A team of researchers reported that socioeconomic, racial/ethnic, and gender factors influence the diagnosis and management of bladder cancer in the United States. They discovered that Black patients and patients of the female gender experienced delayed diagnosis and are less likely to receive appropriate therapies . Researchers designated 434,608 cases of bladder cancer from the National Cancer Database (NCDB) as early, muscle-invasive, locally advanced, or metastatic in accordance with National Comprehensive Cancer Network (NCCN) guidelines. Of these 434,608 cases, 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 (a) stage of cancer at the time of diagnosis and (b) the delivery of appropriate, guideline-recommended treatment. These revealed that the 2 strongest independent predictors of diagnosis made at a later stage of cancer (i.e. the muscle-invasive, locally advanced, or metastatic stages), relative to diagnosis at an earlier stage were being Black and of the female gender. Both groups also had reduced survival rates. Other demographic factors predicting delayed diagnosis were older age, treatment at an academic center (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 clearly identified that gender, race/ethnicity, and socioeconomic status impact the diagnosis and management of bladder cancer in the United States; further exploration of these health disparities can aid in addressing and ameliorating them.
- Hasan S. Social disparities in the diagnosis and management of bladder cancer. ASCO Genitourinary Cancers Symposium, 11–13 February 2021.