Patterns of care for the treatment of bladder cancer

Purpose: We examined bladder cancer patterns of care and differences in treatments administered to patients by age, race/ethnicity and gender using a population based sample. Material and Methods: A random sample of bladder cancer patients diagnosed in 1995 without upper urinary tract involvement in 8 Surveillance, Epidemiology and End Results registries were included. Tumor stage and grade were used to assign patients to risk groups and patterns of care were investigated. Descriptive analyses and logistic regression models examined differences in care based on patient age, race/ethnicity and gender. Results: Of the 669 patients 485 patients had superficial disease, including 222 at low, 151 at intermediate and 112 at high risk, while 154 had muscle invasive disease. Of the patients with superficial bladder cancer 73.4% underwent transurethral bladder resection only. Those with muscle invasive disease were most commonly treated with transurethral bladder resection only (49.1%) or cystectomy only (31%). Intravesical chemotherapy in patients with superficial tumors and aggressive treatment with cystectomy and/or systemic chemotherapy in those with muscle invasive disease increased in relation to risk classification, as may have been expected. However, multivariate analyses suggested an influence of co-morbidities on intravesical therapy in patients with superficial tumors and an influence of patient age and geographic region on aggressive treatment for muscle invasive disease. Conclusions: No differences in treatment were identified based on patient race/ethnicity or gender. Treatment for superficial disease is primarily influenced by risk category and comorbidities, while treatment for muscle invasive disease is influenced by patient age and geographic region.