Main Session
Sep
29
PQA 06 - Genitourinary Cancer, Gynecological Cancer, and Health Care Access and Engagement
Presenter(s)
Nikitha Kalahasti, BS - University of California at San Diego, La Jolla, CA
N. V. Kalahasti1, S. R. Chintala2, E. M. Qiao3, K. M. Morgan4, D. Sabater Minarim5, H. Nguyen1, M. Banegas3, and B. S. Rose6; 1University of California San Diego School of Medicine, La Jolla, CA, 2Center for Health Equity Education & Research, University of California San Diego, San Diego, CA, 3Center for Health Equity, Education and Research, University of California San Diego, La Jolla, CA, 4UCSD Center for Health Equity, Education, and Research, San Diego, CA, 5Department of Radiation Medicine and Applied Sciences, La Jolla, CA, 6Department of Radiation Medicine and Applied Sciences, University of California San Diego, La Jolla, CA
Purpose/Objective(s):
Primary care is critical to the early detection, diagnosis, and treatment of cancer, which can improve patient outcomes. We evaluated the association between prediagnostic primary care provider (PCP) utilization and metastatic disease at diagnosis and cancer related mortality among patients with bladder cancer.Materials/Methods:
We performed a retrospective analysis of patients aged =68 diagnosed with bladder cancer between 2010-2017 using the Surveillance, Epidemiology, and End Results (SEER)-Medicare database. PCP utilization was measured as years with =1 PCP visit in each of the 3 years pre-diagnosis: none (0), partial (1-2), or annual (3). Multivariate logistic regression was performed to evaluate the association between prediagnostic PCP utilization and metastasis at diagnosis. Bladder Cancer specific mortality (CSM) was analyzed using a Fine-Gray competing risks model.Results:
Of the 21,159 patients with bladder cancer, 1,285 (6.1%) had no-prior prediagnostic PCP visits, 8,441 (39.9%) had partial prediagnostic PCP visits, and 11,433 (54.0%) had annual prediagnostic PCP visits. Compared to no-prior PCP visits, patients with partial PCP visits had 51% decreased odds of metastatic disease at diagnosis (Odds Ratio [OR]: 0.49; 95% Confidence Interval [CI]: 0.38-0.62; p<0.001) and a 43% reduced risk of CSM (subdistribution hazard ratio [SHR]: 0.57; 95% CI: 0.52-0.62; p<0.001). Compared to no-prior PCP visits, patients with annual PCP visits had 53% decreased odds of metastatic disease at diagnosis (Odds Ratio [OR]: 0.47; 95% Confidence Interval [CI]: 0.37-0.59; p<0.001) and 52% reduced risk of CSM (subdistribution hazard ratio [SHR]: 0.48; 95% CI: 0.43-0.52; p<0.001).Conclusion:
Increased primary care utilization before bladder cancer diagnosis was associated with lower odds of metastatic disease at diagnosis and reduced bladder cancer specific mortality, with the most benefit in patients having annual prediagnostic PCP visits. Increasing PCP utilization represents an actionable intervention to improve early cancer detection and survival outcomes in bladder cancer patients.