Outcomes Among Rural and Urban Patients With High-Risk Nonmuscle-Invasive Bladder Cancer: Results From the Canadian...

Area of Science:

• Urology
• Oncology
• Public Health

Background:

• High-risk non-muscle invasive bladder cancer (NMIBC) necessitates intensive surveillance and treatment.
• Access to care may be a challenge for patients in rural or remote areas.
• Investigating the impact of geographic remoteness on NMIBC patient outcomes is crucial.

Purpose of the Study:

• To examine how rurality affects the presentation, management, and surveillance of high-risk NMIBC.
• To assess cancer-specific outcomes, including survival and progression rates, in relation to patient location.

Main Methods:

• Utilized the Canadian Bladder Cancer Information System (CBCIS) database.
• Defined rurality using the Stats Canada Remoteness Index (RI ≥ 0.15).
• Analyzed data from 2838 high-risk NMIBC patients, excluding those with non-urothelial histology or metastatic disease.

Main Results:

• Rural patients (30%) were more likely to present with high-grade T1 tumors (42% vs. 37%).
• Fewer rural patients received repeat transurethral resection of bladder tumor (TURBT) within 90 days (23% vs. 29%) and induction BCG therapy (52% vs. 69%).
• Five-year progression-free survival to muscle-invasive bladder cancer (MIBC) was lower in rural patients (80% vs. 85%).

Conclusions:

• Rural patients with high-risk NMIBC are less likely to meet quality benchmarks for guideline-concordant care.
• Disparities in management and surveillance exist based on geographic remoteness.
• Quality improvement initiatives are needed to address these access and outcome gaps for rural NMIBC patients.