UPJ INSIGHT Relationship of Urologist and Primary Care Provider Availability and Stage of Bladder Cancer Diagnosis

By: Joel E. Segel, PhD, Pennsylvania State University, University Park, Pennsylvania State Cancer Institute, Hershey; William G. Wong, DO, Pennsylvania State College of Medicine, Hershey; Matthew Kaag, MD, Pennsylvania State College of Medicine, Hershey; Monika Joshi, MD, MRCP, Pennsylvania State Cancer Institute, Hershey, Pennsylvania State College of Medicine, Hershey; Joshua Warrick, MD, Pennsylvania State Cancer Institute, Hershey, Pennsylvania State College of Medicine, Hershey; Eugene J. Lengerich, VMD, MS, Pennsylvania State Cancer Institute, Hershey, Pennsylvania State University, Hershey; Chan Shen, PhD, Pennsylvania State Cancer Institute, Hershey, Pennsylvania State University, Hershey, Pennsylvania State College of Medicine, Hershey | Posted on: 20 Mar 2024

Segel JE, Wong WG, Kaag M, et al. Relationship between availability of urologists and primary care providers and stage of diagnosis for invasive urinary bladder cancer. Urol Pract. 2024; 11(2):339-346.

Study Need and Importance

With no recommended screening approach, urinary bladder cancer patients require coordination between primary care providers and urologists to ensure timely diagnosis of bladder cancer. However, little is known about the relationship between both primary care provider density and urologist density on the state of diagnosis for urinary bladder cancer.

Table. Predictors of Locoregional Stage of Diagnosis Upon Initial Presentation for Patients With Bladder Cancer, by Primary Care Provider and Urologist Density

	Regressions including PCP density		Regressions including urologist density
	Unadjusted	Multivariate	Unadjusted	Multivariate
	Odds ratio (95% CI)	Odds ratio (95% CI)	Odds ratio (95% CI)	Odds ratio (95% CI)
Age		1.01 (1.01, 1.02)		1.01 (1.01, 1.02)^a
Female		0.70 (0.62, 0.80)^a		0.71 (0.62, 0.81)^a
Race/ethnicity (non-Hispanic White omitted)
Non-Hispanic Black		0.63 (0.50, 0.79)^a		0.64 (0.51, 0.80)^a
Other race/ethnicity		0.82 (0.52, 1.31)		0.83 (0.52, 1.32)
Primary insurance (private omitted)
Medicaid		0.68 (0.51, 0.90)^b		0.68 (0.51, 0.90)^b
Medicare		0.80 (0.68, 0.95)^c		0.80 (0.67, 0.95)^b
Uninsured		0.56 (0.34, 0.92)^c		0.56 (0.34, 0.92)^c
PCP density	1.01 (0.99,1.03)	1.01 (0.99, 1.03)
Urologist density			0.92 (0.79,1.06)	0.96 (0.81, 1.15)
Abbreviations: PCP, primary care provider. ^a P < .001. ^b P < .01. ^c P < .05.

What We Found

Using 2010 to 2016 Pennsylvania Cancer Registry, we identified all adult patients diagnosed with invasive urinary bladder cancer. Based on the patient’s county of residence at the time of diagnosis, we calculated the density of primary care and urologists. We then estimated the association between primary care and urologist density and stage of diagnosis (specifically locoregional vs distant stage). In multivariate logistic regression analyses, we found primary care density was associated with significantly higher odds of locoregional stage of diagnosis (odds ratio 1.05 [95% CI: 1.02-1.08]), while urologist density was associated with significantly lower odds of locoregional stage (odds ratio 0.65 [95% CI: 0.48-0.89]; Table).

Limitations

Our analyses are limited to a single state, albeit the sixth most populous one with a mix of both urban and rural areas. We are also limited to using the 2000 Surveillance, Epidemiology, and End Results Summary Stage definition as it is the only one available in all years of data.

Interpretation for Patient Care

Primary care is usually the first point of contact for patients. It is critical to ensure primary care providers are aware of bladder cancer symptoms and are able to provide appropriate and timely referrals to urology care. Given the burdens on primary care, it is essential they have the appropriate resources to manage the wide mix of patients and conditions. Therefore, proactive outreach from urologists may be important to ensuring timely, well-coordinated bladder cancer referrals and diagnosis.