Discerning Patterns and Quality of Neoadjuvant Chemotherapy Use Among Patients with Muscle-invasive Bladder Cancer

Jinhai Huo, Mohamed D. Ray-Zack, Yong Shan, Karim Chamie, Stephen A. Boorjian, Preston Kerr, Bagi Jana, Stephen J. Freedland, Ashish M. Kamat, Hemalkumar Mehta, Stephen Williams

Research output: Contribution to journalArticle

1 Citation (Scopus)

Abstract

BACKGROUND: Neoadjuvant chemotherapy is underutilized in bladder cancer patients who undergo radical cystectomy. However, the quality of regimens used in this setting remains largely unknown. OBJECTIVE: To determine utilization treatment patterns and survival outcomes according to regimens administered. DESIGN, SETTING, AND PATIENTS: We used the Surveillance, Epidemiology and End Results (SEER)-Medicare linked database to identify patients diagnosed with clinical stage TII-IV bladder cancer from January 1, 2001 to December 31, 2011. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: Temporal trends were assessed using the Cochran-Armitage test. Multivariable logistic regression models were used to identify predictors for neoadjuvant chemotherapy use. Cox proportional hazards models were used to compare overall survival according to regimens administered. RESULTS AND LIMITATIONS: Of 2738 patients treated with radical cystectomy, 344 (12.6%) received neoadjuvant chemotherapy. The agents most commonly used were gemcitabine (72.3%), cisplatin (55.2%), and carboplatin (31.1%). The regimens most commonly used were gemcitabine-cisplatin (45.3%), gemcitabine-carboplatin (24.1%), and methotrexate, vinblastine, doxorubicin, and cisplatin (M-VAC; 6.7%). Use of neoadjuvant chemotherapy more than tripled during the study period, from 5.7% in 2001 to 17.3% in 2011 (p<0.001). The quality of the regimen administered impacted survival outcomes, as M-VAC use was significantly associated with better overall survival among patients diagnosed with stage II bladder cancer (hazard ratio 0.24, 95% confidence interval 0.07-0.86; p=0.030]. Limitations include the limited ability of retrospective analysis to control for selection bias. CONCLUSIONS: Neoadjuvant chemotherapy was underused, and the quality of neoadjuvant chemotherapy regimens administered for bladder cancer was inconsistent with guideline recommendations. These findings are important when interpreting population-based data on the use of chemotherapy and extrapolating survival outcomes. PATIENT SUMMARY: In a large population-based study, 12.6% of patients undergoing radical cystectomy for bladder cancer received neoadjuvant chemotherapy, half of whom received guideline-recommended regimens. The quality of the regimen impacted survival outcomes, as use of cisplatin-based chemotherapy was significantly associated with better overall survival among patients diagnosed with stage II bladder cancer. However, <1% of radical cystectomy patients received this regimen.

Original languageEnglish (US)
Pages (from-to)497-504
Number of pages8
JournalEuropean Urology Oncology
Volume2
Issue number5
DOIs
StatePublished - Sep 1 2019

Fingerprint

Urinary Bladder Neoplasms
gemcitabine
Drug Therapy
Muscles
Cystectomy
Survival
Cisplatin
Carboplatin
Logistic Models
Guidelines
Vinblastine
Selection Bias
Medicare
Proportional Hazards Models
Methotrexate
Doxorubicin
Population
Epidemiology
Databases
Confidence Intervals

Keywords

  • Bladder cancer
  • Epidemiology and End Results
  • Medicare
  • Neoadjuvant chemotherapy
  • Quality
  • Radical cystectomy
  • Surveillance

Cite this

Discerning Patterns and Quality of Neoadjuvant Chemotherapy Use Among Patients with Muscle-invasive Bladder Cancer. / Huo, Jinhai; Ray-Zack, Mohamed D.; Shan, Yong; Chamie, Karim; Boorjian, Stephen A.; Kerr, Preston; Jana, Bagi; Freedland, Stephen J.; Kamat, Ashish M.; Mehta, Hemalkumar; Williams, Stephen.

In: European Urology Oncology, Vol. 2, No. 5, 01.09.2019, p. 497-504.

Research output: Contribution to journalArticle

Huo, J, Ray-Zack, MD, Shan, Y, Chamie, K, Boorjian, SA, Kerr, P, Jana, B, Freedland, SJ, Kamat, AM, Mehta, H & Williams, S 2019, 'Discerning Patterns and Quality of Neoadjuvant Chemotherapy Use Among Patients with Muscle-invasive Bladder Cancer', European Urology Oncology, vol. 2, no. 5, pp. 497-504. https://doi.org/10.1016/j.euo.2018.07.009
Huo, Jinhai ; Ray-Zack, Mohamed D. ; Shan, Yong ; Chamie, Karim ; Boorjian, Stephen A. ; Kerr, Preston ; Jana, Bagi ; Freedland, Stephen J. ; Kamat, Ashish M. ; Mehta, Hemalkumar ; Williams, Stephen. / Discerning Patterns and Quality of Neoadjuvant Chemotherapy Use Among Patients with Muscle-invasive Bladder Cancer. In: European Urology Oncology. 2019 ; Vol. 2, No. 5. pp. 497-504.
@article{15e6d91e514b4dc99019146d7ea34d40,
title = "Discerning Patterns and Quality of Neoadjuvant Chemotherapy Use Among Patients with Muscle-invasive Bladder Cancer",
abstract = "BACKGROUND: Neoadjuvant chemotherapy is underutilized in bladder cancer patients who undergo radical cystectomy. However, the quality of regimens used in this setting remains largely unknown. OBJECTIVE: To determine utilization treatment patterns and survival outcomes according to regimens administered. DESIGN, SETTING, AND PATIENTS: We used the Surveillance, Epidemiology and End Results (SEER)-Medicare linked database to identify patients diagnosed with clinical stage TII-IV bladder cancer from January 1, 2001 to December 31, 2011. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: Temporal trends were assessed using the Cochran-Armitage test. Multivariable logistic regression models were used to identify predictors for neoadjuvant chemotherapy use. Cox proportional hazards models were used to compare overall survival according to regimens administered. RESULTS AND LIMITATIONS: Of 2738 patients treated with radical cystectomy, 344 (12.6{\%}) received neoadjuvant chemotherapy. The agents most commonly used were gemcitabine (72.3{\%}), cisplatin (55.2{\%}), and carboplatin (31.1{\%}). The regimens most commonly used were gemcitabine-cisplatin (45.3{\%}), gemcitabine-carboplatin (24.1{\%}), and methotrexate, vinblastine, doxorubicin, and cisplatin (M-VAC; 6.7{\%}). Use of neoadjuvant chemotherapy more than tripled during the study period, from 5.7{\%} in 2001 to 17.3{\%} in 2011 (p<0.001). The quality of the regimen administered impacted survival outcomes, as M-VAC use was significantly associated with better overall survival among patients diagnosed with stage II bladder cancer (hazard ratio 0.24, 95{\%} confidence interval 0.07-0.86; p=0.030]. Limitations include the limited ability of retrospective analysis to control for selection bias. CONCLUSIONS: Neoadjuvant chemotherapy was underused, and the quality of neoadjuvant chemotherapy regimens administered for bladder cancer was inconsistent with guideline recommendations. These findings are important when interpreting population-based data on the use of chemotherapy and extrapolating survival outcomes. PATIENT SUMMARY: In a large population-based study, 12.6{\%} of patients undergoing radical cystectomy for bladder cancer received neoadjuvant chemotherapy, half of whom received guideline-recommended regimens. The quality of the regimen impacted survival outcomes, as use of cisplatin-based chemotherapy was significantly associated with better overall survival among patients diagnosed with stage II bladder cancer. However, <1{\%} of radical cystectomy patients received this regimen.",
keywords = "Bladder cancer, Epidemiology and End Results, Medicare, Neoadjuvant chemotherapy, Quality, Radical cystectomy, Surveillance",
author = "Jinhai Huo and Ray-Zack, {Mohamed D.} and Yong Shan and Karim Chamie and Boorjian, {Stephen A.} and Preston Kerr and Bagi Jana and Freedland, {Stephen J.} and Kamat, {Ashish M.} and Hemalkumar Mehta and Stephen Williams",
year = "2019",
month = "9",
day = "1",
doi = "10.1016/j.euo.2018.07.009",
language = "English (US)",
volume = "2",
pages = "497--504",
journal = "European urology oncology",
issn = "2588-9311",
publisher = "Elsevier BV",
number = "5",

}

TY - JOUR

T1 - Discerning Patterns and Quality of Neoadjuvant Chemotherapy Use Among Patients with Muscle-invasive Bladder Cancer

AU - Huo, Jinhai

AU - Ray-Zack, Mohamed D.

AU - Shan, Yong

AU - Chamie, Karim

AU - Boorjian, Stephen A.

AU - Kerr, Preston

AU - Jana, Bagi

AU - Freedland, Stephen J.

AU - Kamat, Ashish M.

AU - Mehta, Hemalkumar

AU - Williams, Stephen

PY - 2019/9/1

Y1 - 2019/9/1

N2 - BACKGROUND: Neoadjuvant chemotherapy is underutilized in bladder cancer patients who undergo radical cystectomy. However, the quality of regimens used in this setting remains largely unknown. OBJECTIVE: To determine utilization treatment patterns and survival outcomes according to regimens administered. DESIGN, SETTING, AND PATIENTS: We used the Surveillance, Epidemiology and End Results (SEER)-Medicare linked database to identify patients diagnosed with clinical stage TII-IV bladder cancer from January 1, 2001 to December 31, 2011. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: Temporal trends were assessed using the Cochran-Armitage test. Multivariable logistic regression models were used to identify predictors for neoadjuvant chemotherapy use. Cox proportional hazards models were used to compare overall survival according to regimens administered. RESULTS AND LIMITATIONS: Of 2738 patients treated with radical cystectomy, 344 (12.6%) received neoadjuvant chemotherapy. The agents most commonly used were gemcitabine (72.3%), cisplatin (55.2%), and carboplatin (31.1%). The regimens most commonly used were gemcitabine-cisplatin (45.3%), gemcitabine-carboplatin (24.1%), and methotrexate, vinblastine, doxorubicin, and cisplatin (M-VAC; 6.7%). Use of neoadjuvant chemotherapy more than tripled during the study period, from 5.7% in 2001 to 17.3% in 2011 (p<0.001). The quality of the regimen administered impacted survival outcomes, as M-VAC use was significantly associated with better overall survival among patients diagnosed with stage II bladder cancer (hazard ratio 0.24, 95% confidence interval 0.07-0.86; p=0.030]. Limitations include the limited ability of retrospective analysis to control for selection bias. CONCLUSIONS: Neoadjuvant chemotherapy was underused, and the quality of neoadjuvant chemotherapy regimens administered for bladder cancer was inconsistent with guideline recommendations. These findings are important when interpreting population-based data on the use of chemotherapy and extrapolating survival outcomes. PATIENT SUMMARY: In a large population-based study, 12.6% of patients undergoing radical cystectomy for bladder cancer received neoadjuvant chemotherapy, half of whom received guideline-recommended regimens. The quality of the regimen impacted survival outcomes, as use of cisplatin-based chemotherapy was significantly associated with better overall survival among patients diagnosed with stage II bladder cancer. However, <1% of radical cystectomy patients received this regimen.

AB - BACKGROUND: Neoadjuvant chemotherapy is underutilized in bladder cancer patients who undergo radical cystectomy. However, the quality of regimens used in this setting remains largely unknown. OBJECTIVE: To determine utilization treatment patterns and survival outcomes according to regimens administered. DESIGN, SETTING, AND PATIENTS: We used the Surveillance, Epidemiology and End Results (SEER)-Medicare linked database to identify patients diagnosed with clinical stage TII-IV bladder cancer from January 1, 2001 to December 31, 2011. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: Temporal trends were assessed using the Cochran-Armitage test. Multivariable logistic regression models were used to identify predictors for neoadjuvant chemotherapy use. Cox proportional hazards models were used to compare overall survival according to regimens administered. RESULTS AND LIMITATIONS: Of 2738 patients treated with radical cystectomy, 344 (12.6%) received neoadjuvant chemotherapy. The agents most commonly used were gemcitabine (72.3%), cisplatin (55.2%), and carboplatin (31.1%). The regimens most commonly used were gemcitabine-cisplatin (45.3%), gemcitabine-carboplatin (24.1%), and methotrexate, vinblastine, doxorubicin, and cisplatin (M-VAC; 6.7%). Use of neoadjuvant chemotherapy more than tripled during the study period, from 5.7% in 2001 to 17.3% in 2011 (p<0.001). The quality of the regimen administered impacted survival outcomes, as M-VAC use was significantly associated with better overall survival among patients diagnosed with stage II bladder cancer (hazard ratio 0.24, 95% confidence interval 0.07-0.86; p=0.030]. Limitations include the limited ability of retrospective analysis to control for selection bias. CONCLUSIONS: Neoadjuvant chemotherapy was underused, and the quality of neoadjuvant chemotherapy regimens administered for bladder cancer was inconsistent with guideline recommendations. These findings are important when interpreting population-based data on the use of chemotherapy and extrapolating survival outcomes. PATIENT SUMMARY: In a large population-based study, 12.6% of patients undergoing radical cystectomy for bladder cancer received neoadjuvant chemotherapy, half of whom received guideline-recommended regimens. The quality of the regimen impacted survival outcomes, as use of cisplatin-based chemotherapy was significantly associated with better overall survival among patients diagnosed with stage II bladder cancer. However, <1% of radical cystectomy patients received this regimen.

KW - Bladder cancer

KW - Epidemiology and End Results

KW - Medicare

KW - Neoadjuvant chemotherapy

KW - Quality

KW - Radical cystectomy

KW - Surveillance

UR - http://www.scopus.com/inward/record.url?scp=85071784811&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85071784811&partnerID=8YFLogxK

U2 - 10.1016/j.euo.2018.07.009

DO - 10.1016/j.euo.2018.07.009

M3 - Article

C2 - 31411998

AN - SCOPUS:85071784811

VL - 2

SP - 497

EP - 504

JO - European urology oncology

JF - European urology oncology

SN - 2588-9311

IS - 5

ER -