e29.5% change in access to care for males and þ0.63% and e20.9% for females, respectively. Rural males experienced the worst access to urologists after 18 years (0.4 urologists/10,000 males). On multivariate analysis, metropolitan status was the greatest predictor of urologist availability for males (OR 2.09, 95% CI 1.63-2.68) and females (OR 1.68, 95% CI 1.33-2.10), while other urologist presence was a significant predictor for females (OR 1.29, 95% CI 1.14-1.45). The weight of these factors differed by region, however remained relatively consistent between the two groups.CONCLUSIONS: Urologist, male, and female populations increased in metropolitan areas, however availability of urologists worsened for both genders overall. Metropolitan women experienced a marginal increase in access to care over 18 years, while rural males experienced the worst decrease among all groups. Factors influencing population shifts and their regional drivers need to be investigated to prevent worsening disparities in care, particularly for rural males.
Background: Guideline-based best practice treatment for muscle invasive bladder cancer (MIBC) involves neoadjuvant chemotherapy followed by radical cystectomy (NACRC). Prior studies have shown that a minority of patients receive NACRC and older age and renal function are drivers of non-receipt of NACRC. This study investigates treatment rates and factors associated with not receiving NACRC in MIBC patients with lower comorbidity status most likely to be candidates for NACRC. Materials and Methods: Retrospective United States National Cancer Database analysis from 2006 to 2015 of MIBC patients with Charlson comorbidity index (CCI) of zero. Analysis of NACRC treatment trends in higher CCI patients was also performed. Results: 15.561 MIBC patients met inclusion criteria. 1.507 (9.7%) received NACRC within 9 months of diagnosis. NACRC increased over time (15.0% in 2015 compared to 3.6% in 2006). Higher NACRC was noted in females, cT3 or cT4 cancer, later year of diagnosis, and academic facility treatment. Lower utilization was noted for blacks and NACRC decreased with increasing age and CCI. Only 16.9% of patients aged 23-62 in the lowest age quartile with muscle invasive bladder cancer and CCI of 0 received NACRC. Conclusions: Although utilization is increasing, receipt of NACRC remains low even in populations most likely to be candidates. Further study should continue to elucidate barriers to utilization of NACRC.
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