Disparities in long-term radiographic follow-up after cystectomy for bladder cancer: Analysis of the SEER-Medicare database

INTRODUCTION: It is uncertain whether there are disparities related to receiving long-term radiographic follow-up after cystectomy performed for bladder cancer, and whether intensive follow-up influences survival. MATERIALS AND METHODS: We analyzed 2080 patients treated with cystectomy between 1992 and 2004 isolated from the SEER-Medicare database. The number of abdominal computerized tomography scans performed in patients surviving 2 years after surgery was used as an indicator of long-term radiographic follow-up to exclude patients with early failures. RESULTS: Patients were mainly males (83.18%), had a mean age at diagnosis of 73.4 ± 6.6 (standard deviation) years, and mean survival of 4.6 ± 3.2 years. Multivariate analysis showed age >70 (odds ratio [OR]: 0.796, 95% confidence interval [CI]: 0.651–0.974), African American race (OR: 0.180, 95% CI: 0.081–0.279), and Charlson comorbidity score >2 (OR: 0.694, 95% CI: 0.505–0.954) to be associated with lower odds of long-term radiographic follow-up. Higher disease stage (Stage T4N1) (OR: 1.873, 95% CI: 1.491–2.353), higher quartile for education (OR: 5.203, 95% CI: 1.072–9.350) and higher quartile for income (OR: 6.940, 95% CI: 1.444–12.436) were associated with increased odds of long-term radiographic follow-up. Interestingly, more follow-up with imaging after cystectomy did not improve cancer-specific or overall survival in these patients. CONCLUSION: There are significant age, race, and socioeconomic disparities in long-term radiographic follow-up after radical cystectomy. However, more radiographic follow-up may not be associated with better survival.