Voiding Dysfunction Among Older Adults with Non-Muscle Invasive Bladder Cancer: Incidence and Predictors of Treatment for Overactive Bladder
Boris Gershman, MD1, Sumedh Kaul, MS1, Aaron Fleishman, MPH1, Stephen A. Boorjian, MD2, Aria F. Olumi, MD1, Brian Linder, MD2.
1Beth Israel Deaconess Medical Center, Boston, MA, USA, 2Mayo Clinic, Rochester, MN, USA.
BACKGROUND: Non-muscle invasive bladder cancer (NMIBC) is a chronic disease with a lifelong treatment burden. Although survival rates are excellent, the treatments for NMIBC, including endoscopic resection and intravesical therapy, may cause substantial morbidity in urinary function. Such quality of life changes remain notably understudied. We therefore evaluated the incidence and predictors of treatment for overactive bladder (OAB) among older adults following an incident diagnosis of non-muscle invasive bladder cancer.
METHODS: We identified adults aged 66-89 years with newly diagnosed NMIBC from 2007-2017 in the linked SEER-Medicare database. We excluded patients with a pre-existing diagnosis of OAB or receipt of OAB treatment in the 12 months before bladder cancer diagnosis. Treatments for OAB were identified using Part D, inpatient, and outpatient Medicare claims. We examined the incidence of treatment initiation for OAB following initial transurethral resection of bladder tumor (TURBT), and evaluated associations with baseline characteristics using Cox regression.
RESULTS: The study cohort included 14,047 patients, of whom 67% had Ta disease, 29% had T1 disease, and 4% had CIS. Within the first 12 months of TURBT, 7% of patients received treatment for OAB (Figure 1), and this increased to 16% of patients at 5 years. In the first year, the most utilized therapies were anticholinergic medications (early 3.6%, late 2.7%) and beta-3 agonists (early 0.2%, late 0.4%), while third-line OAB therapy utilization was rare (0.2%). However, third-line OAB therapy utilization increased to 0.8% at 5-years. On multivariable analysis, the following factors were independently associated with an increased risk of OAB treatment: female gender (HR 1.12, 95% CI 1.02-1.25), younger age (HR 0.99, 95% CI 0.99-1.00), congestive heart failure (HR 1.15, 95% CI 1.01-1.31), sleep apnea (HR 1.21, 95% CI 1.03-1.41), high-grade tumor (ref- low grade HR 1.27, 95% CI 1.16-1.40), and T1 tumor stage (HR 1.29, 95% CI 1.16-1.43 vs Ta).
CONCLUSIONS: The incidence of OAB requiring treatment among patients with NMIBC is not insignificant, with approximately 1 in 6 patients receiving treatment by 5 years after diagnosis. Predictive clinicopathologic features for OAB treatment - including age, sex, and high-risk tumor features - may be useful for clinical counseling. 
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