Kidney Cancer Care Research Articles

IKCS 2024: Moving Kidney Cancer Care Forward: Insights from the 25th Anniversary Symposium

IKCS 2024: Moving Kidney Cancer Care Forward: Insights from the 25th Anniversary Symposium

Differences in the treatment patterns of small renal masses: A disaggregated analyses by race/ethnicity

ObjectiveTo characterize differences in the management of small renal masses among disaggregated race/ethnic subgroups. Material and MethodsWe used the National Cancer Database to identify patients diagnosed with clinically localized kidney cancer and tumor size ≤4cm. We studied 16 predefined racial/ethnic subgroups and compared 1) the use of surveillance for tumors <2cm and 2) the use of radical nephrectomy for tumors ≤4cm. We used multivariable logistic regression to evaluate the independent association of race/ethnicity with management, adjusting for baseline characteristics. We also compared our disaggregated analyses to the 6 National Institute of Health aggregate race categories. ResultsWe identified 286,063 patients that met inclusion criteria. For tumors <2cm, Black Non-Hispanic (aOR 1.43) and Mexican patients (aOR 1.29) were significantly more likely to undergo surveillance compared to White patients. For tumors ≤4cm, Black Non-Hispanic (aOR 1.43), Filipino (aOR 1.28), Japanese (aOR 1.28), Mexican (aOR 1.32), and Native Indian patients (aOR 1.15) were significantly more likely to undergo radical nephrectomy compared to White patients. When comparing our disaggregated analyses to the NIH categories, we found that many disaggregated race/ethnic subgroups had associations with management strategies that were not represented by their aggregated group. ConclusionsIn this study, we found that the use of surveillance for tumors <2cm and radical nephrectomy for tumors ≤4cm varied significantly among certain race/ethnic subgroups. Our disaggregated approach provides information on differences in treatment patterns in particular subgroups that warrant further study to optimize kidney cancer care for all patients.

A decade long insight into patient views on kidney cancer care delivery.

A decade long insight into patient views on kidney cancer care delivery.

Hierarchical causal variance decomposition for institution and provider comparisons in healthcare

Disease-specific quality indicators are used to compare institutions and health care providers in terms of processes or outcomes relevant to treatment of a particular condition. In the context of surgical cancer treatments, the performance variations can be due to hospital and/or surgeon level differences, creating a hierarchical clustering. We consider how the observed variation in care received at patient level can be decomposed into that causally explained by the hospital performance, surgeon performance within hospital, patient case-mix, and unexplained (residual) variation. For this purpose, we derive a four-way variance decomposition, with particular attention to the causal interpretation of the components. For estimation, we use inputs from a mixed-effect model with nested random hospital/surgeon-specific effects, and a multinomial logistic model for the hospital/surgeon-specific patient populations. We investigate the performance of our methods in a simulation study and demonstrate them through analysis of administrative data on kidney cancer care in Ontario.

P110 - Impact of the COVID-19 pandemic on kidney cancer care in the Netherlands

P110 - Impact of the COVID-19 pandemic on kidney cancer care in the Netherlands

MP24-02 SURVEY BASED STUDY OF EMERGING MANAGEMENT STRATEGIES FOR VHL

You have accessJournal of UrologyCME1 May 2022MP24-02 SURVEY BASED STUDY OF EMERGING MANAGEMENT STRATEGIES FOR VHL Neal Patel, Aileen Arvelo, Gennady Bratslavsky, Chandra Clark, Othon Iliopoulos, Eric Jonasch, Sandy Liu, Joshua Mann, Peter Muraki, and Brian Shuch Neal PatelNeal Patel More articles by this author , Aileen ArveloAileen Arvelo More articles by this author , Gennady BratslavskyGennady Bratslavsky More articles by this author , Chandra ClarkChandra Clark More articles by this author , Othon IliopoulosOthon Iliopoulos More articles by this author , Eric JonaschEric Jonasch More articles by this author , Sandy LiuSandy Liu More articles by this author , Joshua MannJoshua Mann More articles by this author , Peter MurakiPeter Muraki More articles by this author , and Brian ShuchBrian Shuch More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002563.02AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Belzutifan was recently FDA approved for the management of Von Hippel-Lindau syndrome (VHL). Given the disease complexity and morbidity of recurrent surgery, a well-tolerated systemic agent has been long-awaited. Balancing benefit with chronic usage and toxicity must be considered. To gain insight in future usage, a survey was provided to VHL kidney cancer experts in the United States. METHODS: A survey was developed by members of the VHL Family Alliance Advisory Council. The survey was distributed to practitioners involved in the care of VHL kidney cancer patients at designated VHL Alliance Care Centers and National Comprehensive Cancer Network centers. Center contacts were asked to distribute the survey amongst kidney cancer specialists who would be involved in VHL kidney cancer care. Surveys were anonymous and hosted on a secure, web-based platform. VHL practitioners were asked about the feasibility of using belzutifan, which specialty should administer, clinical indications for renal and non-renal manifestations, and optimal duration of therapy. Descriptive statistics were performed and Pearson chi-square analyses to evaluate differences between groups. RESULTS: A total of 59 respondents from 30 institutions participated. Urologists (51%) and medical oncologists (42%) represented the majority of participants. The majority (98%) of respondents anticipated that belzutifan’s approval would significantly change the current kidney cancer treatment landscape and therapy should be continuous (76%). 43% of urologists planned to prescribe belzitufan compared to 84% of medical oncologists (p=0.006). Only 9% of medical oncologists believed that urologists should be involved in belzutifan administration as opposed to 38% of urologist (p=0.015). In individuals with renal tumors <3 cm with low anticipated surgical morbidity, only 36% would continue the prior treatment paradigm of surveillance then surgery while 36% would initiate belzutifan to prevent growth. In those with multifocal disease with growth of a solitary lesion while on belzutifan, 50% would proceed with isolated treatment of that site. CONCLUSIONS: Most VHL kidney cancer specialists anticipate a paradigm shift in the field with the approval of belzutifan. Provider roles may change with movement away from local treatment. Opinions on which specialists should administer belzutifan differ by specialty. Treatment indications on topics such as when to initiate therapy and how to best salvage vary widely. Collaborative efforts amongst experts to accumulate additional clinical data will help guide a new era of VHL management. Source of Funding: None © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e392 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Neal Patel More articles by this author Aileen Arvelo More articles by this author Gennady Bratslavsky More articles by this author Chandra Clark More articles by this author Othon Iliopoulos More articles by this author Eric Jonasch More articles by this author Sandy Liu More articles by this author Joshua Mann More articles by this author Peter Muraki More articles by this author Brian Shuch More articles by this author Expand All Advertisement PDF DownloadLoading ...

Causal mediation analysis decomposition of between-hospital variance

Causal variance decompositions for a given disease-specific quality indicator can be used to quantify differences in performance between hospitals or health care providers. While variance decompositions can demonstrate variation in quality of care, causal mediation analysis can be used to study care pathways leading to the differences in performance between the institutions. This raises the question of whether the two approaches can be combined to decompose between-hospital variation in an outcome type indicator to that mediated through a given process (indirect effect) and remaining variation due to all other pathways (direct effect). For this purpose, we derive a causal mediation analysis decomposition of between-hospital variance, discuss its interpretation, and propose an estimation approach based on generalized linear mixed models for the outcome and the mediator. We study the performance of the estimators in a simulation study and demonstrate its use in administrative data on kidney cancer care in Ontario.

The Current Evidence for Factors that Influence Treatment Decision Making in Localized Kidney Cancer: A Mixed Methods Systematic Review.

With a growing number of treatment options for localized kidney cancer, patients and health care professionals have both the opportunity and the burden of selecting the most suitable management option. This mixed method systematic review aims to understand the barriers and facilitators of the treatment decision making process in localized kidney cancer. We searched PubMed®, Embase® and Cochrane Central databases between January 1, 2004 and April 23, 2020 using the Joanna Briggs Manual for Evidence Synthesis and the Preferred Reporting Items for Systematic Review and Meta-analysis statement. We identified 553 unique citations; of these, 511 were excluded resulting in 42 articles included for synthesis. The Purpose, Respondents, Explanation, Findings and Significance and the Strengthening the Reporting of Observational Studies in Epidemiology checklist was applied. The key themes describing barriers and facilitators to treatment decision making were identified and categorized into 3 domains: 1) kidney cancer specific characteristics, 2) decision maker related criteria and 3) contextual factors. The main facilitators identified within these domains were size at diagnosis, age, comorbidities, body mass index, gender, nephrometry scoring systems, biopsy, socioeconomic status, family history of cancer, year of diagnosis, geographic region and practice pattern. The key barriers were race, gender, patient anxiety, low confidence in diagnostic and treatment options, cost of procedure, and practice patterns. Future interventions designed to improve the decision making process for localized kidney cancer should consider these barriers and facilitators to ensure a better patient experience.

Impact of the first surge of the COVID-19 pandemic on a tertiary referral centre for kidney cancer.

ObjectiveTo analyse the impact of the COVID‐19 pandemic on a centralized specialist kidney cancer care pathway.Materials and MethodsWe conducted a retrospective analysis of patient and pathway characteristics including prioritization strategies at the Specialist Centre for Kidney Cancer located at the Royal Free London NHS Foundation Trust (RFH) before and during the surge of COVID‐19.ResultsOn 18 March 2020 all elective surgery was halted at RFH to redeploy resources and staff for the COVID‐19 surge. Prioritizing of patients according to European Association of Urology guidance was introduced. Clinics and the specialist multidisciplinary team (SMDT) meetings were maintained with physical distancing, kidney surgery was moved to a COVID‐protected site, and infection prevention measurements were enforced. During the 7 weeks of lockdown (23 March to 10 May 2020), 234 cases were discussed at the SMDT meetings, 53% compared to the 446 cases discussed in the 7 weeks pre‐lockdown. The reduction in referrals was more pronounced for small and asymptomatic renal masses. Of 62 low‐priority cancer patients, 27 (43.5%) were deferred. Only one (4%) COVID‐19 infection occurred postoperatively, and the patient made a full recovery. No increase in clinical or pathological upstaging could be detected in patients who underwent deferred surgery compared to pre‐COVID practice.ConclusionThe first surge of the COVID‐19 pandemic severely impacted diagnosis, referral and treatment of kidney cancer at a tertiary referral centre. With a policy of prioritization and COVID‐protected pathways, capacity for time‐sensitive oncological interventions was maintained and no immediate clinical harm was observed.

Kidney cancer management 3.0: can artificial intelligence make us better?

Artificial intelligence holds tremendous potential for disrupting clinical medicine. Here we review the current role of artificial intelligence in the kidney cancer space. Machine learning and deep learning algorithms have been developed using information extracted from radiomic, histopathologic, and genomic datasets of patients with renal masses. Although artificial intelligence applications in medicine are still in their infancy, they already hold immediate promise to improve accuracy of renal mass characterization, grade, and prognostication. As algorithms become more robust and generalizable, artificial intelligence is poised to significantly disrupt kidney cancer care.

Role of minimally invasive partial nephrectomy in the management of renal mass.

Partial nephrectomy is recommended for surgical management of small renal masses (SRM), or lesions ≤7 cm. The decision for surgical intervention involves a balanced patient assessment. Minimally invasive approach, which includes laparoscopic and robotic techniques, has shown to have improved blood loss, length of hospitalization, and post-operative pain while maintaining oncologic efficacy when compared to an open approach. Transperitoneal approach is preferred at most centers; however, retroperitoneoscopic minimally invasive surgery (MIS) partial nephrectomy expertise is essential for comprehensive kidney cancer care. With advances in surgical technology and deep penetration of robotics into surgical training and practice, robotic partial nephrectomy has become the modality of choice in modern clinical practice. This review discusses the indications and outcomes for various minimally invasive approaches of partial nephrectomy.

Expert consensus on the development of quality care measures for kidney cancer in Spain.

e19180 Background: To promote the continuous improvement of kidney cancer healthcare by proposing quality care measures (with respective indicators and standards) for its diagnosis, treatment and follow-up care that can be used by the corresponding professionals and that can be applied across the Spanish healthcare system. Methods: 1. a) Bibliographic review of international research (previous 5 years) on the quality of kidney cancer care; b) Multidisciplinary nominal group (9 oncology experts from the ECO Foundation –Excellence and Quality in Oncology Foundation – and 2 university methodologists – Francisco de Vitoria University Faculty of Medicine) to identify and select possible quality measures that can be applied in Spain; c) Modified Delphi Consensus (two rounds, remotely) by a panel of 55 oncologists subspecialized in kidney cancer, selected by a geographically stratified snowball sample. The ASCO (American Society of Clinical Oncology) /QOPI (Quality Oncology Practice Initiative) model is followed for the drafting of each item: definition of measures, indicators, information sources, exclusions, clarifications, categorization, acceptable standards. Results: The nominal group proposed 43 possible quality measures to the Delphi panel. Consensus participation rate = 84.5% (47 specialists). A unanimous consensus was achieved for 40 quality measures, grouped into the following areas: 4 structural, 33 regarding treatment process and 3 regarding clinical results. Conclusions: The level of consensus among Spanish oncologists subspecialized in kidney cancer on the proposed care measure for the management of said cancer is very high (93%). These results indicate widespread acceptance and applicability of said measures in the Spanish National Healthcare System and, with this in mind, they will henceforth be a valuable tool for the comparative evaluation of the quality and fairness of the oncological care of kidney cancer patients in Spain.

Genitourinary cancer management during a severe pandemic: Utility of rapid communication tools and evidence-based guidelines.

Objectives: To determine the usefulness of social media for rapid communication with experts to discuss strategies for prioritization and safety of deferred treatment for urologic malignancies during COVID‐19 pandemic, and to determine whether the discourse and recommendations made through discussions on social media (Twitter) were consistent with the current peer‐reviewed literature regarding the safety of delayed treatment. Methods: We reviewed and compiled the responses to our questions on Twitter regarding the management and safety of deferred treatment in the setting of COVID‐19 related constraints on non‐urgent care. We chronicled the guidance published on this subject by various health authorities and professional organizations. Further, we analyzed peerreviewed literature on the safety of deferred treatment (surgery or systemic therapy) to make made evidence‐based recommendations. Results: Due to the rapidly changing information about epidemiology and infectious characteristics of COVID‐19, the health authorities and professional societies guidance required frequent revisions which by design take days or weeks to produce. Several active discussions on Twitter provided real‐time updates on the changing landscape of the restrictions being placed on non‐urgent care. For separate discussion threads on prostate cancer and bladder cancer, dozens of specialists with expertise in treating urologic cancers could be engaged in providing their expert opinions as well as share evidence to support their recommendations. Our analysis of published studies addressing the safety and extent to which delayed cancer care does not compromise oncological outcome revealed that most prostate cancer care and certain aspects of the bladder and kidney cancer care can be safely deferred for 2‐6 months. Urothelial bladder cancer and advanced kidney cancer require a higher priority for timely surgical care. We did not find evidence to support the idea of using nonsurgical therapies, such as hormone therapy for prostate cancer or chemotherapy for bladder cancer for safer deferment of previously planned surgery. We noted that the comments and recommendations made by the participants in the Twitter discussions were generally consistent with our evidence‐based recommendations for safely postponing cancer care for certain types of urologic cancers. Conclusion: The use of social media platforms, such as Twitter, where the comments and recommendations are subject to review and critique by other specialists is not only feasible but quite useful in addressing the situations requiring urgent resolution, often supported by published evidence. In circumstances such as natural disasters, this may be a preferable approach than the traditional expert panels due to its ability to harness the collective intellect to available experts to provide responses and solutions in real‐time. These real‐time communications via Twitter provided sound guidance which was readily available to the public and participants, and was generally in concordance with the peerreviewed data on safety of deferred treatment.

Examining Public Communication About Kidney Cancer on Twitter.

Several studies have described the content of Twitter conversations about lung, breast, and prostate cancer, but little is known about how the public uses Twitter to discuss kidney cancer. We sought to characterize the content of conversations on Twitter about kidney cancer and the participants engaged in these dialogues. This qualitative study analyzed the content of 2,097 tweets that contained the key words kidney cancer from August 1 to 22, 2017. Tweets were categorized by content domain of conversations related to kidney cancer on Twitter and user types of participants in these dialogues. Among the 2,097 kidney cancer-related tweets analyzed, 858 (41.4%) were authored by individuals, 865 (41.2%) by organizations, and 364 (17.4%) by media sites. The most common content discussed was support (29.3%) and treatment (26.5%). Among the 2,097 tweets, 825 were unique tweets, and 1,272 were retweets. The most common unique tweets were about clinical trials (23.9%), most often authored by media sites. The most common retweets were about treatment (38.5%), most often authored by organizations. Twitter dialogues about kidney cancer are most commonly related to support and treatment. Our findings provide insights that may inform the design of new interventions that use social media as a tool to improve communication of kidney cancer information. Additional efforts are needed to improve our understanding of the value and direct utility of social media in improving kidney cancer care.

The impact of health literacy on urologic oncology care.

Health literacy is the ability to access, comprehend, and act upon medical information to make health care decisions. In the United States, 12% of adults have proficient health literacy. Low health literacy has been associated with worse outcomes in several chronic medical conditions. In addition, low health literacy has been associated with longer hospital stays. In the urologic oncology literature low health literacy is associated with increased minor complications following radical cystectomy. There remains sparse data on health literacy and its impacts on prostate, kidney, testicular and penile cancer care. Going forward, in order to provide the best urologic oncology care to our patients it is critical to account for patients' health literacy status.

Genomic classifications of renal cell carcinoma: a critical step towards the future application of personalized kidney cancer care with pan-omics precision.

Over the past 20 years, classifications of kidney cancer have undergone major revisions based on morphological refinements and molecular characterizations. The 2016 WHO classification of renal tumors recognizes more than ten different renal cell carcinoma (RCC) subtypes. Furthermore, the marked inter- and intra-tumor heterogeneity of RCC is now well appreciated. Nevertheless, contemporary multi-omics studies of RCC, encompassing genomics, transcriptomics, proteomics, and metabolomics, not only highlight apparent diversity but also showcase and underline commonality. Here, we wish to provide an integrated perspective concerning the future 'functional' classification of renal cancer by bridging gaps among morphology, biology, multi-omics, and therapeutics. This review focuses on recent progress and elaborates the potential value of contemporary pan-omics approaches with a special emphasis on cancer genomics unveiled through next-generation sequencing technology, and how an integrated multi-omics approach might impact precision-based personalized kidney cancer care in the near future. Copyright © 2017 Pathological Society of Great Britain and Ireland. Published by John Wiley & Sons, Ltd.

Clinical and Molecular Characteristics and Burden of Kidney Cancer Among Hispanics and Native Americans: Steps Toward Precision Medicine.

Cancer disparities in Native Americans (NAs) and Hispanic Americans (HAs) vary significantly in terms of cancer incidence and mortality rates across geographic regions. This review reports that kidney and renal pelvis cancers are unevenly affecting HAs and NAs compared to European Americans of non-Hispanic origin, and that currently there is significant need for improved data and reporting to be able to advance toward genomic-based precision medicine for the assessment of such cancers in these medically underserved populations. More specifically, in states along the US-Mexico border, HAs and NAs have higher kidney cancer incidence rates as well as a higher prevalence of kidney cancer risk factors, including obesity and chronic kidney disease. They are also more likely to receive suboptimal care compared to European Americans. Furthermore, they are underrepresented in epidemiologic, clinical, and molecular genomic studies of kidney cancer. Therefore, we maintain that progress in precision medicine for kidney cancer care requires an understanding of various factors among HAs and NAs, including the real kidney cancer burden, variations in clinical care, issues related to access to care, and specific clinical and molecular characteristics.

Online tools for patient counseling in bladder and kidney cancer-ready for prime time?

Gauging prognosis is a key element when facing treatment decisions in cancer care. Several prognostic tools, such as risk tables and nomograms are at hand to aid this process. In the context of patient-centered care, prognostic tools are of great interest to caregivers and -providers alike, as they can convey sizeable amounts of information and provide tailored, accurate estimates of prognosis. Given the rising number of prognostic tools in cancer care over the last two decades, and similarly, ever increasing presence of the Internet, we aimed to assess how this would translate into the availability of online tools for patient counseling. We used a modified systematic review to evaluate the web-based availability, format, and content of prognostic tools for bladder and kidney cancer care. Our search identified a total of twenty-three tools, offered by eight providers, which assessed a total of six (bladder cancer) and five (kidney cancer) different outcomes. Despite the restricted availability of online tools, we observed that the majority showed limited user-friendliness (including, for example, a statement/explanation of intended use, visualization of data, availability as application software for handheld devices). Only one tool included modifiable risk factors such as smoking behavior and body weight. Lastly, none of the tools incorporated genomic or molecular markers or treatment associated quality of life. Taken together, online tools for patient counseling in bladder and kidney cancer care are only beginning to align with the growing need in clinical reality. Further and future avenues include incorporation of health-related quality of life as well as genomic and biomarkers into prediction tools.

Development and Implementation of a Continuing Medical Education Program in Canada: Knowledge Translation for Renal Cell Carcinoma (KT4RCC).

An in-person multidisciplinary continuing medical education (CME) program was designed to address previously identified knowledge gaps regarding quality indicators of care in kidney cancer. The objective of this study was to develop a CME program and determine if the program was effective for improving participant knowledge. CME programs for clinicians were delivered by local experts (uro-oncologist and medical oncologist) in four Canadian cities. Participants completed knowledge assessment tests pre-CME, immediately post-CME, and 3-month post-CME. Test questions were related to topics covered in the CME program including prognostic factors for advanced disease, surgery for advanced disease, indications for hereditary screening, systemic therapy, and management of small renal masses. Fifty-two participants attended the CME program and completed the pre- and immediate post-CME tests. Participants attended in Ottawa (14; 27%), Toronto (13; 25%), Québec City (18; 35%), and Montréal (7; 13%) and were staff urologists (21; 40%), staff medical oncologists (9; 17%), fellows (5; 10%), residents (16; 31%), and oncology nurses (1; 2%). The mean pre-CME test score was 61% and the mean post-CME test score was 70% (p=0.003). Twenty-one participants (40%) completed the 3-month post-CME test. Of those that completed the post-test, scores remained 10% higher than the pre-test (p value 0.01). Variability in test scores was observed across sites and between French and English test versions. Urologists had the largest specialty-specific increase in knowledge at 13.8% (SD 24.2, p value 0.02). The kidney cancer CME program was moderately effective in improving provider knowledge regarding quality indicators of kidney cancer care. These findings support continued use of this CME program at other sites.

Patient Function and the Value of Surgical Care for Kidney Cancer

Frailty and functional status have emerged as significant predictors of morbidity and mortality for patients undergoing cancer surgery. To articulate the impact on value (ie quality per cost), we compared perioperative outcomes and expenditures according to patient function for older adults undergoing kidney cancer surgery. Using linked SEER (Surveillance, Epidemiology and End Results)-Medicare data, we identified 19,129 elderly patients with kidney cancer treated with nonablative surgery from 2000 to 2009. We quantified patient function using function related indicators (claims indicative of dysfunction and disability) and measured 30-day morbidity, mortality, resource use and cost. Using multivariable, mixed effects models to adjust for patient and hospital characteristics, we estimated the relationship of patient functionality with both treatment outcomes and expenditures. Of 19,129 patients we identified 5,509 (28.8%) and 3,127 (16.4%) with a function related indicator count of 1 and 2 or greater, respectively. While surgical complications did not vary (OR 0.95, 95% CI 0.86-1.05), patients with 2 or more indicators more often experienced a medical event (OR 1.22, 95% CI 1.10-1.36) or a geriatric event (OR 1.55, 95% CI 1.33-1.81), or died within 30 days of surgery (OR 1.43, 95% CI 1.10-1.86) compared with patients with no baseline dysfunction. These patients utilized significantly more medical resources and amassed higher acute care expenditures (p <0.001). During kidney cancer surgery, patients in poor functional health can face a more eventful medical recovery at elevated cost, indicating lower value care. Greater consideration of frailty and functional status during treatment planning and transitions may represent areas for value enhancement in kidney cancer and urology care.