(Poster 162) Treatment of Overactive Bladder in Women with Gynecologic Cancer

Objectives: To describe the number of women with new diagnoses of gynecologic cancer who received treatment for Overactive Bladder (OAB) using the Marketscan Database.

Methods: Using the Merative Marketscan Commercial and Medicare Databases, we identified female participants, 18 years of age and older with an ICD 10 diagnosis of gynecologic cancer (ovarian, uterine, cervix, vulvar and other gynecologic cancers) between 2017 and 2021. The diagnosis of OAB was identified using ICD10 codes for OAB (Overactive Bladder; Urge Incontinence; Mixed Incontinence; Frequency of Micturition; Urgency of Urination, and Nocturia) or prescription of medication for OAB treatment (via NDC codes). We captured treatment for cancer (surgery, chemotherapy and radiation) using CPT codes and treatment for OAB, using outpatient prescription information or CPT codes where appropriate. OAB treatments included oral OAB medications (anticholinergics and beta-3 agonists), intradetrusor injections of Onabotulinum Toxin A (Btx), Sacral Neuromodulation (SNM), and Posterior Tibial Nerve Stimulation (PTNS). OAB treatment timing and patterns were described.

Results: We identified 18,729 patients between 2017 and 2021 who met inclusion criteria. The most common cancer was uterine followed by ovary and cervix. Age of diagnosis differed significantly across all gynecologic cancer types (p < .001) (Table 1). Most patients had private insurance, lived in a metropolitan statistical area and lived in the Southern region of the US. During the study period, 1904 (10.2%) women were diagnosed with OAB. Of these women with an OAB diagnosis, 305 (16%) received treatment. Kaplan Meier estimates suggest that the probability of receiving treatment for OAB at 1-year following diagnosis is 16.4% (95% CI [14.6 18.2]). The majority (244/305, 80%) received anticholinergic medications, followed by beta-3 agonist medications (89/305, 29%). Very few received advanced therapy (Btx: 10/305, 3%; SNM: 6/305, 2%; and PTNS 3/305, 1%). Receipt of oral OAB medications differed across cancer type (p < .001) with cervix cancer patients representing the largest proportion treated with an OAB medication. Most patients only received one treatment during the study period, while only 13 (4.2%) received two types of treatment.

Conclusions: Approximately, 1 in 6 women who receive a diagnosis of OAB in the 5 years following a new diagnosis of gynecologic cancer will receive a treatment for OAB within a year of OAB diagnosis. The majority of patients receive an anticholinergic medication, and given the adverse effects associated with Ach medications in addition to side effects from cancer treatment, special attention should be paid as to how we treat OAB in women undergoing treatment for gynecologic cancer.