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Medical oncology referral and systemic therapy of patients with advanced stage urothelial carcinoma
Aim
To understand physician visit patterns among patients with stage IV (including nonmetastatic [M0] and metastatic [M1] disease) urothelial carcinoma (UC) and understand factors associated with a timely referral to a medical oncologist and systemic treatment.
Patients & Methods
Retrospective analysis of Surveillance, Epidemiology and End Results-Medicare data.
Results
First physician encounter was with a urologist (M0: 69%; M1: 53%) or primary care physician ([PCP]; M0: 19%, M1: 25%) for the majority of patients around UC diagnosis. After the index urologist encounter, most patients had a subsequent medical oncologist visit at a median of 52 days (M0: 69.5 days, M1: 33 days). In an adjusted model, older age, index PCP visit, higher comorbidities and M0 disease were negatively associated with a medical oncologist referral. Among those referred to a medical oncologist, older age, Hispanic or non-Hispanic Black race and not being married were negatively associated with subsequent chemotherapy receipt (p < 0.05).
Conclusion
Many patients with advanced UC encounter multiple specialists during their disease course. Older patients or those with a first UC-related encounter with a PCP are less likely to be referred to medical oncology. Once referred to medical oncology, social determinants, including race and marital status, are relevant predictors of receiving chemotherapy.
Authors
A Abdalla, C Johnson, Y Doleh, R Shenolikar, M F Botteman, A Hussain
Journal
Journal of Comparitive Effectiveness Research
Therapeutic Area
Oncology
Center of Excellence
Health Economic Modeling & Meta-analysis
Year
2020
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