Predicting bladder cancer death amongst Australian Veterans

Background The purpose of this study was to compare the veteran and non-veteran cohorts of patients diagnosed with bladder cancer in order to determine if veterans have a worse clinical outcome, as has previously been demonstrated in prostate cancer. Methods Using the Bladder Cancer Outcomes Database at the Repatriation General Hospital, South Australia, all bladder cancer cases between January 1984 and December 2011 were identified. This data was used to identify independent predictors of death in these populations and to contrast their five year bladder cancerspecific and overall survival. A subgroup of muscle-invasive bladder cancer was also analysed. There were a total of 1177 patients studied. Results Overall, there was no significant difference in bladder cancer specific outcomes for veteran compared to non-veteran subjects. In both groups, the staging of disease at diagnosis was the strongest independent predictor of outcome, followed by the patient's age at diagnosis. Veterans were generally older at diagnosis than non-veterans, and they did demonstrate worse all cause mortality outcomes. In the muscle invasive bladder cancer subgroup, outcomes were similar between veterans and non-veterans but veterans were more likely to be treated with radiotherapy. Conclusion The independent predictors of outcome and bladder cancer specific survival rates in our South Australian cohort were similar to those described in the international literature and do not demonstrate poorer outcomes in our veteran population. All cause mortality was worse in the veteran population, however, which may be related to their older age at diagnosis and different treatments they may be offered as a consequence.