Utilization of palliative chemotherapy for advanced bladder cancer: Patterns of care in routine clinical practice.
Bibliographic record
Abstract
6525 Background: Although palliative chemotherapy for advanced bladder cancer is recommended in clinical practice guidelines, patterns of care in routine care is not described. Here we describe utilization rates of chemotherapy and referral rates to medical oncology in the last year of life among patients who die of bladder cancer. Methods: A population based cohort of bladder cancer patients was identified from the Ontario Cancer Registry; the study population included those patients who died of bladder cancer 1995-2009. Electronic records of treatment and physician billing records were used to identify treatment patterns and referral to medical oncology (MO). Log-binomial and poisson regression were used to examine factors associated with chemotherapy utilization and MO consultation. Results: 8005 patients died of bladder cancer; 25% (1964/8005) of whom received chemotherapy in the last year of life. Use of chemotherapy was independently associated with patient age (Relative risk (RR) 0.49 70-79 vs < 50 years, p < 0.001), comorbidity (RR 0.61 moderate comorbidity vs none, p < 0.001), socioeconomic status (RR 0.84 lowest quintile vs highest, p = 0.01) and gender (RR 0.91 females vs males, p = 0.012). Utilization increased over time (from 22% to 26%, p < 0.001) and varied across geographic regions (range 18-30%, p < 0.001); these findings persisted on adjusted analyses. 68% (5426/8005) of patients were seen by MO in the last year of life. Factors independently associated referral rates to MO include age (RR 0.82 70-79 vs < 50 years, p < 0.001), comorbidity (RR 0.90 moderate comorbidity vs none, p < 0.001), socioeconomic status (RR 0.90 lowest quintile vs highest, p < 0.001), and gender (RR 0.96 females vs males, p = 0.023). Referral rates modestly increased over time (66% to 69%, p = 0.006) and varied widely across geographic regions (range (57% to 79%, p < 0.001); these findings persisted on adjusted analyses. Conclusions: Despite clinical practice guideline recommendations, utilization of palliative chemotherapy for bladder cancer in routine practice remains low. Treatment patterns and referral rates to MO vary substantially across geographic regions.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.004 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.002 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.002 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".