Time to Bladder Cancer Treatment Is Similar Among Black and White Patients, But Other Disparities Persist

Oluwaseun Orikogbo, MD

There was no significant difference in terms of time to treatment between White and Black patients with bladder cancer irrespective of treatment approach, but there remained a difference in treatment outcomes, according to findings from a retrospective study presented in a poster during the 2024 American Urological Association Annual Meeting.

Although there was no statistically significant difference in time to treatment between Black (n = 71) and White (n = 2049) patients with bladder cancer, Black patients were more likely to receive trimodal therapy at rates of 54% vs 35%, respectively, and were also less likely to undergo cystectomy at rates of 47% vs 65%, respectively.

“Black patients [with bladder cancer] have worse outcomes than their White counterparts, despite having a lower incidence of disease,” Oluwaseun Orikogbo, MD, of the University of Pittsburgh Medical Center Urology Department, in Pennsylvania, and coauthors wrote in the poster. “[There is] an 18% increased mortality [rate] after adjusting for demographic and health status, 16% after adjusting for tumor characteristics, and 10% after adjusting for treatment type. Black patients with T2 disease have a statistically significantly worse mortality 1 to 4 years after diagnosis. Possible factors contributing to outcomes [include] stage at presentation, access to care, and treatment decision-making.”

To conduct their study, investigators accessed the Surveillance, Epidemiology and End Results (SEER) Medicare data from 2008 to 2017 regarding patients diagnosed with bladder cancer. They then identified patients who underwent cystectomy, with or without neoadjuvant chemotherapy, or trimodal therapy. The characteristics of the patients in the Black and White populations were then compared and the time from diagnosis to initial treatment was calculated in days. The Kaplan-Meier method was used to create a survival curve and a log-rank analysis was performed.

Additional findings from the study demonstrated that the median age in the White and Black subgroups was 76.0 years (IQR, 71.0-81.0) vs 76.0 years (IQR, 70.0-80.0). Most patients in both groups were male (77.3% vs 56.3%), non-Hispanic (<94.7% vs >84.5%), had stage T2 tumors (71.7% vs 73.2%), were treated between 2008 and 2021 (56.3% vs 59.2%), and had over a 75% incidence of high school–educated individuals in their ZIP code (90.0% vs 81.7%). Notably, more White patients had a median household income of at least $60,001 (47.8% vs 18.3%) and 0 comorbidities (44.2% vs 36.6%) compared with Black patients. Patients in both groups underwent neoadjuvant chemotherapy with cystectomy (48.9% vs 54.5%) and trimodal therapy (34.7% vs 53.5%).

Orikogbo and her coauthors noted that their study was limited by the underrepresentation of Black patients in SEER Medicare data, with representation of only 4% to 5% in the bladder cancer cohort.

“There continues to be a difference in treatment outcomes. Future studies [are needed] to tease out contributing factors with aims of developing interventions,” study authors wrote in conclusion.

Reference

Orikogbo OO, Wu S, Stencel MG, et al. Factors that define the poor outcomes for Black Americans with bladder cancer: does time to treatment contribute? J Urol. Published online May 1, 2024. doi:10.1097/01.JU.0001008796.84999.75.13