OBJECTIVES : This study aimed to characterize treatment patterns, survival outcomes, and healthcare resource use in patients with stage IV urothelial carcinoma (UC) in Denmark.

METHODS : This cohort study used information from Danish population-based and medical registries. Patients diagnosed with incident stage IV UC and registered in the Danish Cancer Registry, from January 1, 2013, to December 31, 2017, were included, with follow-up through December 31, 2018. Summary and descriptive statistics were calculated for categorical and continuous variables as appropriate. The Kaplan-Meier method was used to estimate median overall survival (OS).

RESULTS : A total of 620 patients were included. Median age was 72.2 years (IQR, 65.6-78.2), 474 patients (76.5%) were aged ≥65 years, and 394 (63.5%) were men; 410 patients (66.1%) had a baseline Charlson Comorbidity Index score ≤2. The median follow-up was 10.2 months (IQR, 3.6-19.4). PD-L1 expression testing was not routinely conducted, with only 9 patients (1.5%) being tested. The 12- and 24-month survival rates were 40.4% (95% CI, 36.4-44.4) and 23.6% (95% CI, 20.1-27.4), respectively. Median OS from diagnosis was 9.4 months (95% CI, 8.3-10.6). A total of 353 patients (56.9%) underwent ≥1 therapeutic surgical procedure, 193 (31.1%) received radiation therapy, and 299 (48.2%) received systemic anticancer therapy during follow-up. Platinum-containing agents (69.6%) and antimetabolites (83.6%) were the most commonly administered drug classes in first-line systemic treatment. The mean (SD) per-patient per-year number of hospital admissions, outpatient visits, and emergency department visits, was 7.6 (7.3), 26.6 (24.4), and 3 (3.5), respectively.

CONCLUSIONS : This observational cohort study describes the characteristics of an older and highly comorbid population with stage IV UC in a real-world setting in Denmark. There is a large unmet need for new therapeutic options for these patients with poor outcomes.