Abstract
BACKGROUND: Previous studies have investigated treatment patterns among patients with locally advanced or metastatic urothelial carcinoma (mUC) in Denmark and found that, in an unselected nationwide Danish registry cohort, only 36% of patients received systemic anticancer therapy. The objective of this study was to identify socioeconomic factors associated with the receipt of systemic treatment in patients with mUC in Denmark, a country with universal free access to healthcare. METHODS: This retrospective, population-based study was based on data from the Danish national healthcare registers. We identified all patients diagnosed with mUC from 2010 to 2017 who were potentially eligible for systemic chemotherapy (cohort 1). Two sub-cohorts of interest were identified: patients who received systemic anticancer treatment (cohort 2) and patients who did not receive any systemic anticancer treatment or surgery following the diagnosis of mUC (cohort 3). RESULTS: A total of 3,206 patients diagnosed with mUC were identified (cohort 1), of whom 1,223 (38%) did not meet the study inclusion criteria (i.e., received treatments other than those pre-specified). For patients who received systemic anticancer treatment (cohort 2; n = 1,141 [36%]), the mean time to treatment was 1.3 months. Among untreated patients (cohort 3; n = 842 [26%]), 246 patients died within 1.3 months after the diagnosis of metastatic disease; thus, to account for immortal time bias, these 246 patients were excluded from analyses. Comparing the remaining 596 patients in cohort 3 with all patients in cohort 2, increasing age and region of residence were found to be associated with a lower probability of receiving systemic treatment. Moreover, completion of at least a high school education and being married were associated with a higher probability of receiving systemic treatment. CONCLUSIONS: We found significant and measurable inequality in access to treatment for mUC. Among other factors, residence in two relatively rural regions was associated with lower probability of receiving systemic anticancer treatment compared to residence in other regions. In addition, marital status and education level had a significant impact on treatment rates.