Introduction: We investigated barriers to the receipt of neoadjuvant chemotherapy by patients undergoing radical cystectomy.
Methods: After institutional review board approval we performed a retrospective chart review from January 1, 2012 to March 1, 2018 of cases of radical cystectomy with urinary diversion for bladder cancer. Patients were placed in 1 of 3 groups according to eligibility to receive neoadjuvant chemotherapy before undergoing cystectomy, as "NAC" if they received neoadjuvant chemotherapy, "No NAC - Declined" if they were eligible but declined neoadjuvant chemotherapy and "No NAC - Ineligible" if they were clinically ineligible to receive neoadjuvant chemotherapy. We performed univariate and multivariate analyses on social and pathological factors in these 3 categories.
Results: Of 268 patients identified 209 were eligible to be included in this study. On univariate analysis statistical differences were noted according to age and distance from treatment center. On pathological analysis stage was statistically different between the cohorts. A multivariate analysis revealed that single patients were more likely to decline neoadjuvant chemotherapy as opposed to married patients.
Conclusions: Neoadjuvant chemotherapy before radical cystectomy for muscle invasive bladder cancer continues to be an underused treatment modality in South Florida. Age, marital status and distance from treatment center all appear to have an impact on patient acceptance of or referring doctor recommendations for neoadjuvant chemotherapy. We suggest larger multi-institutional studies to further assess this issue.
Keywords: drug utilization; neoadjuvant therapy; social determinants of health; urology.