Outcomes Among Rural and Urban Patients With High-Risk Nonmuscle-Invasive Bladder Cancer: Results From the Canadian Bladder Cancer Information System.

Abstract

Patients with high-risk nonmuscle-invasive bladder cancer (NMIBC) require frequent surveillance and adjuvant intravesical therapy, which may be less accessible in rural areas. Using the Statistics Canada Remoteness Index, we sought to investigate the effect of rurality/remoteness on the presentation, management, and surveillance of high-risk NMIBC and cancer-specific outcomes such as survival and rate of progression. The Canadian Bladder Cancer Information System database was used to identify all patients diagnosed with high-risk NMIBC (defined as high-grade [HG] Ta, any T1 disease, CIS) on initial transurethral resection of bladder tumor. Using the manual classification method, rural areas were defined as a Remoteness Index ≥ 0.15. Exclusion criteria included patients with nonurothelial histology, unknown T stage, or evidence of nodal or distant metastases at the time of diagnosis. Among 2838 high-risk NMIBC patients, 71% were urban and 30% rural. Rural patients were more likely than urban patients to present with HG T1 tumors (42% vs 37%, <i>P</i> = .059). Repeat transurethral resection of bladder tumor was performed within 90 days for HG T1 disease in 29% of urban and 23% of rural patients (<i>P</i> = .04). Rural patients were less likely than urban patients to receive induction bacillus Calmette-Guérin (52% vs 69%, <i>P</i> < .0001). Five-year progression-free survival to muscle-invasive bladder cancer was significantly lower among rural patients (80% vs 85%; <i>P</i> = .048). Rural patients with high-risk NMIBC were significantly less likely to meet quality indicator benchmarks for guideline-concordant surveillance and management, although overall rates are low indicating a potential area of quality improvement efforts.