Department of Urology, SUNY Downstate Health Sciences University, Brooklyn, NY, USA.
Department of Urology, Kings County Hospital Center, Brooklyn, NY, USA.
Int J Clin Pract. 2021 Aug;75(8):e14262. doi: 10.1111/ijcp.14262. Epub 2021 May 1.
Bladder cancer care has been increasingly concentrated in high-volume metropolitan medical centres (ie, "regionalisation" of care). We aimed to assess the potential role of geographic factors, including facility region and distance to treatment centre, as determinants of neoadjuvant chemotherapy (NAC) delivery in patients with non-metastatic urothelial muscle-invasive bladder cancer (MIBC) using nationally representative data from the United States.
We queried the National Cancer Database to identify patients with cT2-cT4a, N0M0 urothelial MIBC who underwent radical cystectomy (RC) from 2006 to 2015. Patients who received radiation therapy, single-agent chemotherapy, adjuvant chemotherapy or systemic therapies other than multi-agent chemotherapy were excluded. Multivariate logistic regression analysis was performed to identify independent predictors of receiving NAC.
A total of 5986 patients met the criteria for inclusion, of whom 1788 (29.9%) received NAC and 4108 received RC alone. Younger age, increased Charlson-Deyo score, increased cT stage, increased annual income, increased distance from cancer treatment centre, treatment at an Academic Research Program or Integrated Network Cancer Program and a later year of diagnosis were independently predictive of NAC receipt. Older age, Medicare insurance and treatment in the East South Central or West South Central regions were independently associated with decreased odds of NAC receipt.
Distance to treatment centre and United States geographic region were found to affect the likelihood of NAC receipt independently of other established predictors of success in this quality-of-care metric. Access to transportation and related resources merits consideration as additional pertinent social determinants of health in bladder cancer care.
膀胱癌的治疗越来越集中在高容量的大都市医疗中心（即“区域化”治疗）。我们旨在使用美国全国代表性数据评估地理因素（包括设施区域和距治疗中心的距离）作为非转移性尿路上皮肌肉浸润性膀胱癌（MIBC）患者接受新辅助化疗（NAC）的决定因素。
我们查询了国家癌症数据库，以确定 2006 年至 2015 年期间接受根治性膀胱切除术（RC）的 cT2-cT4a、N0M0 尿路上皮 MIBC 患者。排除接受放射治疗、单药化疗、辅助化疗或除多药化疗以外的全身治疗的患者。采用多变量逻辑回归分析确定接受 NAC 的独立预测因素。
共有 5986 例患者符合纳入标准，其中 1788 例（29.9%）接受了 NAC，4108 例仅接受了 RC。年龄较小、Charlson-Deyo 评分增加、cT 分期增加、年收入增加、距癌症治疗中心的距离增加、在学术研究计划或综合网络癌症计划中接受治疗以及诊断年份较晚是接受 NAC 的独立预测因素。年龄较大、医疗保险和在中南部或西南中部地区接受治疗与接受 NAC 的可能性降低独立相关。
距治疗中心的距离和美国地理位置被发现是独立于该质量护理指标中其他成功预测因素影响接受 NAC 的可能性的因素。获得交通和相关资源值得考虑作为膀胱癌治疗中额外的相关健康社会决定因素。
