Access to trimodal therapy in muscle-invasive bladder cancer is lower in unmarried females

Abstract

Objective: Trimodal therapy (TMT) is guideline-recommended for localized muscle-invasive urothelial carcinoma of the urinary bladder (UCUB). Married status represents an important determinant of treatment use in many primaries. The importance of married status is unknown in the context of TMT for localized muscle-invasive UCUB and was addressed in the current study. Methods: We relied on the Surveillance, Epidemiology, and End Results database (2004–2020) to identify patients with localized muscle-invasive UCUB. Univariable logistic regression models were fitted. Additionally, temporal trends were plotted. Results: Overall, 28,035 patients with localized muscle-invasive UCUB were identified. Of those, 7,112 (25%) were female and 20,923 (75%) were male. Of females, 2,389 (34%) were married. Of males, 13,671 (65%) were married. The rates of TMT were 14% in both married females and males and 13% in both unmarried females and males. Married females differed from unmarried females regarding age and race/ethnicity. Prior to multivariable adjustment for age and race/ethnicity, no significant association existed between married status and TMT use in females (p = 0.2). However, after multivariable adjustment, a 1.2-fold (p = 0.02) higher rate of TMT was recorded in married females vs. their unmarried counterparts. Finally, no association between married status and TMT use was recorded in males either prior to or after multivariable adjustment. Conclusion: Unmarried female patients may be at risk of lower TMT access compared to their married counterparts. Consequently, TMT should be given particularly thorough consideration in unmarried female patients to avoid suboptimal TMT access.