Systematic Review of Factors Associated with the Utilization of Radical Cystectomy for Bladder Cancer

Stephen B. Williams, Hogan K. Hudgins, Mohamed D. Ray-Zack, Karim Chamie, Marc C. Smaldone, Stephen A. Boorjian, Siamak Daneshmand, Peter C. Black, Ashish M. Kamat, Peter J. Goebell, Roland Seiler, Bernd Schmitz-Drager, Roman Nawroth, Jacques Baillargeon, Zachary W A Klaassen, Girish S. Kulkarni, Simon P. Kim, Eugene K. Lee, Jeffrey M. Holzbeierlein, Brent K. Hollenbeck & 1 others John L. Gore

Research output: Contribution to journalArticle

2 Citations (Scopus)

Abstract

Context: Despite established guidelines for the treatment of muscle-invasive bladder cancer, it has been reported that radical cystectomy (RC) is markedly underused, especially among patients of advanced age and those with higher comorbidity burden and lower access to care. Understanding the interactions between patient, provider, and hospital factors may inform targeted interventions to optimize RC utilization. Objective: To systematically review the literature regarding factors associated with RC utilization. Evidence acquisition: A systematic search was conducted using Ovid and Medline according to Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines to identify studies between 1970 and 2017 reporting on RC utilization. Prospective and retrospective studies were included. Evidence synthesis: There are no published randomized control trials on RC utilization. Variations in study quality and design precluded a formal statistical meta-analysis. RC receipt significantly depended on patient, provider, and hospital factors. Patient factors associated with lower RC use included advanced age, African American and Hispanic race/ethnicity, higher comorbidity burden, unmarried marital status, higher tumor stage and grade, and lower socioeconomic status. Provider factors associated with underutilization included lower surgeon volume and a metropolitan location. Finally, hospital factors associated with lower RC use included low hospital volume, nonacademic affiliation, and hospital location in the Midwest. Conclusions: RC is reportedly underutilized. We found that age, race, marital status, socioeconomic factors, cancer severity, comorbidity burden, surgeon volume, and facility type and location significantly determined RC receipt. Improved understanding of the varying contributions of the risk factors according to patient, provider, and hospital determinants may assist in developing targeted interventions to improve RC utilization. Patient summary: In this review we explored the clinical evidence for factors predicting the utilization of radical cystectomy for muscle-invasive bladder cancer. Many factors related to the patient, provider, and hospital determine whether patients receive this guideline-recommended treatment. However, there remains a lack of understanding on characterization and targeted interventions according to these levels, which may improve use. We found that age, race, marital status, socioeconomic factors, cancer severity, comorbidity burden, surgeon volume, and facility type and location significantly determined receipt of radical cystectomy. A better understanding of the varying contributions of these risk factors according to patient, provider, and hospital determinants may assist in developing targeted interventions to improve radical cystectomy utilization.

Original languageEnglish (US)
Pages (from-to)119-125
Number of pages7
JournalEuropean Urology Oncology
Volume2
Issue number2
DOIs
StatePublished - Mar 1 2019

Fingerprint

Cystectomy
Urinary Bladder Neoplasms
Comorbidity
Marital Status
Guidelines
Meta-Analysis
Low-Volume Hospitals
Muscles
Neoplasms
Hispanic Americans
Social Class
African Americans

Keywords

  • Predictors
  • Radical cystectomy
  • Use
  • Utilization

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Surgery
  • Oncology
  • Urology

Cite this

Williams, S. B., Hudgins, H. K., Ray-Zack, M. D., Chamie, K., Smaldone, M. C., Boorjian, S. A., ... Gore, J. L. (2019). Systematic Review of Factors Associated with the Utilization of Radical Cystectomy for Bladder Cancer. European Urology Oncology, 2(2), 119-125. https://doi.org/10.1016/j.euo.2018.07.006

Systematic Review of Factors Associated with the Utilization of Radical Cystectomy for Bladder Cancer. / Williams, Stephen B.; Hudgins, Hogan K.; Ray-Zack, Mohamed D.; Chamie, Karim; Smaldone, Marc C.; Boorjian, Stephen A.; Daneshmand, Siamak; Black, Peter C.; Kamat, Ashish M.; Goebell, Peter J.; Seiler, Roland; Schmitz-Drager, Bernd; Nawroth, Roman; Baillargeon, Jacques; Klaassen, Zachary W A; Kulkarni, Girish S.; Kim, Simon P.; Lee, Eugene K.; Holzbeierlein, Jeffrey M.; Hollenbeck, Brent K.; Gore, John L.

In: European Urology Oncology, Vol. 2, No. 2, 01.03.2019, p. 119-125.

Research output: Contribution to journalArticle

Williams, SB, Hudgins, HK, Ray-Zack, MD, Chamie, K, Smaldone, MC, Boorjian, SA, Daneshmand, S, Black, PC, Kamat, AM, Goebell, PJ, Seiler, R, Schmitz-Drager, B, Nawroth, R, Baillargeon, J, Klaassen, ZWA, Kulkarni, GS, Kim, SP, Lee, EK, Holzbeierlein, JM, Hollenbeck, BK & Gore, JL 2019, 'Systematic Review of Factors Associated with the Utilization of Radical Cystectomy for Bladder Cancer', European Urology Oncology, vol. 2, no. 2, pp. 119-125. https://doi.org/10.1016/j.euo.2018.07.006
Williams, Stephen B. ; Hudgins, Hogan K. ; Ray-Zack, Mohamed D. ; Chamie, Karim ; Smaldone, Marc C. ; Boorjian, Stephen A. ; Daneshmand, Siamak ; Black, Peter C. ; Kamat, Ashish M. ; Goebell, Peter J. ; Seiler, Roland ; Schmitz-Drager, Bernd ; Nawroth, Roman ; Baillargeon, Jacques ; Klaassen, Zachary W A ; Kulkarni, Girish S. ; Kim, Simon P. ; Lee, Eugene K. ; Holzbeierlein, Jeffrey M. ; Hollenbeck, Brent K. ; Gore, John L. / Systematic Review of Factors Associated with the Utilization of Radical Cystectomy for Bladder Cancer. In: European Urology Oncology. 2019 ; Vol. 2, No. 2. pp. 119-125.
@article{1ba8261f4f4b4a3bb414da238c0a6e5c,
title = "Systematic Review of Factors Associated with the Utilization of Radical Cystectomy for Bladder Cancer",
abstract = "Context: Despite established guidelines for the treatment of muscle-invasive bladder cancer, it has been reported that radical cystectomy (RC) is markedly underused, especially among patients of advanced age and those with higher comorbidity burden and lower access to care. Understanding the interactions between patient, provider, and hospital factors may inform targeted interventions to optimize RC utilization. Objective: To systematically review the literature regarding factors associated with RC utilization. Evidence acquisition: A systematic search was conducted using Ovid and Medline according to Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines to identify studies between 1970 and 2017 reporting on RC utilization. Prospective and retrospective studies were included. Evidence synthesis: There are no published randomized control trials on RC utilization. Variations in study quality and design precluded a formal statistical meta-analysis. RC receipt significantly depended on patient, provider, and hospital factors. Patient factors associated with lower RC use included advanced age, African American and Hispanic race/ethnicity, higher comorbidity burden, unmarried marital status, higher tumor stage and grade, and lower socioeconomic status. Provider factors associated with underutilization included lower surgeon volume and a metropolitan location. Finally, hospital factors associated with lower RC use included low hospital volume, nonacademic affiliation, and hospital location in the Midwest. Conclusions: RC is reportedly underutilized. We found that age, race, marital status, socioeconomic factors, cancer severity, comorbidity burden, surgeon volume, and facility type and location significantly determined RC receipt. Improved understanding of the varying contributions of the risk factors according to patient, provider, and hospital determinants may assist in developing targeted interventions to improve RC utilization. Patient summary: In this review we explored the clinical evidence for factors predicting the utilization of radical cystectomy for muscle-invasive bladder cancer. Many factors related to the patient, provider, and hospital determine whether patients receive this guideline-recommended treatment. However, there remains a lack of understanding on characterization and targeted interventions according to these levels, which may improve use. We found that age, race, marital status, socioeconomic factors, cancer severity, comorbidity burden, surgeon volume, and facility type and location significantly determined receipt of radical cystectomy. A better understanding of the varying contributions of these risk factors according to patient, provider, and hospital determinants may assist in developing targeted interventions to improve radical cystectomy utilization.",
keywords = "Predictors, Radical cystectomy, Use, Utilization",
author = "Williams, {Stephen B.} and Hudgins, {Hogan K.} and Ray-Zack, {Mohamed D.} and Karim Chamie and Smaldone, {Marc C.} and Boorjian, {Stephen A.} and Siamak Daneshmand and Black, {Peter C.} and Kamat, {Ashish M.} and Goebell, {Peter J.} and Roland Seiler and Bernd Schmitz-Drager and Roman Nawroth and Jacques Baillargeon and Klaassen, {Zachary W A} and Kulkarni, {Girish S.} and Kim, {Simon P.} and Lee, {Eugene K.} and Holzbeierlein, {Jeffrey M.} and Hollenbeck, {Brent K.} and Gore, {John L.}",
year = "2019",
month = "3",
day = "1",
doi = "10.1016/j.euo.2018.07.006",
language = "English (US)",
volume = "2",
pages = "119--125",
journal = "European urology oncology",
issn = "2588-9311",
publisher = "Elsevier BV",
number = "2",

}

TY - JOUR

T1 - Systematic Review of Factors Associated with the Utilization of Radical Cystectomy for Bladder Cancer

AU - Williams, Stephen B.

AU - Hudgins, Hogan K.

AU - Ray-Zack, Mohamed D.

AU - Chamie, Karim

AU - Smaldone, Marc C.

AU - Boorjian, Stephen A.

AU - Daneshmand, Siamak

AU - Black, Peter C.

AU - Kamat, Ashish M.

AU - Goebell, Peter J.

AU - Seiler, Roland

AU - Schmitz-Drager, Bernd

AU - Nawroth, Roman

AU - Baillargeon, Jacques

AU - Klaassen, Zachary W A

AU - Kulkarni, Girish S.

AU - Kim, Simon P.

AU - Lee, Eugene K.

AU - Holzbeierlein, Jeffrey M.

AU - Hollenbeck, Brent K.

AU - Gore, John L.

PY - 2019/3/1

Y1 - 2019/3/1

N2 - Context: Despite established guidelines for the treatment of muscle-invasive bladder cancer, it has been reported that radical cystectomy (RC) is markedly underused, especially among patients of advanced age and those with higher comorbidity burden and lower access to care. Understanding the interactions between patient, provider, and hospital factors may inform targeted interventions to optimize RC utilization. Objective: To systematically review the literature regarding factors associated with RC utilization. Evidence acquisition: A systematic search was conducted using Ovid and Medline according to Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines to identify studies between 1970 and 2017 reporting on RC utilization. Prospective and retrospective studies were included. Evidence synthesis: There are no published randomized control trials on RC utilization. Variations in study quality and design precluded a formal statistical meta-analysis. RC receipt significantly depended on patient, provider, and hospital factors. Patient factors associated with lower RC use included advanced age, African American and Hispanic race/ethnicity, higher comorbidity burden, unmarried marital status, higher tumor stage and grade, and lower socioeconomic status. Provider factors associated with underutilization included lower surgeon volume and a metropolitan location. Finally, hospital factors associated with lower RC use included low hospital volume, nonacademic affiliation, and hospital location in the Midwest. Conclusions: RC is reportedly underutilized. We found that age, race, marital status, socioeconomic factors, cancer severity, comorbidity burden, surgeon volume, and facility type and location significantly determined RC receipt. Improved understanding of the varying contributions of the risk factors according to patient, provider, and hospital determinants may assist in developing targeted interventions to improve RC utilization. Patient summary: In this review we explored the clinical evidence for factors predicting the utilization of radical cystectomy for muscle-invasive bladder cancer. Many factors related to the patient, provider, and hospital determine whether patients receive this guideline-recommended treatment. However, there remains a lack of understanding on characterization and targeted interventions according to these levels, which may improve use. We found that age, race, marital status, socioeconomic factors, cancer severity, comorbidity burden, surgeon volume, and facility type and location significantly determined receipt of radical cystectomy. A better understanding of the varying contributions of these risk factors according to patient, provider, and hospital determinants may assist in developing targeted interventions to improve radical cystectomy utilization.

AB - Context: Despite established guidelines for the treatment of muscle-invasive bladder cancer, it has been reported that radical cystectomy (RC) is markedly underused, especially among patients of advanced age and those with higher comorbidity burden and lower access to care. Understanding the interactions between patient, provider, and hospital factors may inform targeted interventions to optimize RC utilization. Objective: To systematically review the literature regarding factors associated with RC utilization. Evidence acquisition: A systematic search was conducted using Ovid and Medline according to Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines to identify studies between 1970 and 2017 reporting on RC utilization. Prospective and retrospective studies were included. Evidence synthesis: There are no published randomized control trials on RC utilization. Variations in study quality and design precluded a formal statistical meta-analysis. RC receipt significantly depended on patient, provider, and hospital factors. Patient factors associated with lower RC use included advanced age, African American and Hispanic race/ethnicity, higher comorbidity burden, unmarried marital status, higher tumor stage and grade, and lower socioeconomic status. Provider factors associated with underutilization included lower surgeon volume and a metropolitan location. Finally, hospital factors associated with lower RC use included low hospital volume, nonacademic affiliation, and hospital location in the Midwest. Conclusions: RC is reportedly underutilized. We found that age, race, marital status, socioeconomic factors, cancer severity, comorbidity burden, surgeon volume, and facility type and location significantly determined RC receipt. Improved understanding of the varying contributions of the risk factors according to patient, provider, and hospital determinants may assist in developing targeted interventions to improve RC utilization. Patient summary: In this review we explored the clinical evidence for factors predicting the utilization of radical cystectomy for muscle-invasive bladder cancer. Many factors related to the patient, provider, and hospital determine whether patients receive this guideline-recommended treatment. However, there remains a lack of understanding on characterization and targeted interventions according to these levels, which may improve use. We found that age, race, marital status, socioeconomic factors, cancer severity, comorbidity burden, surgeon volume, and facility type and location significantly determined receipt of radical cystectomy. A better understanding of the varying contributions of these risk factors according to patient, provider, and hospital determinants may assist in developing targeted interventions to improve radical cystectomy utilization.

KW - Predictors

KW - Radical cystectomy

KW - Use

KW - Utilization

UR - http://www.scopus.com/inward/record.url?scp=85065332140&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85065332140&partnerID=8YFLogxK

U2 - 10.1016/j.euo.2018.07.006

DO - 10.1016/j.euo.2018.07.006

M3 - Article

VL - 2

SP - 119

EP - 125

JO - European urology oncology

JF - European urology oncology

SN - 2588-9311

IS - 2

ER -