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Real-world systemic therapy utilization in Medicare patients with locally advanced or metastatic urothelial carcinoma diagnosed between 2008 and 2012.

Publication ,  Journal Article
Dinan, MA; Georgieva, MV; Li, Y; Zhang, T; Harrison, M; Shenolikar, R; Scales, CD
Published in: J Geriatr Oncol
March 2021

PURPOSE: Treatment of advanced urothelial carcinoma (UC) remains a challenging clinical entity occurring predominantly in older patients with limited treatment options. However, real-world treatment patterns, differential cancer center access, and association with outcomes is lacking in nationally representative clinical practice and will provide context for emerging therapies. MATERIALS AND METHODS: We used SEER-Medicare data to identify patients with locally advanced or metastatic UC of the bladder or upper urinary tract diagnosed between 2008 and 2012. We characterized utilization systemic therapy, including first- and second-line chemotherapy. Patients receiving neoadjuvant chemotherapy were excluded; results were stratified by academic versus non-academic setting. RESULTS: 3569 patients met study criteria; 48% received some form of chemotherapy within 2 years of diagnosis. Of these, one-third subsequently received second-line chemotherapy. The majority received a regimen including ≥2 agents. Gemcitabine alone or in combination with platinum was the most common first- and second-line treatment. Similar patterns of first- and second-line chemotherapy were observed between patients treated in academic and non-academic centers. Sensitivity analyses of trial-similar patients demonstrated increased utilization (69%). Receipt of platinum doublet as 1st line therapy was less likely in older patients and those with renal disease, and more likely for grade IV disease. CONCLUSIONS: Roughly half of all Medicare patients with locally advanced/metastatic UC receive systemic therapy regardless of access to academic cancer centers and despite poor oncologic outcomes. Cytotoxic, gemcitabine-based doublet chemotherapy remains the most common treatment. A substantial population of older patients exists for whom alternative, non-cytotoxic, treatment options may be of benefit.

Duke Scholars

Published In

J Geriatr Oncol

DOI

EISSN

1879-4076

Publication Date

March 2021

Volume

12

Issue

2

Start / End Page

298 / 304

Location

Netherlands

Related Subject Headings

  • Urinary Bladder Neoplasms
  • United States
  • Medicare
  • Humans
  • Carcinoma, Transitional Cell
  • Antineoplastic Combined Chemotherapy Protocols
  • Aged
  • 3211 Oncology and carcinogenesis
  • 1112 Oncology and Carcinogenesis
 

Citation

APA
Chicago
ICMJE
MLA
NLM
Dinan, M. A., Georgieva, M. V., Li, Y., Zhang, T., Harrison, M., Shenolikar, R., & Scales, C. D. (2021). Real-world systemic therapy utilization in Medicare patients with locally advanced or metastatic urothelial carcinoma diagnosed between 2008 and 2012. J Geriatr Oncol, 12(2), 298–304. https://doi.org/10.1016/j.jgo.2020.08.005
Dinan, Michaela A., Mihaela V. Georgieva, Yanhong Li, Tian Zhang, Michael Harrison, Rahul Shenolikar, and Charles D. Scales. “Real-world systemic therapy utilization in Medicare patients with locally advanced or metastatic urothelial carcinoma diagnosed between 2008 and 2012.J Geriatr Oncol 12, no. 2 (March 2021): 298–304. https://doi.org/10.1016/j.jgo.2020.08.005.
Dinan MA, Georgieva MV, Li Y, Zhang T, Harrison M, Shenolikar R, et al. Real-world systemic therapy utilization in Medicare patients with locally advanced or metastatic urothelial carcinoma diagnosed between 2008 and 2012. J Geriatr Oncol. 2021 Mar;12(2):298–304.
Dinan, Michaela A., et al. “Real-world systemic therapy utilization in Medicare patients with locally advanced or metastatic urothelial carcinoma diagnosed between 2008 and 2012.J Geriatr Oncol, vol. 12, no. 2, Mar. 2021, pp. 298–304. Pubmed, doi:10.1016/j.jgo.2020.08.005.
Dinan MA, Georgieva MV, Li Y, Zhang T, Harrison M, Shenolikar R, Scales CD. Real-world systemic therapy utilization in Medicare patients with locally advanced or metastatic urothelial carcinoma diagnosed between 2008 and 2012. J Geriatr Oncol. 2021 Mar;12(2):298–304.
Journal cover image

Published In

J Geriatr Oncol

DOI

EISSN

1879-4076

Publication Date

March 2021

Volume

12

Issue

2

Start / End Page

298 / 304

Location

Netherlands

Related Subject Headings

  • Urinary Bladder Neoplasms
  • United States
  • Medicare
  • Humans
  • Carcinoma, Transitional Cell
  • Antineoplastic Combined Chemotherapy Protocols
  • Aged
  • 3211 Oncology and carcinogenesis
  • 1112 Oncology and Carcinogenesis