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The following is a summary of “Socioeconomic and Demographic Disparities in Immunotherapy Utilization for Advanced Kidney and Bladder Cancer,” published in the July 2024 issue of Urology by Holland et al.

Immunotherapy (IO) has emerged as a critical treatment for advanced clear cell renal cell carcinoma (ccRCC) and urothelial carcinoma (UC), with numerous clinical trials highlighting its survival benefits. Despite these advancements, access to these therapies often remains limited due to socioeconomic and demographic barriers, a concern previously documented in other malignancies. This study aims to evaluate the impact of socioeconomic and demographic factors on the receipt of IO for advanced-stage ccRCC and UC. Utilizing data from the National Cancer Database (NCDB), researchers analyzed patients with stage IV ccRCC from 2015 to 2020 and stage IV UC from 2017 to 2020. The primary outcome was the receipt of IO therapy, which was assessed using multivariable logistic regression, adjusting for various socioeconomic and demographic variables. The analysis identified 15,926 patients with stage IV ccRCC and 10,380 with stage IV UC; of these, 5,419 (34.0%) and 2,231 (21.5%) received IO therapy, respectively. 

IO utilization showed a consistent increase over time for both malignancies. Key factors influencing IO receipt included treatment at non-academic institutions, educational attainment, income, and insurance status. Specifically, for ccRCC, black (OR = 0.77, 95% CI, 0.64–0.93, P = 0.009) and Hispanic (OR = 0.73, 95% CI, 0.61–0.86, P = 0.006) patients had lower odds of receiving IO therapy, while such racial disparities were not observed in patients with UC. The findings highlight a troubling trend of inequity in the administration of IO therapy, with disparities rooted in socioeconomic status and healthcare access, particularly evident in non-academic settings and among certain racial groups. Addressing these disparities is crucial for ensuring equitable access to advanced cancer therapies and improving outcomes for all patients.

Source: sciencedirect.com/science/article/abs/pii/S1078143924005106