Access to care

Gaps Persist in Access to Bladder Cancer Care

Timely access to urologists, oncologists, and appropriate treatment is an important part of bladder cancer management, yet a large analysis of U.S. Medicare beneficiaries found measurable racial and ethnic differences across several points in the care pathway. Among patients newly diagnosed with bladder cancer, Black and Hispanic patients were less likely to access specialty care and receive treatment than White patients, while several groups experienced longer intervals between diagnosis and treatment initiation.

Researchers analyzed Medicare fee-for-service claims from 2021 through 2022, identifying 136,172 beneficiaries with newly diagnosed bladder cancer. The study examined access to urology and oncology specialists, receipt of pharmacological or non-pharmacological treatment, and time from diagnosis to specialist care and treatment. The cohort had a median age of 77 years, and nearly 97% of patients were 65 years or older, providing a contemporary look at care patterns in an older population in which bladder cancer is particularly common.

Differences were apparent in both specialist access and treatment. Compared with White patients, Hispanic patients had a lower rate of bladder cancer-related specialist visits, with a rate ratio of 0.891, while the rate ratio among Black patients was 0.930. Treatment differences were somewhat larger. The rate ratio for receiving any bladder cancer treatment was 0.806 among Hispanic patients and 0.814 among Black patients compared with White patients. Similar patterns were observed when researchers separately examined pharmacological and non-pharmacological treatments, including procedures such as TURBT and cystectomy.

Timing also varied across groups. White patients began treatment a median of 25 days after diagnosis, compared with 31 days for both Black and Hispanic patients. Differences in the time to a first specialist visit were less uniform: Hispanic patients waited a median of 26 days and American Indian or Alaska Native patients 28 days, compared with 23 days among White patients. The wide ranges observed within each population also suggest considerable variation at the individual patient level.

The analysis cannot establish what caused these differences or whether the relatively small differences in median treatment timing independently affected clinical outcomes. Medicare claims did not include important information such as bladder cancer stage, disease category, or socioeconomic characteristics, and the study was limited to fee-for-service beneficiaries. Still, the findings identify points in the bladder cancer care pathway where differences are occurring, particularly access to specialists and receipt of treatment. Understanding the factors behind those gaps may help healthcare systems identify opportunities to improve timely access to bladder cancer care.