Abstract A059: Facility-level disparities in the delivery of guideline-based treatment across genitourinary cancers
Authors: Washington Samuel L. , Szymaniak Julie A. , Gallardo Pedro , Jin Chengshi , Zhang Li , Porten Sima , Meng Maxwell V. , Cooperberg Matthew R. , Carroll Peter R. 
Published: January 2023

Abstract
Objectives Disparities in guideline-based treatment (GBT) for genitourinary cancers are commonly presented individually, impeding comprehensive examinations of institutional drivers. In this study, we utilize the National Cancer Database to characterize the prevalence of disparities in GBT for prostate (PCa), bladder (BCa), and kidney (KCa) cancer within the same facility to evaluate whether disparities cluster at the institutional level. Methods Patients diagnosed with clinically localized (cT2-4aNX-1MX-0) bladder, (cT2b-4NX-0MX-0) prostate, or (cT2a-3cNX-1MX-0) kidney cancer between 2004-2017 within each National Cancer Database dataset were included. We collected clinicodemographics, treatment received, and facility data. GBT was defined according to NCCN Guidelines by TNM staging. We calculated rates of GBT by cancer type and race and compared rates between White and non-White patients (non-Hispanic Black, Hispanic, and Asian) using Chi-squared tests. Pairwise correlations in GBT rates between PCa, BCa, and KCa treated across the facilities were estimated using Pearson correlation coefficients, where the facilities with &lt;10 cases of each cancer were excluded. Results We identified 86,845 BCa, 73,050 KCa, and 252,403 PCa cases. BCa GBT was highest for White and Asian patients (50.5% and 48.6%, respectively) versus 42.2% for Black patients. KCa GBT rates were equivalent for White, Hispanic, and Asian patients (~76%) but lowest for Black patients (74.8%). In PCa, the highest rate was 80.8% (White patients) and lowest was 76.5% (Black patients). Overall, GBT rates for BCa (41%, SD 18%) were significantly lower than for KCa (72%, SD 17%) and PCa (77%, SD 16%), all p&lt;0.001. Intra-facility rates of GBT correlated poorly across cancer types (r=0.1 for prostate-kidney, 0.2 for prostate-bladder, and 0.31 for bladder-kidney; all p≤0.001). Correlation coefficients at academic medical centers were highest among the four facility types, though still low (r=0.31 prostate-bladder, 0.39 prostate-kidney, 0.39 bladder-kidney). Conclusions Overall rates of GBT for GU cancers vary significantly by cancer type and race, without clustering of high rates within the same facility. Restricting disparities-focused interventions to individual cancers disregards potential facility-level commonalities as actionable targets.
Citation Format: Samuel L. Washington, Julie A. Szymaniak, Pedro Gallardo, Chengshi Jin, Li Zhang, Sima Porten, Maxwell V. Meng, Matthew R. Cooperberg, Peter R. Carroll. Facility-level disparities in the delivery of guideline-based treatment across genitourinary cancers [abstract]. In: Proceedings of the 15th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2022 Sep 16-19; Philadelphia, PA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2022;31(1 Suppl):Abstract nr A059.