Study Analyzes Sex and Racial Disparities in Treatment and Outcomes of Bladder Cancer

A study published in the journal Urology evaluated differences in treatment and outcomes of muscle-invasive bladder cancer based on sex and race. The researchers concluded that men and women did not differ in terms of receiving optimal treatment, but women and black patients had a higher mortality rate, and black patients were less likely to receive optimal treatment.

The researchers queried the National Cancer Database to identify muscle invasive bladder cancer patients from 2004 through 2014 who received no treatment, cystectomy, neoadjuvant chemotherapy plus cystectomy (which was classified as “optimal treatment”), cystectomy plus adjuvant chemotherapy, and chemoradiation. They implemented propensity matching to compare between-sex mortality outcomes and logistic models to assess factors associated with optimal treatment receipt and mortality.

Final analysis included 47,229 bladder cancer patients. About three-quarters of patients (73.4%) were male, and most patients (69.0%) were treated with only cystectomy. Upon propensity score matching, when adjusting for differences in treatments, women had a slightly increased rate of 90-day mortality compared to men (13.0% vs. 11.6%; P=0.009). Men and women did not largely differ in receipt of optimal treatment (odds ratio [OR]=1.01; 95% confidence interval [CI], 0.83 to 1.22). However, black patients were significantly less likely to receive optimal treatment (OR=0.15; 95% CI, 0.05 to 0.48). In logistic regression models, females still had a higher risk for 90-day mortality (OR=1.17; 95% CI, 1.08 to 1.27; P<0.001), as did black patients (OR=1.29; 95% CI, 1.11 to 1.50; P=0.001). In Cox regression analysis, females had a lower rate of overall survival (hazard ratio=0.92; 95% CI, 0.87 to 0.97).

“While there do not appear to be significant treatment disparities between sexes, women experience higher 90-day mortality and lower overall survival. Black patients are less likely to receive optimal treatment and have a higher risk of 90-day mortality. Additional research is needed to determine the variables leading to worse outcomes in females and identify impediments to black patients receiving optimal treatment,” the researchers wrote in their conclusion.