title: Disparities in long-term radiographic follow-up after cystectomy for bladder cancer: Analysis of the SEER-Medicare database.
abstract: BACKGROUND
  It is uncertain whether there are disparities related to receiving long-term radiographic follow-up after cystectomy performed for bladder cancer, and whether intensive follow-up influences survival.
  
  
  METHODS
  We analyzed 2080 patients treated with cystectomy between 1992 and 2004 isolated from the SEER-Medicare database. The number of abdominal computerized tomography scans performed in patients surviving 2 years after surgery was used as an indicator of long-term radiographic follow-up to exclude patients with early failures.
  
  
  RESULTS
  Patients were mainly males (83.18%), had a mean age at diagnosis of 73.4 ± 6.6 (standard deviation) years, and mean survival of 4.6 ± 3.2 years. Multivariate analysis showed age >70 (odds ratio [OR]: 0.796, 95% confidence interval [CI]: 0.651-0.974), African American race (OR: 0.180, 95% CI: 0.081-0.279), and Charlson comorbidity score >2 (OR: 0.694, 95% CI: 0.505-0.954) to be associated with lower odds of long-term radiographic follow-up. Higher disease stage (Stage T4N1) (OR: 1.873, 95% CI: 1.491-2.353), higher quartile for education (OR: 5.203, 95% CI: 1.072-9.350) and higher quartile for income (OR: 6.940, 95% CI: 1.444-12.436) were associated with increased odds of long-term radiographic follow-up. Interestingly, more follow-up with imaging after cystectomy did not improve cancer-specific or overall survival in these patients.
  
  
  CONCLUSIONS
  There are significant age, race, and socioeconomic disparities in long-term radiographic follow-up after radical cystectomy. However, more radiographic follow-up may not be associated with better survival.
authors.affiliation: Department of Surgery, Southern Illinois University School of Medicine, Springfield, IL, USA.
authors.forename: Shaheen
authors.initials: S
authors.lastname: Alanee
authors.affiliation: Department of Surgery, Southern Illinois University School of Medicine, Springfield, IL, USA.
authors.forename: Sabha
authors.initials: S
authors.lastname: Ganai
authors.affiliation: Department of Urology, University of Minnesota, Minneapolis, Minnesota, USA.
authors.forename: Priyanka
authors.initials: P
authors.lastname: Gupta
authors.affiliation: Department of Surgery, Southern Illinois University School of Medicine, Springfield, IL, USA.
authors.forename: Bradley
authors.initials: B
authors.lastname: Holland
authors.affiliation: Department of Surgery, Southern Illinois University School of Medicine, Springfield, IL, USA.
authors.forename: Danuta
authors.initials: D
authors.lastname: Dynda
authors.affiliation: Department of Urology, University of Oklahoma, School of Medicine, Oklahoma City, Oklahoma, USA.
authors.forename: Joel
authors.initials: J
authors.lastname: Slaton
keywords: Bladder cancer; cystectomy; imaging; surveillance