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Racial differences in treatment and outcomes among patients with early stage bladder cancer
Article first published online: 28 OCT 2009
Copyright © 2010 American Cancer Society
Volume 116, Issue 1, pages 50–56, 1 January 2010
How to Cite
Hollenbeck, B. K., Dunn, R. L., Ye, Z., Hollingsworth, J. M., Lee, C. T. and Birkmeyer, J. D. (2010), Racial differences in treatment and outcomes among patients with early stage bladder cancer. Cancer, 116: 50–56. doi: 10.1002/cncr.24701
- Issue published online: 11 JAN 2010
- Article first published online: 28 OCT 2009
- Manuscript Accepted: 20 APR 2009
- Manuscript Revised: 8 APR 2009
- Manuscript Received: 2 FEB 2009
- American Cancer Society Pennsylvania Division-Dr. William and Rita Conrady Mentored Research Scholar Grant. Grant Number: MSRG-07-006-01-CPHPS
- American Urological Association Foundation
- Astellas Pharma US, Inc.
- National Cancer Institute. Grant Numbers: R01 CA098481-01 A1, K05 CA115571-01 A2
- bladder cancer;
- quality of care;
- shared-frailty models
Black patients are at greater of risk of death from bladder cancer than white patients. Potential explanations for this disparity include a more aggressive phenotype and delays in diagnosis resulting in higher stage disease. Alternatively, black patients may receive a lower quality of care, which may explain this difference.
Using Surveillance, Epidemiology, and End Results (SEER)-Medicare data for the years from 1992 through 2002, the authors identified patients with early stage bladder cancer. Multivariate models were fitted to measure relations between race and mortality, adjusting for differences in patients and treatment intensity. Next, shared-frailty proportional hazards models were fitted to evaluate whether the disparity was explained by differences in the quality of care provided.
Compared with white patients (n = 14,271), black patients (n = 342) were more likely to undergo restaging resection (12% vs 6.5%; P < .01) and urine cytologic evaluation (36.8% vs 29.7%; P < .01), yet they received fewer endoscopic evaluations (4 vs 5; P < .01). The use of aggressive therapies (cystectomy, systemic chemotherapy, radiation) was found to be similar among black patients and white patients (12% vs 10.2%, respectively; P = .31). Although black patients had a greater risk of death compared with white patients (hazards ratio [HR], 1.23; 95% confidence interval [95% CI], 1.07-1.42), this risk was attenuated only modestly after adjusting for differences in treatment intensity and provider effects (HR, 1.22; 95% CI, 1.06-1.42).
Although differences in initial treatment were evident, they did not appear to be systematic and had unclear clinical significance. Whereas black patients are at greater risk of death, this disparity did not appear to be caused by differences in the intensity or quality of care provided. Cancer 2010. © 2010 American Cancer Society.