{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,30]],"date-time":"2026-09-30T13:01:42Z","timestamp":1790773302514,"version":"4.1.0"},"reference-count":24,"publisher":"SAGE Publications","issue":"2","license":[{"start":{"date-parts":[[2026,4,13]],"date-time":"2026-04-13T00:00:00Z","timestamp":1776038400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"},{"start":{"date-parts":[[2026,4,13]],"date-time":"2026-04-13T00:00:00Z","timestamp":1776038400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Bladder Cancer"],"published-print":{"date-parts":[[2026,6]]},"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Neoadjuvant chemotherapy followed by radical cystectomy (NACT-RC) is the prevailing standard of care for muscle-invasive bladder cancer (MIBC), but trimodality treatment (TMT) using chemoradiation after transurethral resection of bladder tumor (TURBT) is an effective alternative in select patients.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>This study examined patterns of care and impact of social determinants of health on the overall survival (OS) using the National Cancer Database (NCDB).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Data on patients aged \u226518 years with stage II-IIIA MIBC treated with TMT or NACT-RC during 2014\u20132021 were analyzed with propensity score matching. Logistic and Cox regression were used to evaluate the association of social determinants of health with patterns of care and OS.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Among 18,072 cases (mean age 68.3 years), 77.1% received NACT-RC. TMT use increased from 18.4% in 2014 to 27.1% in 2021 (p\u2009&lt;\u20090.001). The odds for receiving NACT-RC were higher for patients with stage IIIA (odds ratio (OR)\u2009=\u20091.21, 95% confidence interval (CI) 1.09-1.34). However, older patients (OR 0.86, 95% CI 0.87-0.88), those treated at comprehensive community cancer programs (OR 0.51, 95% CI: 0.46-0.55), or used Medicaid (OR = 0.48, 95% CI 0.39-0.61) had lower odds for receiving NACT-RC. In propensity score matching analysis, NACT-RC was associated with lower mortality compared to TMT (Hazard ratio (HR)\u2009=\u20090.66, 95% CI:0.59-0.73). Medicaid users receiving NACT-RC had the highest mortality risk (HR\u2009=\u20091.47, 95% CI:1.28-1.68, p\n                      <jats:sub>interaction<\/jats:sub>\n                      =0.001).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>TMT for MIBC has increased in recent years. Selection between NACT-RC and TMT was influenced by age, stage, diagnosis year, comorbidities, travel distance, facility, and insurance type, highlighting disparities in MIBC treatment.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Categories<\/jats:title>\n                    <jats:p>Radiation Oncology, Oncology<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/23523735261438727","type":"journal-article","created":{"date-parts":[[2026,4,13]],"date-time":"2026-04-13T13:29:27Z","timestamp":1776086967000},"source":"Crossref","is-referenced-by-count":0,"title":["Patterns of care and associated social determinants of health in the definitive treatment of localized muscle-invasive bladder cancer patients"],"prefix":"10.1177","volume":"12","author":[{"given":"Megan","family":"Mai","sequence":"first","affiliation":[{"name":"Texas Tech University Health Sciences Center"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vivie","family":"Tran","sequence":"additional","affiliation":[{"name":"Texas Tech University Health Sciences Center"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Albert","family":"Zhu","sequence":"additional","affiliation":[{"name":"Rice University"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Duke","family":"Appiah","sequence":"additional","affiliation":[{"name":"Texas Tech University Health Sciences Center"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zheng","family":"Shi","sequence":"additional","affiliation":[{"name":"Texas Tech University Health Sciences Center"},{"name":"Radiation Oncology Clinic, University Medical Center Cancer Center, Lubbock, TX, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2026,4,13]]},"reference":[{"key":"e_1_3_4_2_2","unstructured":"American Cancer Society. Cancer Statistics Center. http:\/\/cancerstatisticscenter.cancer.org (2024 accessed 19 June 2024)."},{"key":"e_1_3_4_3_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa022148"},{"key":"e_1_3_4_4_2","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.2015.65.9797"},{"key":"e_1_3_4_5_2","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.2001.19.3.666"},{"key":"e_1_3_4_6_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.eururo.2005.04.006"},{"key":"e_1_3_4_7_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.eururo.2008.07.031"},{"key":"e_1_3_4_8_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijrobp.2016.08.023"},{"key":"e_1_3_4_9_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.eururo.2016.12.020"},{"key":"e_1_3_4_10_2","doi-asserted-by":"publisher","DOI":"10.1016\/S1470-2045(23)00170-5"},{"key":"e_1_3_4_11_2","first-page":"985","article-title":"15-year Survival rates after transurethral resection and radiochemotherapy or radiation in bladder cancer treatment","volume":"31","author":"Krause FS","year":"2011","unstructured":"Krause FS, Walter B, Ott OJ, et al. 15-year Survival rates after transurethral resection and radiochemotherapy or radiation in bladder cancer treatment. Anticancer Res 2011; 31: 985\u2013990.","journal-title":"Anticancer Res"},{"key":"e_1_3_4_12_2","doi-asserted-by":"publisher","DOI":"10.1111\/j.1464-410X.2010.09564.x"},{"key":"e_1_3_4_13_2","first-page":"3801","article-title":"Long-term outcomes in patients with muscle-invasive bladder cancer after selective bladder-preserving combined-modality therapy: a pooled analysis of radiation therapy","volume":"233","author":"Mak RH","unstructured":"Mak RH, Hunt D, Shipley WU, et al. Long-term outcomes in patients with muscle-invasive bladder cancer after selective bladder-preserving combined-modality therapy: a pooled analysis of radiation therapy. Oncology Group Protocols 8802; 233: 3801\u20133809.","journal-title":"Oncology Group Protocols"},{"key":"e_1_3_4_14_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.clgc.2018.09.023"},{"key":"e_1_3_4_15_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.critrevonc.2014.11.007"},{"key":"e_1_3_4_16_2","doi-asserted-by":"publisher","DOI":"10.1002\/cam4.6972"},{"key":"e_1_3_4_17_2","doi-asserted-by":"publisher","DOI":"10.1002\/cam4.1684"},{"key":"e_1_3_4_18_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.eururo.2017.03.038"},{"key":"e_1_3_4_19_2","doi-asserted-by":"publisher","DOI":"10.3390\/curroncol31050192"},{"key":"e_1_3_4_20_2","unstructured":"National Comprehensive Cancer Network. NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines\u00ae): Bladder Cancer Version 2.2022.https:\/\/www.nccn.org\/professionals\/physician_gls\/pdf\/bladder.pdf (2024 accessed 14 November 2024)."},{"key":"e_1_3_4_21_2","unstructured":"American College of Surgeons. 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