Disparities in Access to High-volume Centers for Muscle Invasive Bladder Cancer and Its Association With Treatment...

Area of Science:

• Urology
• Oncology
• Health Services Research

Background:

• Muscle-invasive bladder cancer (MIBC) is a significant oncologic diagnosis.
• Treatment outcomes for MIBC can vary based on the healthcare facility.
• Access to specialized cancer centers is crucial for optimal patient care.

Purpose of the Study:

• To examine patient access to high-volume centers (HVCs) for non-metastatic MIBC.
• To assess if socioeconomic and demographic factors influence access to HVCs.
• To evaluate the impact of HVC access on treatment outcomes and survival.

Main Methods:

• Retrospective analysis of the National Cancer Database (NCDB) from 2004-2020.
• Categorization of treatment facilities into HVCs, IVCs, and LVCs based on annual volume.
• Multivariable logistic regression to identify factors associated with HVC access and outcome comparisons across facility volumes.

Main Results:

• 57.2% of patients received care at HVCs, with disparities noted.
• Black patients and those from lower socioeconomic backgrounds were less likely to access HVCs.
• HVC treatment was associated with higher rates of radical cystectomy, neoadjuvant chemotherapy, better perioperative outcomes, and improved overall survival.

Conclusions:

• Significant disparities exist in HVC access for MIBC, disproportionately affecting minority and economically disadvantaged populations.
• HVCs demonstrate superior treatment outcomes and survival rates for MIBC patients.
• Systemic interventions are necessary to ensure equitable access to high-quality cancer care for all bladder cancer patients.