Socioeconomic and Demographic Disparities in Immunotherapy Utilization for Advanced Kidney and Bladder Cancer

被引:0
作者
Holland, Levi [1 ]
Bhanvadia, Raj [1 ]
Ibeziako, Nathanaelle [1 ]
Taylor, Jacob [1 ]
Gerlt, Deitrich [2 ]
Chaplin, Iftach [1 ]
Bagrodia, Aditya [3 ]
Desai, Neil [4 ]
Gaston, Kris [1 ]
Lotan, Yair [1 ]
Margulis, Vitaly [1 ]
Zhang, Tian [5 ]
Cole, Suzanne [5 ]
Woldu, Solomon [1 ]
机构
[1] Univ Texas Southwestern Med Ctr, Dept Urol, Dallas, TX 75390 USA
[2] Univ North Texas, Texas Coll Osteopath Med, Hlth Sci Ctr, Ft Worth, TX USA
[3] Univ Calif San Diego, Dept Urol, San Diego, CA USA
[4] Univ Texas Southwestern Med Ctr, Dept Radiat Oncol, Dallas, TX USA
[5] Univ Texas Southwestern Med Ctr, Dept Internal Med, Div Hematol & Oncol, Dallas, TX USA
关键词
Immunotherapy; Renal cell carcinoma; Kidney cancer; Bladder cancer; Healthcare disparities; Socioeconomic factors; UROTHELIAL CARCINOMA; ATEZOLIZUMAB; NIVOLUMAB;
D O I
10.1016/j.urolonc.2024.06.012
中图分类号
R73 [肿瘤学];
学科分类号
100214 ;
摘要
Objectives: Immunotherapy (IO) drugs have been increasingly utilized in locally advanced or metastatic clear cell renal cell carcinoma (ccRCC) and urothelial carcinoma of the bladder (UC). Multiple trials have demonstrated clear survival benefit, however, there are often barriers to access for these advanced therapies which has been demonstrated in other non-urologic malignancies. The goal of this study was to assess socioeconomic and demographic factors associated with the receipt of IO for advanced ccRCC and UC. Materials and methods: We queried the National Cancer Database (NCDB) for patients with stage IV ccRCC and UC. The study period was 2015 to 2020 for ccRCC (FDA approval date of IO) and 2017 to 2020 for UC (FDA approval date of broadened indication for IO, initial limited approval in 2016). The primary outcome of interest was receipt of IO therapy using multivariable logistic regression, adjusting for relevant socioeconomic and demographic variables. Results: We identified 15,926 patients with stage IV ccRCC and 10,380 patients with stage IV UC of which 5,419 (34.0%) and 2,231 (21.5%) received IO therapy, respectively. IO utilization increased with each successive year. In both malignancies, treatment at a nonacademic facility, education level, income, and insurance were independently associated with IO utilization. For ccRCC, black (OR = 0.77, 95% CI, 0.64-0.93, P = 0.009) and Hispanic race (OR = 0.73, 95% CI, 0.61-0.86, P = 0.006) were each associated with decreased IO utilization but there were no independent associations between race and receipt of IO in patients with UC. Conclusions: In the era of FDA-approved IO therapy for advanced ccRCC and UC, this national cohort analysis suggests that IO utilization is increasing over time, but significant disparities exist based on income, education, and insurance status in both malignancies. Additionally, patients treated at non-academic facilities were less likely to receive IO therapy for these specific genitourinary malignancies. In ccRCC, additional disparities were seen black and Hispanic races which each were associated with lower odds of IO receipt. Identifying strategies to mitigate these differences and provide equitable access to IO therapy is of imperative need. (c) 2024 Elsevier Inc. All rights are reserved, including those for text and data mining, AI training, and similar technologies.
引用
收藏
页码:374e11 / 374e20
页数:10
相关论文
共 31 条
  • [1] Disparities of Immunotherapy Utilization in Patients with Stage III Cutaneous Melanoma: A National Perspective
    Al-Qurayshi, Zaid
    Crowther, Jason E.
    Hamner, John B.
    Ducoin, Christopher
    Killackey, Mary T.
    Kandil, Emad
    [J]. ANTICANCER RESEARCH, 2018, 38 (05) : 2897 - 2901
  • [2] Atezolizumab as first-line treatment in cisplatin-ineligible patients with locally advanced and metastatic urothelial carcinoma: a single-arm, multicentre, phase 2 trial
    Balar, Arjun V.
    Galsky, Matthew D.
    Rosenberg, Jonathan E.
    Powles, Thomas
    Petrylak, Daniel P.
    Bellmunt, Joaquim
    Loriot, Yohann
    Necchi, Andrea
    Hoffman-Censits, Jean
    Perez-Gracia, Jose Luis
    Dawson, Nancy A.
    van der Heijden, Michiel S.
    Dreicer, Robert
    Srinivas, Sandy
    Retz, Margitta M.
    Joseph, Richard W.
    Drakaki, Alexandra
    Vaishampayan, Ulka N.
    Sridhar, Srikala S.
    Quinn, David I.
    Duran, Ignacio
    Shaffer, David R.
    Eigl, Bernhard J.
    Grivas, Petros D.
    Yu, Evan Y.
    Li, Shi
    Kadel, Edward E., III
    Boyd, Zachary
    Bourgon, Richard
    Hegde, Priti S.
    Mariathasan, Sanjeev
    Thastrom, AnnChristine
    Abidoye, Oyewale O.
    Fine, Gregg D.
    Bajorin, Dean F.
    [J]. LANCET, 2017, 389 (10064) : 67 - 76
  • [3] Using the National Cancer Database for Outcomes Research
    Boffa, Daniel J.
    Rosen, Joshua E.
    Mallin, Katherine
    Loomis, Ashley
    Gay, Greer
    Palis, Bryan
    Thoburn, Kathleen
    Gress, Donna
    McKellar, Daniel P.
    Shulman, Lawrence N.
    Facktor, Matthew A.
    Winchester, David P.
    [J]. JAMA ONCOLOGY, 2017, 3 (12) : 1722 - 1728
  • [4] Real-World Survival Outcomes Associated With First-Line Immunotherapy, Targeted Therapy, and Combination Therapy for Metastatic Clear Cell Renal Cell Carcinoma
    Chakiryan, Nicholas H.
    Jiang, Da David
    Gillis, Kyle A.
    Green, Elizabeth
    Hajiran, Ali
    Hugar, Lee
    Zemp, Logan
    Zhang, Jingsong
    Jain, Rohit K.
    Chahoud, Jad
    Spiess, Philippe E.
    Sexton, Wade
    Gilbert, Scott M.
    Manley, Brandon J.
    [J]. JAMA NETWORK OPEN, 2021, 4 (05) : E2111329
  • [5] Unequal racial distribution of immunotherapy for late-stage non-small cell lung cancer
    Chang, Annie
    Flores, Raja M.
    Taioli, Emanuela
    [J]. JNCI-JOURNAL OF THE NATIONAL CANCER INSTITUTE, 2023, : 1224 - 1226
  • [6] Association Between Food and Drug Administration Approval and Disparities in Immunotherapy Use Among Patients With Cancer in the US
    Ermer, Theresa
    Canavan, Maureen E.
    Maduka, Richard C.
    Li, Andrew X.
    Salazar, Michelle C.
    Kaminski, Michael F.
    Pichert, Matthew D.
    Zhan, Peter L.
    Mase, Vincent
    Kluger, Harriet
    Boffa, Daniel J.
    [J]. JAMA NETWORK OPEN, 2022, 5 (06) : E2219535
  • [7] facs, NATL CANC DATABASE P
  • [8] Socioeconomic disparities in immunotherapy use among advanced-stage non-small cell lung cancer patients: analysis of the National Cancer Database
    Gupta, Anjali
    Omeogu, Chioma
    Islam, Jessica Y.
    Joshi, Ashwini
    Zhang, Dongyu
    Braithwaite, Dejana
    Karanth, Shama D.
    Tailor, Tina D.
    Clarke, Jeffrey M.
    Akinyemiju, Tomi
    [J]. SCIENTIFIC REPORTS, 2023, 13 (01)
  • [9] Racial and Socioeconomic Disparities in the Delivery of Immunotherapy for Metastatic Melanoma in the United States
    Haque, Waqar
    Verma, Vivek
    Butler, Edward Brian
    Teh, Bin S.
    [J]. JOURNAL OF IMMUNOTHERAPY, 2019, 42 (06) : 228 - 235
  • [10] Provider roles in the recruitment of underrepresented populations to cancer clinical trials
    Howerton, Mollie W.
    Gibbons, M. Chris
    Baffi, Charles R.
    Gary, Tiffany L.
    Lai, Gabriel Y.
    Bolen, Shari
    Tilburt, Jon
    Tanpitukpongse, Teerath Peter
    Wilson, Renee F.
    Powe, Neil R.
    Bass, Eric B.
    Ford, Jean G.
    [J]. CANCER, 2007, 109 (03) : 465 - 476