Systemic therapy is guideline-recommended for metastatic urothelial carcinoma of the urinary bladder (UCUB). Unmarried status represents an important barrier to treatment access in many primaries. The importance of married status is unknown in the context of systemic therapy in metastatic UCUB and was addressed in the current study.
We relied on the Surveillance, Epidemiology, and End Results database (2004-2020) to identify patients with metastatic UCUB. Univariable and multivariable logistic regression models were fitted to address systemic therapy rates. Additionally, temporal trends were plotted.
Overall, 6873 patients with stage IV UCUB were identified. Of those, 4853 (71%) were male. Of males, 2993 (62%) were married vs. 797 (39%) of females. The rates of systemic therapy were 55% in both married males and married females. Married males and females differed from their unmarried counterparts regarding age and race/ethnicity. In males, prior to any adjustment, married status was associated with an odds ratio of 1.46 (P < .001). After adjustment for age and race/ethnicity, the odds ratio increased to 1.73 (P < .001). In females, prior to any adjustment, married status was associated with an odds ratio of 1.94 (P < .001). After adjustment for age and race/ethnicity, the odds ratio decreased to 1.57 (P < .001).
Unmarried males and unmarried females are significantly exposed to lower access to systemic therapy compared to their married counterparts. In consequence, both unmarried men and unmarried women should be given very careful consideration when use of systemic therapy in metastatic UCUB is contemplated.
Clinical genitourinary cancer. 2024 Jul 18 [Epub ahead of print]
Kira Vitucci, Carolin Siech, Andrea Baudo, Letizia M I Jannello, Mario de Angelis, Francesco Di Bello, Jordan A Goyal, Zhe Tian, Fred Saad, Shahrokh F Shariat, Nicola Longo, Luca Carmignani, Ottavio de Cobelli, Alberto Briganti, Luis A Kluth, Felix K H Chun, Pierre I Karakiewicz
Division of Urology, Cancer Prognostics and Health Outcomes Unit, University of Montréal Health Center, Montréal, Québec, Canada; Department of Urology, Goethe University Frankfurt, University Hospital, Frankfurt am Main, Germany. Electronic address: ., Division of Urology, Cancer Prognostics and Health Outcomes Unit, University of Montréal Health Center, Montréal, Québec, Canada; Department of Urology, Goethe University Frankfurt, University Hospital, Frankfurt am Main, Germany., Division of Urology, Cancer Prognostics and Health Outcomes Unit, University of Montréal Health Center, Montréal, Québec, Canada; Department of Urology, IRCCS Policlinico San Donato, Milan, Italy., Division of Urology, Cancer Prognostics and Health Outcomes Unit, University of Montréal Health Center, Montréal, Québec, Canada; Department of Urology, IEO European Institute of Oncology, IRCCS, Milan, Italy; Scuola di Specializzazione in Urologia, Università degli Studi di Milano, Italy., Division of Urology, Cancer Prognostics and Health Outcomes Unit, University of Montréal Health Center, Montréal, Québec, Canada; Scuola di Specializzazione in Urologia, Vita-Salute San Raffaele University, Milan, Italy; Division of Experimental Oncollgy/Unit of Urology; URI; IRCCS Ospedale San Raffaele Milan, Italy., Division of Urology, Cancer Prognostics and Health Outcomes Unit, University of Montréal Health Center, Montréal, Québec, Canada; Department of Neurosciences, Science of Reproduction and Odontostomatology, University of Naples Federico II, Naples, Italy; Department of Urology, Weill Cornell Medical College, New York, NY., Division of Urology, Cancer Prognostics and Health Outcomes Unit, University of Montréal Health Center, Montréal, Québec, Canada., Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX; Hourani Center for Applied Scientific Research, Al-Ahliyya Amman University, Amman, Jordan; Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria., Department of Neurosciences, Science of Reproduction and Odontostomatology, University of Naples Federico II, Naples, Italy., Department of Urology, IRCCS Policlinico San Donato, Milan, Italy; Department of Urology, IRCCS Ospedale Galeazzi - Sant'Ambrogio, Milan, Italy., Department of Urology, IEO European Institute of Oncology, IRCCS, Milan, Italy; Scuola di Specializzazione in Urologia, Università degli Studi di Milano, Italy., Scuola di Specializzazione in Urologia, Vita-Salute San Raffaele University, Milan, Italy., Department of Urology, Goethe University Frankfurt, University Hospital, Frankfurt am Main, Germany.