MP57-19 A SAFETY NET FOR SAFETY NET HOSPITALS: AFFILIATION WITH CANCER CENTERS IMPROVES SURVIVAL IN METASTATIC GENITOURINARY CANCERS AMONG THE MEDICALLY VULNERABLE

You have accessJournal of UrologyHealth Services Research: Value of Care: Cost and Outcomes II (MP57)1 May 2024MP57-19 A SAFETY NET FOR SAFETY NET HOSPITALS: AFFILIATION WITH CANCER CENTERS IMPROVES SURVIVAL IN METASTATIC GENITOURINARY CANCERS AMONG THE MEDICALLY VULNERABLE Raj R. Bhanvadia, Jacob Taylor, Aditya Bagrodia, Kris Gaston, Solomon Woldu, Isamu Tachibana, Yair Lotan, and Vitaly Margulis Raj R. BhanvadiaRaj R. Bhanvadia , Jacob TaylorJacob Taylor , Aditya BagrodiaAditya Bagrodia , Kris GastonKris Gaston , Solomon WolduSolomon Woldu , Isamu TachibanaIsamu Tachibana , Yair LotanYair Lotan , and Vitaly MargulisVitaly Margulis View All Author Informationhttps://doi.org/10.1097/01.JU.0001009420.83948.eb.19AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Safety net hospitals (SNH) care for a large proportion of medically vulnerable populations (MVP). Addressing health disparities at a hospital level through partnerships with cancer centers is a strategy to improve outcomes of MVPs. We compared outcomes for metastatic prostate (mPCa), kidney (mKCa), and urothelial cancer (mUCa) among National Cancer Institute cancer centers (NCI) and NCI affiliated SNH (NCI-SNH) using the Texas Cancer Registry (TCR). METHODS: With 98% case ascertainment, TCR can uniquely identify each treatment facility, allowing detailed hospital level comparisons. The TCR was queried from 2004-2017 for mPCa, mKCa, and mUCa. Public data identified Texas NCIs. Top quartile of Disproportionate Share Hospital Index values identified SNHs. SNHs with relationships to NCI were designated NCI-SNHs. All other hospitals were Non-SNHs. MVPs were defined as age >75, non-US natives, non-whites, and uninsured or Medicaid. We examined rates of systemic therapy using chi-square tests, and overall survival using multivariable Cox regression. RESULTS: TCR identified 20,503 metastatic GU cancers (47.4% mPCa, 41.2% mKCa, 11.1% mUCa). Within a hospital designation, MVPs were the majority of patients seen at NCI-SNHs (80%) versus other SNH (45%) or NCI (37.1%, p<0.01). For mPCa, rates of hormone therapy were similar between NCI-SNH (76.7%) and NCI (76.2%), but greater than other hospital types (p<0.01). Chemotherapy or immunotherapy was greater at NCI-SNHs compared to other SNH or non-SNH for mKCa (36.1% vs 31.1% vs 27.1%, p<0.01) and mUCa (44.0% vs 36.7% vs 33.2%, p<0.01). On multivariable cox analysis, survival was equivalent between NCI and NCI-SNH and superior to other hospital types across GU cancers (Table 1). CONCLUSIONS: Despite caring for a significant majority of MVPs, NCI-SNHs had comparable OS to NCIs and superior OS compared to other hospital types. Future initiatives to improve cancer care should focus on strengthening existing relationships between NCI and SNH and examine mechanisms to centralize care of MVPs to these facilities. Source of Funding: None © 2024 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 211Issue 5SMay 2024Page: e946 Advertisement Copyright & Permissions© 2024 by American Urological Association Education and Research, Inc.Metrics Author Information Raj R. Bhanvadia More articles by this author Jacob Taylor More articles by this author Aditya Bagrodia More articles by this author Kris Gaston More articles by this author Solomon Woldu More articles by this author Isamu Tachibana More articles by this author Yair Lotan More articles by this author Vitaly Margulis More articles by this author Expand All Advertisement PDF downloadLoading ...