Potentially curative treatments for muscle-invasive bladder cancer (MIBC) are underused in the United States, according to a recent study.

Using the National Cancer Data Base, investigators Phillip J. Gray, MD, and colleagues at Massachusetts General Hospital in Boston analyzed data from 28,691 patients with MIBC (stages II–IV) treated between 2004 and 2008. The researchers excluded patients with cT4b tumors or distant metastases. Treatments included radical or partial cystectomy with or without chemotherapy (CT), chemoradiotherapy (CRT), radiation therapy (RT), or CT alone and observation following biopsy. The investigators defined aggressive therapy (AT) as radical or partial cystectomy or definitive RT/CRT (total dose 50 Gy or greater).

The study showed that only 52% of patients received AT, 44.9% received surgical treatment, 7.6% received definitive CRT or RT, and 25.9% were managed by observation alone, according to an online report in European Urology. The use of AT decreased with increasing age: compared with patients aged 50 years or younger, those aged 81-90 years were 66% less likely to receive AT. Blacks were 26% less likely than non-blacks, uninsured patients were 27% less likely than insured patients, and Medicaid patients were 19% less likely than non-Medicaid patients to receive AT, data show. All between-group differences were statistically significant.

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Furthermore, AT use was significantly greater with increasing tumor stage: patients with T3/T4a disease were 2.2 times more likely to receive AT than patients with T2 disease.

The study is limited by its retrospective design and lack of information about patient and provider motivations with respect to therapy selection, the investigators noted.

“These data point to a significant unmet need to inform policy makers, payers, and physicians regarding appropriate therapies for MIBC,” the authors concluded.