Poorer outcomes in bladder cancer predicted by race/ethnicity and gender

Socioeconomic, racial/ethnic, and gender considerations influence the diagnosis and management of bladder cancer in the United States. A recent study found that Black patients and patients of the female gender experienced delayed diagnosis and are less likely to receive appropriate therapies [1].

Dr Shaakir Hasan (New York Proton Centre, USA) reported on his team’s research into social disparities in the diagnosis and management of bladder cancer. Cases of bladder cancer (n=434,608) were designated from the National Cancer Database. In accordance with National Comprehensive Cancer Network Guidelines, 331,714 (76.3%) were identified as early cases, 72,154 (16.6%) as muscle invasive, 15,579 (3.6%) as locally advanced, and 15,161 (3.5%) as metastatic.

Next, they employed multivariate binomial and multinomial logistic regression analyses to identify demographic characteristics associated with (i) stage of cancer at time of diagnosis and (ii) the delivery of appropriate, guideline-recommended treatment. The analyses revealed that relative to early diagnosis, the 2 strongest predictors of diagnosis made at later stages were being Black (muscle invasive, HR 1.19; 95% CI 1.15–1.23; locally advanced, HR 1.49 95% CI 1.40–1.59; metastatic, HR 1.66; 95% CI 1.56–1.76) and of the female gender (muscle invasive, HR 1.21; 95% CI 1.18–1.21; locally advanced, HR 1.16; 95% CI 1.12–1.20; metastatic, HR 1.34; 95% CI 1.29–1.38). Multivariable cox regression analysis additionally revealed that Black patients (HR 1.13; 95% CI 1.11–1.16) and patients of the female gender (HR 1.03; 95% CI 1.02–1.05) also had reduced survival rates.

Other demographic factors predicting delayed diagnosis were older age, treatment at an academic centre (excluding metastasis), the presence of Medicaid insurance, and coming from a lower-income/less educated/more rural area. These same factors, as well as being Hispanic, were also associated with a lack of receiving appropriate, cancer-focused therapy.

This study has identified that gender, race/ethnicity, and socioeconomic status impact the diagnosis and management of bladder cancer in the United States. Further investigation is warranted to explore these health disparities so that strategies can be formulated to address and ameliorate them.

1. Hasan S. Social disparities in the diagnosis and management of bladder cancer. Abstract 403, ASCO Genitourinary Cancers Symposium, 11–13 February 2021.

 

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Posted on 24 March 202117 May 2024