Identification of High-Performing Safety Net Hospitals for Radical Cystectomy: Implications for National Cancer Institute Cancer Center Partnership.

Abstract

For patients with bladder cancer (BCa) undergoing radical cystectomy (RC), National Cancer Institute-designated (NCI-D) cancer centers are considered the gold standard treatment hospital. Underserved populations face disparities in access to NCI-D and receive care at safety net hospitals (SNHs). Variation in quality of care for the underserved at safety-nets remains understudied. We hypothesized that safety-nets with NCI-D partnerships (affiliated safety-nets) would have superior RC outcomes compared with unaffiliated safety-nets. We compared outcomes for BCa undergoing RC between affiliated and unaffiliated safety-nets using the Texas Cancer Registry. Federal payments to hospitals for uncompensated care were used to identify safety-nets. Multivariate accelerated failure time modeled the primary outcome of overall (OS); secondary outcomes of pelvic lymph node dissection (PLND) and neoadjuvant chemotherapy (NAC) were modeled with logistic regression. From 2004 to 2019, there were 1,927 cases of RC. Overall survival was no different at affiliated safety-nets and NCI-D (hazard ratio [HR], 0.99; <i>P</i> = .96), and was worse at unaffiliated safety-nets compared with NCI-D (HR, 1.28; <i>P</i> = .03). Unaffiliated safety-nets had lower odds of NAC (odds ratio [OR], 0.61; <i>P</i> = .02) and PLND (OR, 0.48; <i>P</i> < .001) compared with NCI-D or affiliated safety-nets. NCI-D affiliated safety-nets may represent a subset of high preforming safety net hospitals for BCa patients undergoing RC. Survival differences are partly explained by greater odds of NAC and PLND at affiliated safety-nets. More work is needed to understand the drivers of higher-quality care at NCI-D affiliated safety net hospitals to improve BCa care across all safety net hospitals.