared to the White population. The Black population, patients without insurance, and patients with lower income status exhibited worse survival outcomes.
Collapse
Affiliation(s)
- Andrew Bonner
- Department of Surgery, University of Alabama at Birmingham, Birmingham, Alabama
| | - Brendon Herring
- Department of Surgery, University of Alabama at Birmingham, Birmingham, Alabama
| | - Rongzhi Wang
- Department of Surgery, University of Alabama at Birmingham, Birmingham, Alabama
| | - Andrea Gillis
- Department of Surgery, University of Alabama at Birmingham, Birmingham, Alabama
| | - Polina Zmijewski
- Department of Surgery, University of Alabama at Birmingham, Birmingham, Alabama
| | - Brenessa Lindeman
- Department of Surgery, University of Alabama at Birmingham, Birmingham, Alabama
| | - Jessica Fazendin
- Department of Surgery, University of Alabama at Birmingham, Birmingham, Alabama
| | - Herbert Chen
- Department of Surgery, University of Alabama at Birmingham, Birmingham, Alabama.
| |
Collapse
|
13
|
Yu J, Li H, Liu Z, Wang T, Zhou F, Ma S, Chen B, Chen W. Meat Intake and the Risk of Bladder Cancer: A Systematic Review and Meta-Analysis of Observational Studies. Nutr Cancer 2023; 75:825-845. [PMID: 36537666 DOI: 10.1080/01635581.2022.2159043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/18/2023]
Abstract
The evidence for the association between meat intake and the risk of bladder cancer (BC) is still inconclusive. A total of 29 studies involving 1,475,125 participants and 18,836 cases of BC were included in the meta-analysis. Among these studies, 11 reported total meat intake, 20 reported red meat intake, 19 reported processed meat intake, 15 reported white meat intake, and 15 reported fish intake. The results suggested that there was an overall increase in BC risk associated with total meat intake (RR = 1.10; 95% confidence interval: 0.92-1.31; I2 = 55.20%; P = 0.014), and a higher red meat (RR = 1.23; 95% CI: 1.08-1.39; I2 = 51.30%; P = 0.004) or processed meat (RR = 1.16; 95% CI: 1.08-1.25; I2 = 28.00%; P = 0.125) intake may increase the risk of BC. In contrast, a higher intake of fish (RR = 0.80; 95% CI: 0.67-0.95; I2 = 62.90%; P = 0.001) was inversely associated with the risk of BC. Moreover, we did not observe an association between white meat (RR = 0.96; 95% CI: 0.83-1.10; I2 = 53.70%; P = 0.007) and the risk of BC. Our findings suggested that dietary intervention may be an effective approach to preventing BC, which still needs to be confirmed by further well-designed observational studies.
Collapse
Affiliation(s)
- Jinchuan Yu
- Department of Nutrition and Food Hygiene, School of Public Health, Anhui Medical University, Hefei, China
| | - Haigui Li
- Department of Nutrition and Food Hygiene, School of Public Health, Anhui Medical University, Hefei, China
| | - Zhengxiang Liu
- Department of Nutrition and Food Hygiene, School of Public Health, Anhui Medical University, Hefei, China
| | - Ting Wang
- Department of Nutrition and Food Hygiene, School of Public Health, Anhui Medical University, Hefei, China
| | - Fuding Zhou
- Department of Nutrition and Food Hygiene, School of Public Health, Anhui Medical University, Hefei, China
| | - Shaodi Ma
- Department of Epidemiology and Health Statistics, School of Public Health, Anhui Medical University, Hefei, China
| | - Baochun Chen
- Department of Anhui No.2 Provincial People' Hospital, Hefei, China
| | - Wenjun Chen
- Department of Nutrition and Food Hygiene, School of Public Health, Anhui Medical University, Hefei, China
| |
Collapse
|
14
|
Hasan S, Lazarev S, Garg M, Mehta K, Press RH, Chhabra A, Choi JI, Simone CB, Gorovets D. Racial inequity and other social disparities in the diagnosis and management of bladder cancer. Cancer Med 2023; 12:640-650. [PMID: 35674112 PMCID: PMC9844648 DOI: 10.1002/cam4.4917] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2021] [Revised: 03/28/2022] [Accepted: 05/04/2022] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND We investigate the impact of gender, race, and socioeconomic status on the diagnosis and management of bladder cancer in the United States. METHODS We utilized the National Cancer Database to stratify cases of urothelial cell carcinoma of the bladder as early (Tis, Ta, T1), muscle invasive (T2-T3, N0), locally advanced (T4, N1-3), and metastatic. Multivariate binomial and multinomial logistic regression analyses identified demographic characteristics associated with stage at diagnosis and receipt of cancer-directed therapies. Odds ratios (OR) are reported with 95% confidence intervals. RESULTS After exclusions, we identified 331,714 early, 72,154 muscle invasive, 15,579 locally advanced, and 15,161 metastatic cases from 2004-2016. Relative to diagnosis at early stage, the strongest independent predictors of diagnosis at muscle invasive, locally advanced, and metastatic disease included Black race (OR = 1.19 [1.15-1.23], OR = 1.49 [1.40-1.59], OR = 1.66 [1.56-1.76], respectively), female gender (OR = 1.21 [1.18-1.21], OR = 1.16 [1.12-1.20], and OR = 1.34 [1.29-1.38], respectively), and uninsured status (OR = 1.22 [1.15-1.29], OR = 2.09 [1.94-2.25], OR = 2.57 [2.39-2.75], respectively). Additional demographic factors associated with delayed diagnosis included older age, treatment at an academic center, Medicaid insurance and patients from lower income/less educated/more rural areas (all p < 0.01). Treatment at a non-academic center, older age, women, Hispanic and Black patients, lower income and rural areas were all less likely to receive cancer-directed therapies in early stage disease (all p < 0.01). Women, older patients, and Black patients remained less likely to receive treatment in muscle invasive, locally advanced, and metastatic disease (all p < 0.01). CONCLUSION Black race was the strongest independent predictor of delayed diagnosis and substandard treatment of bladder cancer.
Collapse
Affiliation(s)
- Shaakir Hasan
- The New York Proton CenterNew YorkNew YorkUSA
- Montefiore Medical Center, Department of Radiation OncologyBronxNew YorkUSA
| | - Stanislav Lazarev
- Mount Sinai Medical Center, Department of Radiation OncologyNew YorkNew YorkUSA
| | - Madhur Garg
- Montefiore Medical Center, Department of Radiation OncologyBronxNew YorkUSA
| | - Keyur Mehta
- Montefiore Medical Center, Department of Radiation OncologyBronxNew YorkUSA
| | - Robert H. Press
- The New York Proton CenterNew YorkNew YorkUSA
- Mount Sinai Medical Center, Department of Radiation OncologyNew YorkNew YorkUSA
| | | | - J. Isabelle Choi
- The New York Proton CenterNew YorkNew YorkUSA
- Memorial Sloan Kettering Cancer Center, Department of Radiation OncologyNew YorkNew YorkUSA
| | - Charles B. Simone
- The New York Proton CenterNew YorkNew YorkUSA
- Memorial Sloan Kettering Cancer Center, Department of Radiation OncologyNew YorkNew YorkUSA
| | - Daniel Gorovets
- Memorial Sloan Kettering Cancer Center, Department of Radiation OncologyNew YorkNew YorkUSA
| |
Collapse
|
15
|
Lobo N, Afferi L, Moschini M, Mostafid H, Porten S, Psutka SP, Gupta S, Smith AB, Williams SB, Lotan Y. Epidemiology, Screening, and Prevention of Bladder Cancer. Eur Urol Oncol 2022; 5:628-639. [PMID: 36333236 DOI: 10.1016/j.euo.2022.10.003] [Citation(s) in RCA: 66] [Impact Index Per Article: 33.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2022] [Revised: 09/09/2022] [Accepted: 10/10/2022] [Indexed: 11/05/2022]
Abstract
CONTEXT Bladder cancer (BC) represents a significant health problem due to the potential morbidity and mortality associated with disease burden, which has remained largely unaltered over time. OBJECTIVE To provide an expert collaborative review and describe the incidence, prevalence, and mortality of BC and to evaluate current evidence for BC screening and prevention. EVIDENCE ACQUISITION Data on the estimated incidence and mortality of BC for 2020 in 185 countries were derived from the International Agency for Research on Cancer GLOBOCAN database. A review of English-language articles published over the past 5 yr was conducted using PubMed/MEDLINE to identify risk factors in addition to contemporary evidence on BC screening and prevention. EVIDENCE SYNTHESIS BC is the tenth most common cancer worldwide, with 573 278 cases in 2020. BC incidence is approximately fourfold higher in men than women. Tobacco smoking remains the principal risk factor, accounting for approximately 50% of cases. There is insufficient evidence to recommend routine BC screening. However, targeted screening of high-risk individuals (defined according to smoking history or occupational exposure) may reduce BC mortality and should be the focus of prospective randomized trials. In terms of disease prevention, smoking cessation represents the most important intervention, followed by a reduction in exposure to occupational and environmental carcinogens. CONCLUSIONS BC confers a significant disease burden. An understanding of BC epidemiology and risk factors provides an optimal foundation for disease prevention and the care of affected patients. PATIENT SUMMARY Bladder cancer is the tenth most common cancer worldwide and is approximately four times more common among men than among women. The main risk factors are tobacco smoking, followed by exposure to carcinogens in the workplace or the environment. Routine screening is not currently recommended, but may be beneficial in individuals at high risk, such as heavy smokers. Primary prevention is extremely important, and smoking cessation represents the most important action for reducing bladder cancer cases and deaths.
Collapse
Affiliation(s)
- Niyati Lobo
- Royal Surrey NHS Foundation Trust, Guildford, UK
| | | | - Marco Moschini
- Urological Research Institute, IRCCS San Raffaele Hospital, Milan, Italy
| | | | - Sima Porten
- University of California-San Francisco, San Francisco, CA, USA
| | - Sarah P Psutka
- University of Washington, Fred Hutchinson Cancer Center, Seattle, WA, USA
| | | | - Angela B Smith
- University of North Carolina Lineberger Comprehensive Cancer Center, Chapel Hill, NC, USA
| | | | - Yair Lotan
- University of Texas Southwestern Medical Centre, Dallas, TX, USA.
| |
Collapse
|
16
|
Estevez A, Kaul S, Fleishman A, Korets R, Chang P, Wagner A, Bellmunt J, Olumi AF, Rayala H, Gershman B. Disparities in the prevalence and management of high-risk non-muscle invasive bladder cancer. Urol Oncol 2022; 41:255.e15-255.e21. [PMID: 36456453 DOI: 10.1016/j.urolonc.2022.11.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Revised: 10/05/2022] [Accepted: 11/03/2022] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To evaluate the associations of socioeconomic characteristics with the management of non-muscle invasive bladder cancer (NMIBC). METHODS We identified adult patients aged 18 to 89 years with Ta, T1, or Tis NMIBC 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 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 vs. White) patients were more likely to be diagnosed with high-risk 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 guideline recommended intravesical BCG, while those residing in rural and higher education level areas were more likely to receive BCG. 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 1.07, 6.98 vs. private) were associated with radiotherapy use. CONCLUSION There are strong disparities in the prevalence and management of high-risk NMIBC. These observations highlight important targets for future strategies to reduce such healthcare disparities and provide more equitable bladder cancer treatment to patients.
Collapse
|
17
|
Kami Reddy KR, Piyarathna DWB, Kamal AHM, Putluri V, Ravi SS, Bollag RJ, Terris MK, Lotan Y, Putluri N. Lipidomic Profiling Identifies a Novel Lipid Signature Associated with Ethnicity-Specific Disparity of Bladder Cancer. Metabolites 2022; 12:metabo12060544. [PMID: 35736477 PMCID: PMC9230655 DOI: 10.3390/metabo12060544] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Revised: 06/03/2022] [Accepted: 06/09/2022] [Indexed: 11/28/2022] Open
Abstract
Bladder Cancer (BLCA) is the ninth most frequently diagnosed cancer globally and the sixth most common cancer in the US. African Americans (AA) exhibit half the BLCA incidence compared to European Americans (EA), but they have a 70% higher risk of cancer-related death; unfortunately, this disparity in BLCA mortality remains poorly understood. In this study, we have used an ethnicity-balanced cohort for unbiased lipidomics profiling to study the changes in the lipid fingerprint for AA and EA BLCA tissues collected from similar geographical regions to determine a signature of ethnic-specific alterations. We identified 86 lipids significantly altered between self-reported AA and EA BLCA patients from Augusta University (AU) cohort. The majority of altered lipids belong to phosphatidylcholines (PCs), phosphatidylethanolamines (PEs), ly sophosphatidylcholines (lysoPCs), phosphatidylserines (PSs), and diglycerides (DGs). Interestingly, levels of four lysoPCs (lyso PCs 20:3, lyso PCs 22:1, lyso PCs 22:2, and lyso PCs 26:1) were elevated while, in contrast, the majority of the PCs were reduced in AA BLCA. Significant alterations in long-chain monounsaturated (MonoUN) and polyunsaturated (PolyUN) lipids were also observed between AA and EA BLCA tumor tissues. These first-in-field results implicate ethnic-specific lipid alterations in BLCA.
Collapse
Affiliation(s)
- Karthik Reddy Kami Reddy
- Department of Molecular and Cellular Biology, Baylor College of Medicine, One Baylor Plaza, Houston, TX 77030, USA; (K.R.K.R.); (D.W.B.P.); (S.S.R.)
| | | | - Abu Hena Mostafa Kamal
- Advanced Technology Cores, Dan L Duncan Comprehensive Cancer Center, Baylor College of Medicine, One Baylor Plaza, Houston, TX 77030, USA; (A.H.M.K.); (V.P.)
| | - Vasanta Putluri
- Advanced Technology Cores, Dan L Duncan Comprehensive Cancer Center, Baylor College of Medicine, One Baylor Plaza, Houston, TX 77030, USA; (A.H.M.K.); (V.P.)
| | - Shiva Shankar Ravi
- Department of Molecular and Cellular Biology, Baylor College of Medicine, One Baylor Plaza, Houston, TX 77030, USA; (K.R.K.R.); (D.W.B.P.); (S.S.R.)
| | - Roni J. Bollag
- Georgia Cancer Center, Augusta University, Augusta, GA 30912, USA; (R.J.B.); (M.K.T.)
| | - Martha K. Terris
- Georgia Cancer Center, Augusta University, Augusta, GA 30912, USA; (R.J.B.); (M.K.T.)
| | - Yair Lotan
- Department of Urology, University of Texas Southwestern, Dallas, TX 75390, USA;
| | - Nagireddy Putluri
- Department of Molecular and Cellular Biology, Baylor College of Medicine, One Baylor Plaza, Houston, TX 77030, USA; (K.R.K.R.); (D.W.B.P.); (S.S.R.)
- Advanced Technology Cores, Dan L Duncan Comprehensive Cancer Center, Baylor College of Medicine, One Baylor Plaza, Houston, TX 77030, USA; (A.H.M.K.); (V.P.)
- Correspondence:
| |
Collapse
|
18
|
Exarchakou A, Kipourou DK, Belot A, Rachet B. Socio-economic inequalities in cancer survival: how do they translate into Number of Life-Years Lost? Br J Cancer 2022; 126:1490-1498. [PMID: 35149855 PMCID: PMC9090931 DOI: 10.1038/s41416-022-01720-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Revised: 01/15/2022] [Accepted: 01/26/2022] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND We aimed to investigate the impact of socio-economic inequalities in cancer survival in England on the Number of Life-Years Lost (NLYL) due to cancer. METHODS We analysed 1.2 million patients diagnosed with one of the 23 most common cancers (92.3% of all incident cancers in England) between 2010 and 2014. Socio-economic deprivation of patients was based on the income domain of the English Index of Deprivation. We estimated the NLYL due to cancer within 3 years since diagnosis for each cancer and stratified by sex, age and deprivation, using a non-parametric approach. The relative survival framework enables us to disentangle death from cancer and death from other causes without the information on the cause of death. RESULTS The largest socio-economic inequalities were seen mostly in adults <45 years with poor-prognosis cancers. In this age group, the most deprived patients with lung, pancreatic and oesophageal cancer lost up to 6 additional months within 3 years since diagnosis than the least deprived. For most moderate/good prognosis cancers, the socio-economic inequalities widened with age. CONCLUSIONS More deprived patients and particularly the young with more lethal cancers, lose systematically more life-years than the less deprived. To reduce these inequalities, cancer policies should systematically encompass the inequities component.
Collapse
Affiliation(s)
- Aimilia Exarchakou
- Inequalities in Cancer Outcomes Network (ICON), Department of Non-Communicable Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK.
| | - Dimitra-Kleio Kipourou
- Inequalities in Cancer Outcomes Network (ICON), Department of Non-Communicable Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK
| | - Aurélien Belot
- Inequalities in Cancer Outcomes Network (ICON), Department of Non-Communicable Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK
| | - Bernard Rachet
- Inequalities in Cancer Outcomes Network (ICON), Department of Non-Communicable Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK
| |
Collapse
|
19
|
About Time: Assessing Time Spent in Urology Ambulatory Visits and Patient Race. Urology 2022; 162:68-69. [DOI: 10.1016/j.urology.2021.06.047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Accepted: 06/30/2021] [Indexed: 11/24/2022]
|
20
|
Treatment disparities in muscle-invasive bladder cancer: Evidence from a large statewide cancer registry. Urol Oncol 2022; 40:164.e17-164.e23. [DOI: 10.1016/j.urolonc.2021.12.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Revised: 11/18/2021] [Accepted: 12/09/2021] [Indexed: 11/19/2022]
|
21
|
Mehmood S, Alothman K, Al Rumayyan M, Altaweel W, Alhussain T. Clinical behavior and survival outcome of urothelial bladder cancer in young adults. Urol Ann 2022; 14:162-166. [PMID: 35711476 PMCID: PMC9197011 DOI: 10.4103/ua.ua_15_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Accepted: 09/22/2021] [Indexed: 11/05/2022] Open
Abstract
Background: Bladder cancer (BC) is rare in young adults and therefore natural history of BC is still debatable. This study aimed to determine clinical behavior and prognosis of BC in patients <40 years. Materials and Methods: We reviewed patients (<40 years) managed with urothelial BC from 2003 to 2019. Patients with nonurothelial histology were excluded. Clinical behavior and prognosis such as recurrence, progression, and survival were assessed. The recurrence is defined as a newly diagnosed occurrence of BC at previous or new site(s). Cancer progression is defined as an increase in staging or grade. Results: Fifty-five patients inclusive of 45 males and 10 females with a median age of 30.0 (interquartile range [IQR] 25.0–33.0) years were included. The median follow-up was 3.5 (IQR: 1.5–7.0) years. Fifty-one (92.72%) patients were diagnosed with nonmuscle-invasive BC while four (7.27%) patients were diagnosed with muscle-invasive disease. Three out of four patients with muscle-invasive BC died of metastatic disease. According to stage and grade, there were 42 (76.36%) Ta, 9 (16.36%) T1 and 4 (7.27%) having T2 stage while 41 (74.54%) low grade and 14 (25.45%) were having high grade disease. Thirty-six (65.45%) patients remained stable, 13 (26.63%) patients progressed, and 6 (10.90%) patients regressed to lower stage and grade. Higher stage and grade (P = 0.0431) and tumor size >3 cm (P = 0.0454) were significant for recurrence, and higher stage and grade (P = 0.0012) and tumor size >3 cm (P = 0.0055) were associated with tumor progression. Conclusion: BC in younger adults is mostly low stage and low grade. We should be vigilant in patients with higher stage and grade as it is related with recurrence, progression, and metastatic disease.
Collapse
|
22
|
Cooke IJ, Patil D, Bobrek K, Narayan V, Master V, Rapaport M, Filson CP, Joshi SS. Longitudinal impact of bladder cancer diagnosis on common psychiatric disorders. Cancer Med 2021; 10:8412-8420. [PMID: 34773389 PMCID: PMC8633250 DOI: 10.1002/cam4.4346] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Revised: 09/13/2021] [Accepted: 09/17/2021] [Indexed: 11/30/2022] Open
Abstract
Background The presence of psychiatric disorders in patients with cancer is associated with increased morbidity and poorer outcomes. We sought to determine the impact of a new bladder cancer diagnosis on the incidence of depression and anxiety. Methods We used a database of billing claims (MarketScan®) to identify patients newly diagnosed with bladder cancer between 2009 and 2018. Patients with preexisting psychiatric disorders or use of anxiolytics/antidepressants were excluded. We matched cases to patients without a bladder cancer or psychiatric diagnosis. Our primary outcome was a new diagnosis of depression, anxiety, or use of anxiolytics/antidepressants. Other exposures of interest included gender and treatment received. We used multivariable regression to estimate odds ratios for these exposures. Results We identified 65,846 cases with a new diagnosis of bladder cancer (31,367 privately insured; 34,479 Medicare‐eligible). Compared to controls, bladder cancer patients were more likely to develop new‐onset depression/anxiety at 6 months (privately insured: 6.9% vs. 3.4%, p < 0.001; Medicare‐eligible: 5.7% vs. 3.4%, p < 0.001) and 36 months (privately insured: 19.2% vs. 13.5%, p < 0.001; Medicare‐eligible: 19.3% vs. 16.0%, p < 0.001). Women (vs. men, privately insured: OR 1.65, 95%CI 1.53–1.78; Medicare‐eligible: OR 1.63, 95%CI 1.50–1.76) and those receiving cystectomy and chemotherapy (vs. no treatment, privately insured: OR 4.94, 95%CI 4.13–5.90; Medicare‐eligible: OR 2.35, 95%CI 1.88–2.94) were more likely to develop significant depression/anxiety. Conclusion A new diagnosis of bladder cancer was associated with increased burden of significant depression/anxiety compared with matched controls. Women and patients receiving more radical treatments had higher rates of depression and anxiety.
Collapse
Affiliation(s)
- Ian J Cooke
- Department of Urology, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Dattatraya Patil
- Department of Urology, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Katherine Bobrek
- Department of Urology, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Vikram Narayan
- Department of Urology, Emory University School of Medicine, Atlanta, Georgia, USA.,Winship Cancer Institute, Atlanta, Georgia, USA
| | - Viraj Master
- Department of Urology, Emory University School of Medicine, Atlanta, Georgia, USA.,Winship Cancer Institute, Atlanta, Georgia, USA
| | - Mark Rapaport
- Department of Psychiatry, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Christopher P Filson
- Department of Urology, Emory University School of Medicine, Atlanta, Georgia, USA.,Winship Cancer Institute, Atlanta, Georgia, USA
| | - Shreyas S Joshi
- Department of Urology, Emory University School of Medicine, Atlanta, Georgia, USA.,Winship Cancer Institute, Atlanta, Georgia, USA
| |
Collapse
|
23
|
Almubarak AA, Albkiry YA, Alsalem AA, Elkrim Saad MA. The association of low socioeconomic status with advanced stage thyroid cancer. J Taibah Univ Med Sci 2021; 16:482-490. [PMID: 34408604 PMCID: PMC8348293 DOI: 10.1016/j.jtumed.2021.04.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Revised: 04/10/2021] [Accepted: 04/12/2021] [Indexed: 11/25/2022] Open
Abstract
Objectives This study investigates the link between low socioeconomic status (SES) and advanced thyroid cancer at the time of detection. It also assesses the socioeconomic variables that may potentially affect the stage of thyroid cancer at presentation. Methods This retrospective cohort study was conducted on patients with thyroid cancer between January 2016 and April 2020. The data were collected using the patients' medical records from the hospital information system (BESTcare) and through interview-based surveys. To assess the factors predicting the stage of advanced thyroid cancer, socioeconomic status (SES) predictors like area of residency, educational level, income, and marital status were collected. Results A total of 220 patients with thyroid cancer were included in this study. Male patients (p = 0.025), older than 55 years (p < 0.001), living in rural areas (p = 0.002), with low educational level (p = 0.021) were found to be significantly associated with advanced-stage thyroid cancer at presentation. Multivariate analysis showed that gender (men) and age (above 55 years) were significant predictors of advanced stage thyroid cancer. However, no association between income and the stage of thyroid cancer has been found in this study. Conclusion This study has shown that even in a country like KSA with a strong government-funded healthcare system, health disparity among people battling thyroid cancer exists. Our study has found that SES factors have a significant impact on the stage of thyroid cancer at the time of presentation, whereas the economic status of the patients had no impact on the stage of thyroid cancer. Furthermore, patients in lower SES groups were diagnosed with more advanced stages at presentation.
Collapse
Affiliation(s)
- Ali A Almubarak
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, KSA
| | - Yara A Albkiry
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, KSA
| | - Abdulaziz A Alsalem
- Division of Otorhinolaryngology-Head and Neck Surgery, Department of Surgery, King Abdulaziz Medical City, National Guard-Health Affairs, Riyadh, KSA
| | - Mohammed A Elkrim Saad
- Division of Otorhinolaryngology-Head and Neck Surgery, Department of Surgery, King Abdulaziz Medical City, National Guard-Health Affairs, Riyadh, KSA
| |
Collapse
|
24
|
He H, Liu T, Han D, Li C, Xu F, Lyu J, Gao Y. Incidence trends and survival prediction of urothelial cancer of the bladder: a population-based study. World J Surg Oncol 2021; 19:221. [PMID: 34311753 PMCID: PMC8314553 DOI: 10.1186/s12957-021-02327-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2021] [Accepted: 07/03/2021] [Indexed: 11/25/2022] Open
Abstract
Background The aim of this study is to determine the incidence trends of urothelial cancer of the bladder (UCB) and to develop a nomogram for predicting the cancer-specific survival (CSS) of postsurgery UCB at a population-based level based on the SEER database. Methods The age-adjusted incidence of UCB diagnosed from 1975 to 2016 was extracted, and its annual percentage change was calculated and joinpoint regression analysis was performed. A nomogram was constructed for predicting the CSS in individual cases based on independent predictors. The predictive performance of the nomogram was evaluated using the consistency index (C-index), net reclassification index (NRI), integrated discrimination improvement (IDI), a calibration plot and the receiver operating characteristics (ROC) curve. Results The incidence of UCB showed a trend of first increasing and then decreasing from 1975 to 2016. However, the overall incidence increased over that time period. The age at diagnosis, ethnic group, insurance status, marital status, differentiated grade, AJCC stage, regional lymph nodes removed status, chemotherapy status, and tumor size were independent prognostic factors for postsurgery UCB. The nomogram constructed based on these independent factors performed well, with a C-index of 0.823 and a close fit to the calibration curve. Its prediction ability for CSS of postsurgery UCB is better than that of the existing AJCC system, with NRI and IDI values greater than 0 and ROC curves exhibiting good performance for 3, 5, and 8 years of follow-up. Conclusions The nomogram constructed in this study might be suitable for clinical use in improving the clinical predictive accuracy of the long-term survival for postsurgery UCB.
Collapse
Affiliation(s)
- Hairong He
- Clinical Research Center, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, People's Republic of China.,School of Public Health, Xi'an Jiaotong University Health Science Center, Xi'an, Shaanxi, People's Republic of China
| | - Tianjie Liu
- Department of Urology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, People's Republic of China
| | - Didi Han
- School of Public Health, Xi'an Jiaotong University Health Science Center, Xi'an, Shaanxi, People's Republic of China
| | - Chengzhuo Li
- School of Public Health, Xi'an Jiaotong University Health Science Center, Xi'an, Shaanxi, People's Republic of China
| | - Fengshuo Xu
- School of Public Health, Xi'an Jiaotong University Health Science Center, Xi'an, Shaanxi, People's Republic of China
| | - Jun Lyu
- School of Public Health, Xi'an Jiaotong University Health Science Center, Xi'an, Shaanxi, People's Republic of China.,Department of Clinical Research, The First Affiliated Hospital of Jinan University, Guangzhou, People's Republic of China
| | - Ye Gao
- Department of Emergency, The First Affiliated Hospital of Xi'an Jiaotong University, 277 West Yanta Road, Xi'an, Shaanxi, 710061, People's Republic of China.
| |
Collapse
|
25
|
Lawler C, Gu L, Howard LE, Branche B, Wiggins E, Srinivasan A, Foster ML, Klaassen Z, De Hoedt AM, Gingrich JR, Theodorescu D, Freedland SJ, Williams SB. The impact of the social construct of race on outcomes among bacille Calmette-Guérin-treated patients with high-risk non-muscle-invasive bladder cancer in an equal-access setting. Cancer 2021; 127:3998-4005. [PMID: 34237155 DOI: 10.1002/cncr.33792] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Revised: 05/24/2021] [Accepted: 06/04/2021] [Indexed: 11/08/2022]
Abstract
BACKGROUND The objective of this study was to describe bladder cancer outcomes as a function of race among patients with high-risk non-muscle-invasive bladder cancer (NMIBC) in an equal-access setting. METHODS A total of 412 patients with high-risk NMIBC who received bacille Calmette-Guérin (BCG) from January 1, 2010, to December 31, 2015, were assessed. The authors used the Kaplan-Meier method to estimate event-free survival and Cox regression to determine the association between race and recurrence, progression, disease-specific, and overall survival outcomes. RESULTS A total of 372 patients who had complete data were included in the analysis; 48 (13%) and 324 (87%) were Black and White, respectively. There was no difference in age, sex, smoking status, or Charlson Comorbidity Index by race. White patients had a higher socioeconomic status with a greater percentage of patients living above the poverty level in comparison with Black patients (median, 85% vs 77%; P < .001). A total of 360 patients (97%) received adequate induction BCG, and 145 patients (39%) received adequate maintenance BCG therapy. There was no significant difference in rates of adequate induction or maintenance BCG therapy according to race. There was no significant difference in recurrence (hazard ratio [HR], 1.53; 95% confidence interval [CI], 0.64-3.63), progression (HR, 0.77; 95% CI, 0.33-1.82), bladder cancer-specific survival (HR, 1.01; 95% CI, 0.30-3.46), or overall survival (HR, 0.97; 95% CI, 0.56-1.66) according to Black race versus White race. CONCLUSIONS In this small study from an equal-access setting, there was no difference in the receipt of BCG or any differences in bladder cancer outcomes according to race.
Collapse
Affiliation(s)
- Corinne Lawler
- Department of Surgery, Durham Veterans Affairs Health Care System, Durham, North Carolina
| | - Lin Gu
- Department of Surgery, Durham Veterans Affairs Health Care System, Durham, North Carolina.,Biostatistics Shared Resource, Duke Cancer Institute, Durham, North Carolina
| | - Lauren E Howard
- Department of Surgery, Durham Veterans Affairs Health Care System, Durham, North Carolina.,Biostatistics Shared Resource, Duke Cancer Institute, Durham, North Carolina
| | - Brandee Branche
- Department of Urology, Virginia Commonwealth University School of Medicine, Richmond, Virginia
| | - Emily Wiggins
- Department of Surgery, Durham Veterans Affairs Health Care System, Durham, North Carolina
| | - Aditya Srinivasan
- Department of Surgery, Durham Veterans Affairs Health Care System, Durham, North Carolina.,Division of Urology, The University of Texas Medical Branch, Galveston, Texas
| | - Meagan L Foster
- Department of Surgery, Durham Veterans Affairs Health Care System, Durham, North Carolina
| | - Zachary Klaassen
- Section of Urology, Department of Surgery, Augusta University-Medical College of Georgia, Augusta, Georgia
| | - Amanda M De Hoedt
- Department of Surgery, Durham Veterans Affairs Health Care System, Durham, North Carolina
| | - Jeffrey R Gingrich
- Department of Surgery, Durham Veterans Affairs Health Care System, Durham, North Carolina
| | - Dan Theodorescu
- Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, California
| | - Stephen J Freedland
- Department of Surgery, Durham Veterans Affairs Health Care System, Durham, North Carolina.,Division of Urology, Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, California.,Center for Integrated Research on Cancer and Lifestyle, Cedars-Sinai Medical Center, Los Angeles, California
| | - Stephen B Williams
- Department of Surgery, Durham Veterans Affairs Health Care System, Durham, North Carolina.,Division of Urology, The University of Texas Medical Branch, Galveston, Texas
| |
Collapse
|
26
|
Wolff DT, Monaghan TF, Gordon DJ, Michelson KP, Jones T, Khargi R, Smith MT, Maffucci F, Kwun H, Suss NR, Winer AG. Racial Differences in Incident Genitourinary Cancer Cases Captured in the National Cancer Database. ACTA ACUST UNITED AC 2021; 57:medicina57070671. [PMID: 34209546 PMCID: PMC8303448 DOI: 10.3390/medicina57070671] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2021] [Revised: 06/18/2021] [Accepted: 06/22/2021] [Indexed: 11/16/2022]
Abstract
Background and Objectives: The National Cancer Database (NCDB) captures nearly 70% of all new cancer diagnoses in the United States, but there exists significant variation in this capture rate based on primary tumor location and other patient demographic factors. Prostate cancer has the lowest coverage rate of all major cancers, and other genitourinary malignancies likewise fall below the average NCDB case coverage rate. We aimed to explore NCDB coverage rates for patients with genitourinary cancers as a function of race. Materials and Methods: We compared the incidence of cancer cases in the NCDB with contemporary United States Cancer Statistics data. Results: Across all malignancies, American Indian/Alaskan Natives subjects demonstrated the lowest capture rates, and Asian/Pacific Islander subjects exhibited the second-lowest capture rates. Between White and Black subjects, capture rates were significantly higher for White subjects overall and for prostate cancer and kidney cancer in White males, but significantly higher for bladder cancer in Black versus White females. No significant differences were observed in coverage rates for kidney cancer in females, bladder cancer in males, penile cancer, or testicular cancer in White versus Black patients. Conclusions: Differential access to Commission on Cancer-accredited treatment facilities for racial minorities with genitourinary cancer constitutes a unique avenue for health equity research.
Collapse
Affiliation(s)
- Dylan T. Wolff
- Department of Urology, Wake Forest School of Medicine, Winston-Salem, NC 27101, USA;
| | - Thomas F. Monaghan
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX 75390, USA
- Correspondence:
| | - Danielle J. Gordon
- Department of Urology, SUNY Downstate Health Sciences University, Brooklyn, NY 11203, USA; (D.J.G.); (R.K.); (M.T.S.); (A.G.W.)
- Department of Urology, Kings County Hospital Center, Brooklyn, NY 11203, USA
| | - Kyle P. Michelson
- Department of Urology, University of South Florida, Tampa, FL 33606, USA;
| | - Tashzna Jones
- Department of Urology, Yale University School of Medicine, New Haven, CT 06520, USA;
| | - Raymond Khargi
- Department of Urology, SUNY Downstate Health Sciences University, Brooklyn, NY 11203, USA; (D.J.G.); (R.K.); (M.T.S.); (A.G.W.)
- Department of Urology, Kings County Hospital Center, Brooklyn, NY 11203, USA
| | - Matthew T. Smith
- Department of Urology, SUNY Downstate Health Sciences University, Brooklyn, NY 11203, USA; (D.J.G.); (R.K.); (M.T.S.); (A.G.W.)
- Department of Urology, Kings County Hospital Center, Brooklyn, NY 11203, USA
| | - Fenizia Maffucci
- Department of Urology, Temple University Hospital, Philadelphia, PA 19104, USA;
| | - Hyezo Kwun
- Division of Urology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA 19104, USA;
| | - Nicholas R. Suss
- Department of Surgery, University of Chicago, Chicago, IL 60637, USA;
| | - Andrew G. Winer
- Department of Urology, SUNY Downstate Health Sciences University, Brooklyn, NY 11203, USA; (D.J.G.); (R.K.); (M.T.S.); (A.G.W.)
- Department of Urology, Kings County Hospital Center, Brooklyn, NY 11203, USA
| |
Collapse
|
27
|
Michel KF, Spaulding A, Jemal A, Yabroff KR, Lee DJ, Han X. Associations of Medicaid Expansion With Insurance Coverage, Stage at Diagnosis, and Treatment Among Patients With Genitourinary Malignant Neoplasms. JAMA Netw Open 2021; 4:e217051. [PMID: 34009349 PMCID: PMC8134994 DOI: 10.1001/jamanetworkopen.2021.7051] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
IMPORTANCE Health insurance coverage is associated with improved outcomes in patients with cancer. However, it is unknown whether Medicaid expansion through the Patient Protection and Affordable Care Act (ACA) was associated with improvements in the diagnosis and treatment of patients with genitourinary cancer. OBJECTIVE To assess the association of Medicaid expansion with health insurance status, stage at diagnosis, and receipt of treatment among nonelderly patients with newly diagnosed kidney, bladder, or prostate cancer. DESIGN, SETTING, AND PARTICIPANTS This case-control study included adults aged 18 to 64 years with a new primary diagnosis of kidney, bladder, or prostate cancer, selected from the National Cancer Database from January 1, 2011, to December 31, 2016. Patients in states that expanded Medicaid were the case group, and patients in nonexpansion states were the control group. Data were analyzed from January 2020 to March 2021. EXPOSURES State Medicaid expansion status. MAIN OUTCOMES AND MEASURES Insurance status, stage at diagnosis, and receipt of cancer and stage-specific treatments. Cases and controls were compared with difference-in-difference analyses. RESULTS Among a total of 340 552 patients with newly diagnosed genitourinary cancers, 94 033 (27.6%) had kidney cancer, 25 770 (7.6%) had bladder cancer, and 220 749 (64.8%) had prostate cancer. Medicaid expansion was associated with a net decrease in uninsured rate of 1.1 (95% CI, -1.4 to -0.8) percentage points across all incomes and a net decrease in the low-income population of 4.4 (95% CI, -5.7 to -3.0) percentage points compared with nonexpansion states. Expansion was also associated with a significant shift toward early-stage diagnosis in kidney cancer across all income levels (difference-in-difference, 1.4 [95% CI, 0.1 to 2.6] percentage points) and among individuals with low income (difference-in-difference, 4.6 [95% CI, 0.3 to 9.0] percentage points) and in prostate cancer among individuals with low income (difference-in-difference, 3.0 [95% CI, 0.3 to 5.7] percentage points). Additionally, there was a net increase associated with expansion compared with nonexpansion in receipt of active surveillance for low-risk prostate cancer of 4.1 (95% CI, 2.9 to 5.3) percentage points across incomes and 4.5 (95% CI, 0 to 9.0) percentage points among patients in low-income areas. CONCLUSIONS AND RELEVANCE These findings suggest that Medicaid expansion was associated with decreases in uninsured status, increases in the proportion of kidney and prostate cancer diagnosed in an early stage, and higher rates of active surveillance in the appropriate, low-risk prostate cancer population. Associations were concentrated in population residing in low-income areas and reinforce the importance of improving access to care to all patients with cancer.
Collapse
Affiliation(s)
- Katharine F. Michel
- University of Pennsylvania Perelman School of Medicine, Philadelphia
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia
| | - Aleigha Spaulding
- Surveillance and Health Equity Science, American Cancer Society, Atlanta, Georgia
- Department of Biostatistics and Epidemiology, College of Public Health, East Tennessee State University, Johnson City
| | - Ahmedin Jemal
- Surveillance and Health Equity Science, American Cancer Society, Atlanta, Georgia
| | - K. Robin Yabroff
- Surveillance and Health Equity Science, American Cancer Society, Atlanta, Georgia
| | - Daniel J. Lee
- University of Pennsylvania Perelman School of Medicine, Philadelphia
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia
| | - Xuesong Han
- Surveillance and Health Equity Science, American Cancer Society, Atlanta, Georgia
| |
Collapse
|
28
|
Zhou Q, Yu J, Zheng Q, Wu T, Ji Z, Zhuo Y. Kinesin family member 3A stimulates cell proliferation, migration, and invasion of bladder cancer cells in vitro and in vivo. FEBS Open Bio 2021; 11:1487-1496. [PMID: 31774623 PMCID: PMC8091814 DOI: 10.1002/2211-5463.12768] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2019] [Revised: 11/13/2019] [Accepted: 11/25/2019] [Indexed: 12/21/2022] Open
Abstract
Bladder cancer is one of the most common malignant tumors of the urinary system, with high morbidity and mortality. At present, the survival rates and prognosis of patients with bladder cancer are still relatively low; thus, there remains a need to improve prognosis by identifying novel targets. Kinesins (kinesin superfamily proteins) are a series of microtubule-based motor proteins that mediate various types of cellular processes. Kinesin family member 3A (KIF3A) is critical for cytoplasm separation in mitosis, and it has been reported to be misexpressed in multiple types of cancer. However, its effects on the progression and development of bladder cancer remain unclear. Herein, we report that KIF3A is highly expressed in human bladder cancer. We identified a significant correlation between KIF3A and clinical features, including clinical stage (P = 0.047), pathological tumor status (P = 0.045), lymph node status (P = 0.041) and metastasis (P = 0.035). KIF3A expression was also correlated with poor prognosis of patients with bladder cancer. Our results further indicated that KIF3A ablation resulted in cell cycle arrest; blocked the proliferation, migration and invasion of bladder cancer cells in vitro; and restrained tumor growth in mice in a microtubule-dependent manner. In summary, our findings suggest that KIF3A is a potential therapeutic target for bladder cancer.
Collapse
Affiliation(s)
- Qingchun Zhou
- Department of UrologyFirst Affiliated HospitalJinan UniversityGuangzhou CityChina
- Department of UrologyShenzhen HospitalSouthern Medical UniversityShenzhen CityChina
| | - Juan Yu
- Department of Medical ImagingShenzhen Second People's HospitalThe First Affiliated Hospital of Shenzhen UniversityChina
| | - Qingyou Zheng
- Department of UrologyShenzhen HospitalSouthern Medical UniversityShenzhen CityChina
| | - Tao Wu
- Department of UrologyShenzhen HospitalSouthern Medical UniversityShenzhen CityChina
| | - Ziliang Ji
- Department of UrologyShenzhen HospitalSouthern Medical UniversityShenzhen CityChina
| | - Yumin Zhuo
- Department of UrologyFirst Affiliated HospitalJinan UniversityGuangzhou CityChina
| |
Collapse
|
29
|
Tian J, Sun J, Fu G, Xu Z, Chen X, Shi Y, Jin B. Population-based outcome of muscle-invasive bladder cancer following radical cystectomy: who can benefit from adjuvant chemotherapy? Transl Androl Urol 2021; 10:356-373. [PMID: 33532324 PMCID: PMC7844522 DOI: 10.21037/tau-20-960] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
Background The benefit of adjuvant chemotherapy remains controversial in muscle-invasive bladder cancer (MIBC) after radical cystectomy. The present study’s primary objective was to construct a predictive tool for the reasonable application of adjuvant chemotherapy. Methods All of the patients analyzed in the present study were recruited from the Surveillance Epidemiology and End Results program between 2004 and 2015. Propensity score matching (PSM) was used to reduce inherent selection bias. Cox proportional hazards models were applied to identify the independent prognostic factors of overall survival (OS) and cancer-specific survival (CSS), which were further used to construct prognostic nomogram and risk stratification systems to predict survival outcomes. The prognostic nomogram’s performance was assessed by concordance index (C-index), receiver-operating characteristic (ROC) and calibration curves. Decision curve analysis (DCA) was performed to evaluate the clinical net benefit of the prognostic nomogram. Results A total of 6,384 patients with or without adjuvant chemotherapy were included after PSM. Several independent predictors for OS and CSS were identified and further applied to establish a nomogram for 3-, 5- and 10-year, respectively. The nomogram showed favorable discriminative ability for the prediction of OS and CSS, with a C-index of 0.709 [95% confidence interval (CI): 0.699–0.719] for OS and 0.728 (95% CI: 0.718–0.738) for CSS. ROC and calibration curves showed satisfactory consistency. The DCA revealed high clinical positive net benefits of the prognostic nomogram. The different risk stratification systems showed that adjuvant chemotherapy resulted in better OS (P<0.001) and CSS (P<0.001) than without adjuvant chemotherapy for high-risk patients; while the OS (P=0.350) and CSS (P=0.260) for low-risk patients were comparable. Conclusions We have constructed a predictive model and different risk stratifications for selecting a population that could benefit from postoperative adjuvant chemotherapy. Adjuvant chemotherapy was found to be beneficial for high-risk patients, while low-risk patients should be carefully monitored.
Collapse
Affiliation(s)
- Junjie Tian
- Department of Urology, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Junjie Sun
- Department of Urology, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Guanghou Fu
- Department of Urology, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Zhijie Xu
- Department of Urology, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Xiaoyi Chen
- Department of Urology, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Yue Shi
- Department of Urology, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Baiye Jin
- Department of Urology, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| |
Collapse
|
30
|
Wenzel M, Deuker M, Stolzenbach F, Nocera L, Collà Ruvolo C, Tian Z, Shariat SF, Saad F, Briganti A, Kluth LA, Chun FKH, Karakiewicz PI. The effect of race/ethnicity on histological subtype distribution, stage at presentation and cancer specific survival in urethral cancer. Urol Oncol 2020; 39:369.e9-369.e17. [PMID: 33309509 DOI: 10.1016/j.urolonc.2020.11.031] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Revised: 10/28/2020] [Accepted: 11/21/2020] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To test the effect of race/ethnicity on histological subtype, stage at presentation, and cancer specific mortality (CSM) in urethral cancer patients. MATERIAL AND METHODS Stratified analyses (Surveillance, Epidemiology and End Results [2004-2016]) tested the effect of race/ethnicity on histology and stage. Cumulative incidence-plots and multivariable competing-risks regression models (CRR), addressed CSM, after matching for TNM-stage, histology, age, and gender. RESULTS Of 1,904 urethral cancer patients, 71% were Caucasian, 16% African American, 7% Hispanic and 5% other. African Americans were younger (66 years) than Caucasians (73 years) and Hispanics (74 years). In African Americans, adenocarcinoma (25%) and squamous cell carcinoma (SCC; 29%) were more frequent than in Caucasians (12% and 23%) or Hispanics (15% and 20%). African Americans with adenocarcinoma exhibited higher stage than other adenocarcinoma patients. In CRR, African Americans (35%) and Hispanics (29%) exhibited highest and second highest 3-year CSM, even after matching. After further multivariable adjustment of matched CRRs, CSM was higher in Hispanics (HR: 1.93, P= 0.03) and in African Americans (Hazard ratio 1.35, P= 0.07), relative to Caucasians. CONCLUSION Race/ethnicity impacts important differences on urethral cancer patients. African American race/ethnicity predisposes to higher rate of SCC and adenocarcinoma. Moreover, African Americans are younger and present with higher stage at diagnoses. Finally, even after most detailed matching for stage, age, gender, and adjustment for treatment and systemic therapy and socioeconomic status, African Americans and Hispanics exhibit higher CSM than Caucasians.
Collapse
Affiliation(s)
- Mike Wenzel
- Department of Urology, University Hospital Frankfurt, Frankfurt am Main, Germany; Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montréal Health Center, Montréal, Québec, Canada.
| | - Marina Deuker
- Department of Urology, University Hospital Frankfurt, Frankfurt am Main, Germany; Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montréal Health Center, Montréal, Québec, Canada
| | - Franziska Stolzenbach
- Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montréal Health Center, Montréal, Québec, Canada; Martini-Klinik Prostate Cancer Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Luigi Nocera
- Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montréal Health Center, Montréal, Québec, Canada; Division of Experimental Oncology, Department of Urology, URI, Urological Research Institute, IBCAS San Raffaele Scientific Institute, Milan, Italy
| | - Claudia Collà Ruvolo
- Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montréal Health Center, Montréal, Québec, Canada; Department of Neurosciences, Reproductive Sciences and Odontostomatology, University of Naples Federico II, Italy
| | - Zhe Tian
- Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montréal Health Center, Montréal, Québec, Canada
| | - Shahrokh F Shariat
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria; Departments of Urology, Weill Cornell Medical College, New York, NY; Department of Urology, University of Texas Southwestern, Dallas, TX; Department of Urology, Second Faculty of Medicine, Charles University, Prag, Czech Republic; Institute for Urology and Reproductive Health, I.M. Sechenov First Moscow State Medical University, Moscow, Russia; Division of Urology, Department of Special Surgery, Jordan University Hospital, The University of Jordan, Amman, Jordan
| | - Fred Saad
- Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montréal Health Center, Montréal, Québec, Canada
| | - Alberto Briganti
- Division of Experimental Oncology, Department of Urology, URI, Urological Research Institute, IBCAS San Raffaele Scientific Institute, Milan, Italy
| | - Luis A Kluth
- Department of Urology, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Felix K H Chun
- Department of Urology, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Pierre I Karakiewicz
- Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montréal Health Center, Montréal, Québec, Canada
| |
Collapse
|
31
|
Palumbo C, Pecoraro A, Rosiello G, Luzzago S, Deuker M, Stolzenbach F, Tian Z, Shariat SF, Simeone C, Briganti A, Saad F, Berruti A, Antonelli A, Karakiewicz PI. Bladder cancer incidence rates and trends in young adults aged 20-39 years. Urol Oncol 2020; 38:934.e11-934.e19. [DOI: 10.1016/j.urolonc.2020.06.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Revised: 05/08/2020] [Accepted: 06/13/2020] [Indexed: 01/21/2023]
|
32
|
Zhai M, Tang C, Li M, Chen X, Jin Y, Ying X, Tang Z, Wang X, Wu Y, Sun C, Chen K, Guo X. Short-term mortality risks among patients with non-metastatic bladder cancer. BMC Cancer 2020; 20:1148. [PMID: 33238972 PMCID: PMC7691110 DOI: 10.1186/s12885-020-07655-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Accepted: 11/17/2020] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Population-based analysis for the short-term non-bladder cancer related mortality among patients with non-metastatic bladder cancer is currently lacking. The objective of the current study was to assess and quantify cause of death after bladder cancer diagnosis. METHODS The custom Surveillance, Epidemiology, and End Results (SEER) dataset for standardized mortality ratios (SMRs) was utilized to identify 24,074 patients who were diagnosed with nonmetastatic (M0) bladder cancer from 2014 to 2015. SMRs for causes of death were calculated. Risk factors for bladder cancer-specific mortality, competing mortality, second-cancer mortality, and noncancer mortality were determined using either multivariable Cox or competing risk regression models. RESULTS Among all the 4179 (17.4%) deaths occurred during the follow-up period, almost half of them (44.2%) were attributed to non-bladder cancer cause, including second non-bladder cancer (10%) and other non-cancer causes (34.2%). The most common noncancer causes of death were heart diseases followed by chronic obstructive pulmonary disease. Patients had a higher risk of death from second malignancies (SMR, 1.59; 95% CI, 1.47-1.74) compared with death from first malignancies in the US general population, and also had higher risks of death from heart diseases (SMR, 1.29; 95% CI, 1.18-1.40) and chronic obstructive pulmonary disease (SMR, 1.52; 95% CI, 1.29-1.79) compared with the US general population. Additionally, some risk factors for competing second malignancies or noncancer mortality were determined, such as age, gender, marital status and treatment modalities. CONCLUSIONS Death from non-bladder cancer cause contributed to almost half of all deaths in bladder cancer survivors during the short-term follow-up period. These findings can inform medical management and assist clinicians in counseling those survivors regarding their short-term health risks.
Collapse
Affiliation(s)
- Menghe Zhai
- Department of Urology, The Second Affiliated Hospital of Jiaxing University, Jiaxing, Zhejiang Province, People's Republic of China
| | - Chenye Tang
- Department of Urology, The Second Affiliated Hospital of Jiaxing University, Jiaxing, Zhejiang Province, People's Republic of China
| | - Ming Li
- Department of Urology, The Second Affiliated Hospital of Jiaxing University, Jiaxing, Zhejiang Province, People's Republic of China
| | - Xin Chen
- Department of Urology, The Second Affiliated Hospital of Jiaxing University, Jiaxing, Zhejiang Province, People's Republic of China
| | - Yigang Jin
- Department of Urology, The Second Affiliated Hospital of Jiaxing University, Jiaxing, Zhejiang Province, People's Republic of China
| | - Xiangjun Ying
- Department of Urology, The Second Affiliated Hospital of Jiaxing University, Jiaxing, Zhejiang Province, People's Republic of China
| | - Zhiling Tang
- Department of Urology, The Second Affiliated Hospital of Jiaxing University, Jiaxing, Zhejiang Province, People's Republic of China
| | - Xiao Wang
- Department of Urology, The Second Affiliated Hospital of Jiaxing University, Jiaxing, Zhejiang Province, People's Republic of China
| | - Yuntao Wu
- Department of Urology, The Second Affiliated Hospital of Jiaxing University, Jiaxing, Zhejiang Province, People's Republic of China
| | - Chun Sun
- Department of Urology, The Second Affiliated Hospital of Jiaxing University, Jiaxing, Zhejiang Province, People's Republic of China
| | - Kean Chen
- Department of Urology, The Second Affiliated Hospital of Jiaxing University, Jiaxing, Zhejiang Province, People's Republic of China
| | - Xiao Guo
- Department of Urology, The Second Affiliated Hospital of Jiaxing University, Jiaxing, Zhejiang Province, People's Republic of China.
| |
Collapse
|
33
|
Marinaro J, Zeymo A, Egan J, Carvalho F, Krasnow R, Stamatakis L, Lynch J, Hwang J, Williams S, Kowalczyk K. Sex and Racial Disparities in the Treatment and Outcomes of Muscle-invasive Bladder Cancer. Urology 2020; 151:154-162. [PMID: 32810481 DOI: 10.1016/j.urology.2020.06.087] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2020] [Revised: 06/16/2020] [Accepted: 06/28/2020] [Indexed: 12/11/2022]
Abstract
OBJECTIVE To identify racial and sex disparities in the treatment and outcomes of muscle-invasive bladder cancer (MIBC) using a nationwide oncology outcomes database. METHODS Using the National Cancer Database, we identified patients with muscle invasive bladder cancer from 2004 to 2014. Treatments analyzed included no treatment, cystectomy, neoadjuvant chemotherapy plus cystectomy ("optimal treatment"), cystectomy plus adjuvant chemotherapy, and chemoradiation. Propensity matching compared mortality outcomes between sexes. Logistic models evaluated predictors of receiving optimal treatment, as well as mortality. RESULTS Forty seven thousand two hundred and twenty nine patients were identified. Most patients were male (73.4%) and underwent cystectomy alone (69.0%). Propensity score matching demonstrated increased 90-day mortality in women vs men (13.0% vs 11.6%, P = .009), despite adjusting for differences in treatments between sexes. Logistic regression models showed no difference in receipt of optimal treatment between sexes (odds ratio [OR] 1.01, 95% confidence interval [CI] 0.83-1.22) although black patients were less likely to receive optimal treatment (OR 0.15, 95% CI 0.05-0.48). Logistic regression models confirmed increased 90-day mortality in female (OR 1.17, CI 1.08-1.27, P < .001) and black (OR 1.29, CI 1.11-1.50, P = .001) patients. Females had a lower overall survival on Cox regression analysis (Hazard Ratio 0.92, 95% CI 0.87-0.97). CONCLUSION While there do not appear to be significant treatment disparities between sexes, women experience higher 90-day mortality and lower overall survival. Black patients are less likely to receive optimal treatment and have a higher risk of 90-day mortality. Additional research is needed to determine the variables leading to worse outcomes in females and identify impediments to black patients receiving optimal treatment.
Collapse
Affiliation(s)
- Jessica Marinaro
- MedStar Georgetown University Hospital, Department of Urology, Washington, DC.
| | | | - Jillian Egan
- MedStar Georgetown University Hospital, Department of Urology, Washington, DC
| | - Filipe Carvalho
- MedStar Georgetown University Hospital, Department of Urology, Washington, DC
| | - Ross Krasnow
- MedStar Washington Hospital Center, Department of Urology, Washington, DC
| | - Lambros Stamatakis
- MedStar Washington Hospital Center, Department of Urology, Washington, DC
| | - John Lynch
- MedStar Georgetown University Hospital, Department of Urology, Washington, DC
| | - Jonathan Hwang
- MedStar Washington Hospital Center, Department of Urology, Washington, DC
| | - Stephen Williams
- Division of Urology, The University of Texas Medical Branch at Galveston, Galveston, TX
| | - Keith Kowalczyk
- MedStar Georgetown University Hospital, Department of Urology, Washington, DC
| |
Collapse
|
34
|
Ko OS, Weiner AB, Desai AS, Vo AX, Miller JA, Cooley LF, Kundu SD. Bladder Cancer Following Medicaid Expansion: No Changes in the Diagnosis of Muscle-Invasive Disease and Time to Treatment. Bladder Cancer 2020. [DOI: 10.3233/blc-200294] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND: Bladder cancer patients who are insured experience improved outcomes. Medicaid expansion aimed to increase insurance coverage and improve access to care. However, the association between Medicaid expansion and stage at diagnosis or time to treatment for those with advanced bladder cancer is unknown. OBJECTIVE: We sought to determine to association of Medicaid expansion with stage at diagnosis, and time to treatment for patients with muscle-invasive bladder cancer. METHODS: A US-based cancer registry was utilized to evaluate the association between Medicaid expansion and cancer stage at diagnosis, insurance rates, and time to treatment (>60 days from diagnosis) for those diagnosed with bladder cancer. We compared outcomes in non-Medicare-aged patients in non-expansion states (n = 16,602) and expansion states (n = 15,921) before (years 2012-2013) and after (years 2015-2016) Medicaid expansion with adjusted difference-in-differences (DIDs) using multivariable linear regression. RESULTS: The DIDs of percentage of bladder cancer patients with Stage≥II disease (0.02%; 95% confidence interval [CI] –1.91 to 1.95%, p = 0.9), without insurance (–0.65%; 95% CI –1.71 to 0.41), and with metastatic disease at diagnosis (–0.07%; 95% CI –1.14 to 1.00, both p > 0.10) did not change following insurance expansion despite an increase in Medicaid coverage (6.03%; 95% CI 4.79 to 7.29, p < 0.01). Any treatment with either cystectomy, radiation or systemic therapy > 60 days after diagnosis of stage≥II disease did not change (DID 1.48%; 95% CI –3.29 to 6.25%, p = 0.50). On subgroup analysis of patients living in low-income regions, the rates of stage≥II disease, no insurance, metastatic disease, and time to treatment did not significantly change. CONCLUSION: Medicaid expansion was not associated with changes in advanced cancer stage at diagnosis or time to treatment in newly diagnosed bladder cancer patients.
Collapse
Affiliation(s)
- Oliver S. Ko
- Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Adam B. Weiner
- Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Anuj S. Desai
- Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Amanda X. Vo
- Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Jake A. Miller
- Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Lauren F. Cooley
- Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Shilajit D. Kundu
- Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| |
Collapse
|
35
|
Janisch F, Yu H, Vetterlein MW, Dahlem R, Engel O, Fisch M, Shariat SF, Soave A, Rink M. Do Younger Patients with Muscle-Invasive Bladder Cancer have Better Outcomes? J Clin Med 2019; 8:jcm8091459. [PMID: 31540247 PMCID: PMC6780834 DOI: 10.3390/jcm8091459] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2019] [Revised: 09/01/2019] [Accepted: 09/11/2019] [Indexed: 01/09/2023] Open
Abstract
Urothelial cancer of the bladder (UCB) is usually a disease of the elderly. The influence of age on oncological outcomes remains controversial. This study aims to investigate the impact of age on UCB outcomes in Europe focusing particularly on young and very young patients. We collected data of 669 UCB patients treated with RC at our tertiary care center. We used various categorical stratifications as well as continuous age to investigate the association of age and tumor biology as well as endpoints with descriptive statistics and Cox regression. The median age was 67 years and the mean follow-up was 52 months. Eight patients (1.2%) were ≤40 years old and 39 patients (5.8%) were aged 41-50 years, respectively. In multivariable analysis, higher continuous age and age above the median were independent predictors for disease recurrence, and cancer-specific and overall mortality (all p-values ≤ 0.018). In addition, patients with age in the oldest tertile group had inferior cancer-specific and overall survival rates compared to their younger counterparts. Young (40-50 years) and very young (≤40 years) patients had reduced hazards for all endpoints, which, however, were not statistically significant. Age remains an independent determinant for survival after RC. Young adults did, however, not have superior outcomes in our analyses. Quality of life and complications are endpoints that need further evaluation in patients undergoing RC.
Collapse
Affiliation(s)
- Florian Janisch
- Department of Urology, Medical University of Hamburg, Martinistraße 52, 20246 Hamburg, Germany.
- Department of Urology, Medical University of Vienna, Währinger Gürtel 18-20, 1090 Vienna, Austria.
| | - Hang Yu
- Department of Urology, Medical University of Hamburg, Martinistraße 52, 20246 Hamburg, Germany.
| | - Malte W Vetterlein
- Department of Urology, Medical University of Hamburg, Martinistraße 52, 20246 Hamburg, Germany.
| | - Roland Dahlem
- Department of Urology, Medical University of Hamburg, Martinistraße 52, 20246 Hamburg, Germany.
| | - Oliver Engel
- Department of Urology, Medical University of Hamburg, Martinistraße 52, 20246 Hamburg, Germany.
| | - Margit Fisch
- Department of Urology, Medical University of Hamburg, Martinistraße 52, 20246 Hamburg, Germany.
| | - Shahrokh F Shariat
- Department of Urology, Medical University of Vienna, Währinger Gürtel 18-20, 1090 Vienna, Austria.
- Institute for Urology and Reproductive Health, Sechenov University, Bolshaya Pirogovskaya str. 2-4, 119991 Moscow, Russia.
- Department of Urology, Weill Cornell Medical School, 1300 York Avenue, New York, NY 10065, USA.
- Department of Urology, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75390, USA.
- Karl Landsteiner Institute of Urology and Andrology, Franziskanergasse 4, a 3100 St. Poelten, Austria.
- Department of Urology, Second Faculty of Medicine, Charles University, Ovocný trh 5, Prague 1-116 36, Czech Republic.
| | - Armin Soave
- Department of Urology, Medical University of Hamburg, Martinistraße 52, 20246 Hamburg, Germany.
| | - Michael Rink
- Department of Urology, Medical University of Hamburg, Martinistraße 52, 20246 Hamburg, Germany.
| |
Collapse
|