ASPO Abstracts

Authors: Shu TD, Schumacher FR, Conroy B, Ponsky LE, Mahran A, Bukavina L, Markt SC

Category: Cancer Health Disparities
Conference Year: 2021

Abstract Body:
Significance A growing proportion of patients diagnosed with bladder cancer are dying from causes other than the primary malignancy. The aim of this study was to characterize cause of death among bladder cancer patients by race and sex, follow-up, and calendar time. Methods We identified 160,141 patients diagnosed with bladder cancer in the Surveillance, Epidemiology, and End Results (SEER) database from 1975-2017. We calculated cumulative incidence of death due to seven causes (bladder cancer, COPD, diabetes, heart disease, external causes, other cancer, and other specified causes). We analyzed differences in mortality by race-sex subgroups (white men and women, black men and women, and Asian and Pacific Islander [API] men and women), length of follow-up, and calendar time. We used multivariable Fine and Gray competing risk models to compare risk of bladder cancer-specific mortality between race-sex subgroups, adjusting for age at diagnosis, year of diagnosis, rural/urban, stage, and histology. Results Among the 160,141 bladder cancer patients, 19% died from bladder cancer (n=30,758), 50% died from other causes (n=79,248), primarily other cancer (27%) and diseases of the heart (22%), and 31% were still alive (n=50,135). Among those who died with less than 5 years of follow-up, bladder cancer was the most common cause of death for all race-sex subgroups. The 5-year cumulative incidence of bladder cancer death was highest among black women (64%). For patients with more than 5 years of follow-up, the most common cause of death was other cancer. The cumulative incidence of bladder cancer death decreased by calendar time (1975-1980: 26%; 2011-2017: 13%); however, the risk of dying from other causes increased. White women, API women, and black men and women had increased overall risks of dying from bladder cancer compared to white men when accounting for competing risks. Results were qualitatively similar among those diagnosed with localized disease. Conclusions Among those diagnosed with bladder cancer, mortality from other causes, including diseases of the heart and other cancer, contributed a significant proportion to overall mortality. In addition, we found differences in cause- specific mortality by race-sex subgroups, follow-up, and calendar time.

Keywords: bladder cancer death, race, sex

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