MP24-20 PALLIATIVE CARE IN PATIENTS WITH ADVANCED BLADDER CANCER IN THE US

INTRODUCTION AND OBJECTIVE: Palliative care improves quality of life for patients with advanced bladder cancer. Nevertheless, it is neither well defined nor incorporated in urological guidelines. This study sought to determine the rates and predictors of palliative care use among advanced bladder cancer patients. METHODS: Using the National Cancer Data Base (NCDB) from 2004 to 2015, we identified 41,165 patients with advanced bladder cancer (T4, N+ or M+) and known palliative care status, as coded in the NCDB. Patients were dichotomized as those who did not undergo palliative therapy and those who received any type of palliative therapy such as surgery, radiation therapy, chemotherapy or pain management treatment. Chi-square test was used to determine differences between these two groups. Multivariable logistic regression analysis was performed to identify predictors associated with receiving palliative care. RESULTS: 3,402 (8.3%) out of 41,165 patients with advanced bladder cancer underwent palliative care, categorized as: surgery (14%), radiation therapy (34%), chemotherapy (24.3%), pain management (10%) and combined palliative care (18.7%). In this cohort of patients, the majority were over 65 years of age (69%), male (69%), white (86%), had Medicare (65%) and were treated in a comprehensive community cancer program (42%). The multivariable logistic regression analysis showed that female sex (OR 1.1, p=0.029), African American race (OR 1.16, p=0.022), Charleston comorbidity index > 2 (OR 1.28, p=0.001), type of facility [community cancer program (OR 1.32, p=0.001), comprehensive community cancer program (OR 1.22, P<0.001) and integrated network cancer program (OR 1.26, p=0.001)], insurance type [Medicaid (OR 1.47, p<0.001), Medicare (OR 1.29, p<0.001), other government (OR 1.46, p=0.026), and uninsured status (OR 1.56, p<0.001)], diagnosis after 2012 (OR 1.34, p<0.001), squamous cell histology (OR 1.23, p=0.031), and presence of metastases (OR 4.92, p<0.001) were associated with receiving palliative care. CONCLUSIONS: Palliative care remains underused in the advanced bladder cancer population, even for those with metastatic disease. Our study demonstrated that patient insurance, comorbidities, metastatic disease, tumor histology, and type of treatment facility have predictive value for determining which patients receive palliative care. Source of Funding: none