Factors Influencing Aggressive Therapy for Bladder Cancer: An Analysis of Data From the SEER Program

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Abstract
We examined the association of various demographic, geographic and disease related factors, and the use of aggressive therapy defined as radical cystectomy or radiation therapy for bladder cancer. We also examined the correlation between these factors and disease specific survival such aggressive therapy. Data from the Surveillance, Epidemiology and End Results (SEER) program public use files from 1992 to 1999 were used to analyze the demographic and disease related variables of patient age, sex, race, reporting SEER site/geographic region, disease stage, number of lymph nodes examined and number of positive lymph nodes. Cox proportional hazards model analysis was used to test for associations with disease specific survival and logistic regression was used to test the predictors of aggressive therapy. In multivariate models age, SEER site and disease stage were predictors of radical cystectomy while race, age, sex, SEER site and disease stage were significant factors predicting likelihood of radiation therapy. Disease stage and number of nodes examined were significantly associated with survival after radical cystectomy, while age, sex, SEER site and stage significantly affected survival after radiation therapy. Demographic, geographic and disease related characteristics of the patient population can significantly affect treatment choice in patients with bladder cancer. Disease specific survival after radical cystectomy appears to be influenced only by disease related factors (stage and extent of lymphadenectomy) compared to radiation therapy, where survival is influenced by nondisease related factors such as age, sex and SEER site. A significant number of patients who are older or live in certain geographic areas who are being denied aggressive therapy for bladder cancer would benefit from such therapy.