Reasons for delay in receipt of neoadjuvant chemotherapy in patients with muscle invasive bladder cancer.

Abstract

178 Background: Delay in time from muscle invasive bladder cancer (MIBC) diagnosis to neoadjuvant chemotherapy (NACT) > 60 days, can negatively impact cancer related outcomes. However, the underlying causes of these delays remain poorly characterized, underscoring the need for further investigation. Methods: We performed a retrospective cohort study of patients with MIBC treated with NACT at a large academic cancer center between 2014- 2024. Patients were identified through the electronic health record. Chart review was performed to determine specific reasons for delay and patients with missing or insufficient treatment data were excluded. The primary outcome was delay in NACT initiation (NACTI) defined as >60 days from pathologic diagnosis to first systemic chemotherapy treatment. The secondary outcome was number of days from diagnosis to treatment initiation. Covariates included sex, race, preferred language, and disease stage. Descriptive statistics were used to summarize cohort characteristics, frequency of delay, and reasons for delays. Univariate associations between covariates and incidence of delay (yes/no) were assessed using chi-square tests, and multivariable associations between covariates and incidence of delay were assessed using logistic modeling. Multivariable associations between covariates and time from diagnosis to chemotherapy initiation was assessed using Cox proportional-hazards modeling. Results: A total of 117 patients with MIBC who received NACT prior to surgery were included. Across the entire cohort, 78.6% were male, 84.6% were White, and 88.0% were non-Hispanic. Median time from pathologic diagnosis to NACTI was 47 days (IQR: 33-65). Of these patients, 41 (35%) experienced a delay greater than 60 days from pathologic diagnosis to NACTI. Reasons for delay were additional imaging or procedure (29.2%), second opinion or transfer of care (22.0%), comorbidity management (19.5%), psychosocial factors (7.3%), clinical trial enrollment (4.9%), and unknown (17.1%). There were no significant predictors of incidence of delay (yes/no) in either univariate or multivariable analyses. In a multivariable analysis evaluating time from diagnosis to NACTI, Black race was associated with a higher likelihood of delay in chemotherapy initiation compared to White race (HR 1.92, 95% CI 0.92–4.00, p=0.082). No statistically significant associations were observed between sex, preferred language, or clinical stage and time to treatment initiation. Conclusions: NACTI delays were common and largely driven by modifiable care-coordination factors, including additional workup and second opinions. Black race was associated with a trend toward longer time to treatment initiation. Future initiatives to streamline care coordination are needed in this high risk population.