Julia Arnold
Research Mentor(s): Jeffrey Montgomery
Mentor Department: Urology
Authors: Julia Arnold, Jeffrey Montgomery, Sadia Islam, Sinthia Kabarah
Session: Session 5 (2:00pm – 2:50pm)
Presentation Type: Poster 65
Abstract
Of those who are diagnosed with muscle-invasive bladder cancer (MIBC), neoadjuvant chemotherapy (NAC) has been shown to be sufficient in increasing survival rates by 5-7%. However, the use of neoadjuvant chemotherapy among this population remains low. This project seeks to identify the factors that contribute to the under-utilizing of NAC and explore ways to mitigate them through quality intervention sessions. Our data was collected through an IRB-approved Bladder Cancer Database at Michigan Medicine that is regularly updated. The database collected demographic information, pre-cystectomy treatment plans, outcomes after cystectomy, and post-cystectomy treatments. Through the database, we identified 399 patients with greater than or equal to clinical stage T2 bladder cancer who also underwent radical cystectomies between 2012-2017. We then analyzed the rate at which NAC was recommended by clinicians, the rate at which patients went through with NAC, the reasons as to why patients did not participate in the treatment, and the reasons as to why NAC was deferred by the clinician. The results of this study showcase that renal insufficiency (eGFR <60 ml per minute) and hearing loss were conclusively associated with lower odds of receiving NAC while other medical comorbidities like CHF, older age, and higher ECOG also seem to decrease the odds of receiving NAC. Although the increased distance to a local medical oncologist is potentially associated with increased NAC use, we hypothesize that this is because those patients may be more likely to travel to our institution for medical oncology evaluation where rates of NAC use are high. Within our institution, we were able to identify two groups that could benefit from quality intervention sessions. Those with characteristics like poor renal function and ECOG score >2 can expedite their treatment to a cystectomy since it is medically agreed upon that these comorbidities do not work well with NAC. However, those with other comorbidities like neuropathy, CHF, and hearing loss are more nuanced and should still have the opportunity to be referred to NAC. A QI initiative catering to these findings may result in better care for bladder cancer and an increase in NAC usage where it is appropriate.
