Race modifies survival benefit of guideline‐based treatment: Implications for reducing disparities in muscle invasive bladder cancer. (1st September 2020)

• Record Type: Journal Article
• Authors: Washington, Samuel L.; Gregorich, Steven E.; Meng, Maxwell V.; Suskind, Anne M.; Porten, Sima P.
• Is Part Of: Cancer medicine. Volume 9:Number 22(2020)
• Page Start: 8310
• Page End: 8317
• Publication Date: 2020-09-01
• Subjects: African continental ancestry group -- cohort studies -- social determinants of health -- United States -- urinary bladder neoplasms; 616.994005
• DOI: 10.1002/cam4.3429
• Languages: English
• ISSNs: 2045-7634

Abstract

Abstract: Background: Black individuals with muscle‐invasive bladder cancer (MIBC) experienced 21% lower odds of guideline‐based treatment (GBT) and differences in treatment explain 35% of observed Black‐White differences in survival. Yet little is known of how interactions between race/ethnicity and receipt of GBT drive within‐ and between‐race survival differences. Methods: Black, White, and Latino individuals diagnosed with nonmetastatic, locally advanced MIBC from 2004 to 2013 within the National Cancer Database were included. Guideline‐based treatment was defined as the receipt including one or more of the following treatment modalities: radical cystectomy (RC), neoadjuvant chemotherapy with RC, RC with adjuvant chemotherapy, and/or chemoradiation based on American Urological Association guidelines. Cox proportional hazards model of mortality estimated effects of GBT status, race/ethnicity, and the GBT‐by‐race/ethnicity interaction, adjusting for covariates. Results: Of the 54 910 MIBC individuals with 125 821 person‐years of posttreatment observation (max = 11 years), 6.9% were Black, and 3.0% were Latino. Overall, 51.4%, 45.3%, and 48.5% of White, Black, and Latino individuals received GBT. Latino individuals had lower hazard of death compared to Black (HR 0.81, 95% CI 0.75‐0.87) and White individuals (HR 0.92, 95% 0.86‐0.98). With GBT, Latino and White individuals had similar outcomes (HR = 1.00, 95% 0.91‐1.10) and both fared better than Black individuals (HR = 0.88, 95% 0.79‐0.99 and HR = 0.88, 95% 0.83‐0.94, respectively). Without GBT, Latino individuals fared better than White (HR = 0.85, 95% 0.77‐0.93) and Black individuals (HR = 0.74, 95% 0.67‐0.82) while White individuals fared better than Black individuals (HR = 0.87, 95% 0.83‐0.92). Black individuals with GBT fared worse than Latinos without GBT (HR = 1.02, 95% 0.92‐1.14), although not statistically significant. Conclusion: Low GBT levels demonstrated an "under‐allocation" of GBT to those who needed it most—Black individuals. Interventions to improve GBT allocation may mitigate race‐based survival differences observed in MIBC. Abstract : Receipt of guideline‐based treatment nearly eliminated survival disparities between Latino and white individuals with bladder cancer but the benefit was not the same for black individuals, highlighting several potential targets for intervention.