The Influence of Access Related Factors on Adherence to Clinical Practice Guidelines for Muscle Invasive Bladder...

Area of Science:

• Urology
• Oncology
• Health Services Research

Background:

• Clinical guidelines recommend radical cystectomy with pelvic lymph node dissection for muscle invasive bladder cancer.
• Adherence to these guidelines is variable and may be influenced by access-related factors.

Purpose of the Study:

• To investigate the association between access-related characteristics and adherence to muscle invasive bladder cancer treatment guidelines.
• To determine if these associations vary by geographic region.

Main Methods:

• Analysis of 27,585 patients with muscle invasive bladder cancer from the National Cancer Database (1998-2010).
• Examination of the relationship between access variables and radical cystectomy/pelvic lymph node dissection versus non-radical cystectomy.
• Multivariate logistic regression models used for national and geographically stratified analyses.

Main Results:

• 23.2% of patients underwent radical cystectomy/pelvic lymph node dissection.
• Black patients, uninsured patients, and Medicaid patients were less likely to receive the recommended treatment.
• Patients living >120 miles from a hospital, treated at academic hospitals, or high-volume centers were more likely to undergo radical cystectomy.
• Race, insurance, income, and hospital volume showed significant regional variation in predicting treatment.

Conclusions:

• Access-related factors are significantly associated with disparities in guideline adherence for muscle invasive bladder cancer.
• The impact of these access factors on treatment decisions varies across different geographic regions.