The following is a summary of “Social Vulnerability and Receipt of Neoadjuvant Chemotherapy in Patients Undergoing Radical Cystectomy for Bladder Cancer,” published in the May 2024 issue of Urology by Sekar et al.
To assess the impact of social determinants of health on the utilization of neoadjuvant chemotherapy among patients with muscle-invasive bladder cancer (MIBC) undergoing radical cystectomy, the researchers utilized the Centers for Disease Control and Prevention Social Vulnerability Index (SVI) as a measure. Using data from the institutional database spanning 2000 to 2022, the study group identified 978 patients with nonmetastatic MIBC who underwent radical cystectomy. Patients were categorized into quintiles based on SVI scores derived from their ZIP codes, ranging from least to most vulnerable. Multivariable logistic regression, adjusted for age, race, gender, and cancer stage, was employed to evaluate the association between SVI quintiles and receipt of neoadjuvant chemotherapy. Subsequent analyses examined specific SVI subthemes—socioeconomic status, household composition/disability, race/ethnicity/language, and housing/transportation—and their associations with neoadjuvant chemotherapy receipt.
Among the cohort, 490 patients (50.1%) received neoadjuvant chemotherapy. Those who underwent neoadjuvant chemotherapy tended to have lower SVI scores, younger age, and more advanced cancer stages (all p < 0.05). Notably, patients in the most vulnerable SVI quintile exhibited significantly reduced odds of receiving neoadjuvant chemotherapy compared to those in the least vulnerable quintile (odds ratio [OR] 0.61, 95% CI 0.39–0.95). Subtheme analyses revealed consistent findings, particularly for socioeconomic status (OR 0.56, 95% CI 0.36–0.86) and household composition/disability (OR 0.57, 95% CI 0.33–0.99).
Discussion of these findings underscores the impact of adverse social determinants of health—captured by the SVI—on disparities in neoadjuvant chemotherapy utilization among patients with MIBC undergoing radical cystectomy. Addressing these disparities requires targeted interventions aimed at identifying and supporting vulnerable populations, thereby promoting more equitable care strategies for patients with bladder cancer.
Source: sciencedirect.com/science/article/abs/pii/S0090429524003595
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