JCO oncology practice · 2026
Identification of High-Performing Safety Net Hospitals for Radical Cystectomy: Implications for National Cancer Institute Cancer Center Partnership.
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Bhanvadia Raj, Bochner Emily, Jiang Changchuan, Hong Arthur S, Khene Zine-Eddine, Lotan Yair, Margulis Vitaly
Аннотация
PURPOSE: 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.
METHODS: 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.
RESULTS: 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; P = .96), and was worse at unaffiliated safety-nets compared with NCI-D (HR, 1.28; P = .03). Unaffiliated safety-nets had lower odds of NAC (odds ratio [OR], 0.61; P = .02) and PLND (OR, 0.48; P < .001) compared with NCI-D or affiliated safety-nets.
CONCLUSION: 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.
METHODS: 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.
RESULTS: 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; P = .96), and was worse at unaffiliated safety-nets compared with NCI-D (HR, 1.28; P = .03). Unaffiliated safety-nets had lower odds of NAC (odds ratio [OR], 0.61; P = .02) and PLND (OR, 0.48; P < .001) compared with NCI-D or affiliated safety-nets.
CONCLUSION: 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.