Determinants of neoadjuvant chemotherapy use in muscle-invasive bladder cancer

Abstract

Cisplatin-based neoadjuvant chemotherapy (NAC) followed by radical cystectomy (RC) is standard of care for muscleinvasive bladder cancer (MIBC). However, NAC is used in less than 20% of patients with MIBC. Our goal is to investigate factors that contribute to underutilization NAC to facilitate more routine incorporation into clinical practice. Materials and Methods: We identified 5,915 patients diagnosed with cT2-T3N0M0 MIBC who underwent RC between 2004 and 2014 from the National Cancer Database. Univariate and multivariable models were created to identify variables associated with NAC utilization. Results: Only 18.8% of patients received NAC during the study period. On univariate analyses, NAC utilization was more likely at academic hospitals, US South and Midwest (p<0.05). Higher Charlson score was associated with decrease use of NAC (p<0.05). On multivariate analysis, treatment in academic hospitals (odds ratio [

Determinants of neoadjuvant chemotherapy for urothelial muscle‐invasive bladder cancer: Does location matter?

“…Our results are consistent with and extend upon these findings by demonstrating travel distance and United States geographic region to be additional independent determinants of NAC use in these patients. While other recent studies have explored geographic determinants of chemotherapy for MIBC, those identified in our literature search must be interpreted in view of the fact that they did not specify tumour histology, 9 included both urothelial and non‐urothelial histology 10 or considered all forms of perioperative chemotherapy (ie, NAC or adjuvant chemotherapy) together 11 . Thus, to our knowledge, our study was the first to model determinants of NAC in patients undergoing RC for cT2‐cT4a/N0M0 urothelial MIBC while incorporating factors related to transportation and geography.…”

“…Access to transportation and related resources merits greater consideration in the context of social determinants of health in bladder cancer care. must be interpreted in view of the fact that they did not specify tumour histology, 9 included both urothelial and non-urothelial histology 10 or considered all forms of perioperative chemotherapy (ie, NAC or adjuvant chemotherapy) together. 11 Thus, to our knowledge, our study was the first to model determinants of NAC in patients undergoing RC for cT2-cT4a/N0M0 urothelial MIBC while incorporating factors related to transportation and geography.…”

Cisplatin-Based Neoadjuvant Chemotherapy for Elderly Patients with Muscle-Invasive Bladder Cancer: Is It Feasible?

“…Retrospective studies have clearly shown that C-NAC is underutilized worldwide, although recent surveys indicate an increase in its application since 2010 [12,13]. The potential clinical reasons contributing to the underutilization of C-NAC in elderly patients include older age as well as higher comorbidity scores [6][7][8]. Based on a national database from the United States and Porto-Rico, Carvalho et al reported that only 18.8% of patients aged ≥ 75 received C-NAC.…”

“…Of the 81.2% of patients who did not receive C-NAC, only 2.5% were ineligible due to true contraindication. In addition, 68% of patients did not receive C-NAC simply because it was not planned, implying that this treatment option may not even be offered or discussed by some providers after the initial diagnosis of MIBC [8].…”

“…Results of subgroup analyses in prospective trials indicate that C-NAC is beneficial for patients ≥ 65 years. However, several studies have reported the underutilization of C-NAC in real life, which may be due to factors like toxicity concerns, increased perioperative complications, etc., as well as higher comorbidity scores in elderly patients as primary factors associated with lower use of C-NAC [6][7][8]. In the present report, we assessed the feasibility of C-NAC in a cohort of 51 consecutive patients aged 75 years or above who were treated at our institution in the last decade.…”