Kidney Cancer Care Research Articles

Needs Assessment Survey for the Management of Kidney Cancer

IntroductionIn this study we determined self-perceived knowledge gaps and continuing medical education preferences among Canadian urologists and medical oncologists related to the treatment of patients with kidney cancer. MethodsA needs assessment survey was created by the Quality Initiative group of the Kidney Cancer Research Network of Canada using an iterative feedback process. The survey determined knowledge gaps and continuing medical education preferences pertaining to 23 previously validated quality indicators of kidney cancer care. Topics included screening, diagnosis, prognosis, surgical management, systemic therapies and followup care. The survey was distributed via e-mail to Canadian urologists and medical oncologists. ResultsAmong the 164 respondents 121 (74%) were urologists and 43 (26%) were medical oncologists. The majority of respondents practice in academic (72, 57%) or large urban community centers (40, 32%). Of the 23 quality indicators examined 14 were designated as priority continuing medical education topics based on perceived inadequate knowledge or high interest in the topic. Priority topics were similar for urologists and medical oncologists, and covered the spectrum of kidney cancer care with an emphasis on hereditary kidney cancer and management of advanced disease. Most respondents preferred that continuing medical education be delivered through in person, case based group discussions. ConclusionsCanadian urologists and medical oncologists report similar knowledge gaps and continuing medical education preferences regarding kidney cancer care. Priority topics include screening for hereditary kidney cancer and management of advanced disease.

Health Insurance Status and Disparities in Kidney Cancer Care

IntroductionThrough PPACA (Patient Protection and Affordable Care Act) many adults have or will gain health insurance via Medicaid expansion. To understand how this policy change may potentially impact patients with kidney cancer we examined the relationship between insurance status and cancer related outcomes. MethodsUsing SEER (Surveillance, Epidemiology and End Results) data we identified 18,632 patients 26 to 64 years old with kidney cancer from 2007 to 2009. For each patient we classified insurance status as no insurance, Medicaid or private insurance. After adjusting for patient and county characteristics we measured the association of insurance status with cancer stage, treatment and 1-year mortality using multinomial logistic regression with clustering or generalized estimating equations as appropriate. ResultsIn our study cohort 937 (5.0%) and 2,027 patients (10.9%) had no insurance and Medicaid, respectively. These patients were more likely to be younger, nonwhite, unmarried and residing in areas with lower income, education or employment (p <0.001). On adjusted analyses uninsured and Medicaid patients more often presented with advanced disease (21.3% vs 19.6% vs 11.0%) but less frequently received treatment (86.2% vs 87.9% vs 93.4%, each p <0.001) compared with privately insured patients. These adults also died of kidney cancer more often (13.6% vs 12.5% vs 6.4%, p <0.001) likely due to differences in stage and receipt of cancer directed therapy. ConclusionsUninsured and Medicaid patients suffer disproportionately from kidney cancer with equal magnitude. Given the reliance on Medicaid, even as insurance coverage expands differences in outcomes will likely persist, underscoring the need for additional efforts that address disparities in kidney cancer care.

MP24-09 INSURANCE COVERAGE AND DISPARITIES IN KIDNEY CANCER CARE: IMPLICATIONS FOR THE AFFORDABLE CARE ACT

You have accessJournal of UrologyGeneral & Epidemiological Trends & Socioeconomics: Practice Patterns, Cost Effectiveness III1 Apr 2015MP24-09 INSURANCE COVERAGE AND DISPARITIES IN KIDNEY CANCER CARE: IMPLICATIONS FOR THE AFFORDABLE CARE ACT Hung-Jui Tan, Ryan J. Chuang, Aaron A. Laviana, and Jim C. Hu Hung-Jui TanHung-Jui Tan More articles by this author , Ryan J. ChuangRyan J. Chuang More articles by this author , Aaron A. LavianaAaron A. Laviana More articles by this author , and Jim C. HuJim C. Hu More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2015.02.1151AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES The Affordable Care Act aims to improve access to healthcare coverage for the uninsured. While some will obtain insurance through newly created exchanges, many will gain coverage with the expansion of Medicaid. Therefore, to assess the potential impact of this policy on kidney cancer care, we examined the relationship between outcomes and insurance status among potentially eligible patients with kidney cancer. METHODS Using SEER data, we identified adults aged 26–64 diagnosed with kidney cancer from 2007–2009 and classified their insurance status as uninsured, Medicaid, or privately insured. For each patient, we characterized stage (i.e., I–IV), treatment, and 1-year all-cause mortality for our primary outcomes. Adjusting for patient demographics, cancer data, and county-level measures of socioeconomic status and health, we estimated the association between outcomes and insurance status using multinomial logistic regression with clustering or generalized estimating equations. RESULTS From 2007–2009, we identified 18,632 patients with kidney cancer including 937 (5.0%) without insurance and 2,027 (10.9%) with Medicaid. Insurance coverage was more common among older, Caucasian, and married patients and those residing in urban locales or areas with greater income, education, or employment (p<0.001). In adjusted analyses, uninsured and Medicaid patients more often presented with metastatic disease compared to insured adults (21.3 vs. 19.6 vs. 11.0%, p<0.001) and were less likely to receive treatment, especially for stage IV disease (Figure). When further accounting for histopathology and treatment, uninsured patients had similar while Medicaid patients had higher 1-year adjusted mortality (all-cause) compared to adults with private insurance (10.3 vs. 12.1 vs. 10.3%, p<0.001). CONCLUSIONS Uninsured patients present with more aggressive disease but receive treatment less frequently, highlighting the potential benefits of insurance expansion. However, because many of the uninsured will receive coverage through Medicaid, disparities in kidney cancer care will likely persist, underscoring the need for additional efforts toward addressing the social determinants of cancer-related health. © 2015 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 193Issue 4SApril 2015Page: e278-e279 Advertisement Copyright & Permissions© 2015 by American Urological Association Education and Research, Inc.MetricsAuthor Information Hung-Jui Tan More articles by this author Ryan J. Chuang More articles by this author Aaron A. Laviana More articles by this author Jim C. Hu More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

MP24-10 DECLINING USE OF URINARY HERBAL AND VITAMIN SUPPLEMENTS AMONG U.S. MEN IN LONGITUDINAL NATIONAL PROSTATE CANCER SCREENING COHORTS

insurance status as uninsured, Medicaid, or privately insured. For each patient, we characterized stage (i.e., IeIV), treatment, and 1-year allcause mortality for our primary outcomes. Adjusting for patient demographics, cancer data, and county-level measures of socioeconomic status and health, we estimated the association between outcomes and insurance status using multinomial logistic regression with clustering or generalized estimating equations. RESULTS: From 2007e2009, we identified 18,632 patients with kidney cancer including 937 (5.0%) without insurance and 2,027 (10.9%) with Medicaid. Insurance coverage was more common among older, Caucasian, and married patients and those residing in urban locales or areas with greater income, education, or employment (p<0.001). In adjusted analyses, uninsured and Medicaid patients more often presented with metastatic disease compared to insured adults (21.3 vs. 19.6 vs. 11.0%, p<0.001) and were less likely to receive treatment, especially for stage IV disease (Figure). When further accounting for histopathology and treatment, uninsured patients had similar while Medicaid patients had higher 1-year adjusted mortality (allcause) compared to adults with private insurance (10.3 vs. 12.1 vs. 10.3%, p<0.001). CONCLUSIONS: Uninsured patients present with more aggressive disease but receive treatment less frequently, highlighting the potential benefits of insurance expansion. However, because many of the uninsured will receive coverage through Medicaid, disparities in kidney cancer care will likely persist, underscoring the need for additional efforts toward addressing the social determinants of cancer-related health.

Contemporary, age-based trends in the incidence and management of patients with early-stage kidney cancer

PurposeAlthough kidney cancer incidence and nephrectomy rates have risen in tandem, clinical advances have generated new uncertainty regarding the optimal management of patients with small renal tumors, especially the elderly. To clarify existing practice patterns, we assessed contemporary trends in the incidence and management of patients with early-stage kidney cancer. Materials and methodsUsing Surveillance, Epidemiology, and End Results data, we identified adult patients diagnosed with T1aN0M0 kidney cancer from 2000 to 2010. We determined age-adjusted and age-specific incidence and management rates (i.e., nonoperative, ablation, partial nephrectomy [PN], and radical nephrectomy) per 100,000 adults and determined the average annual percent change (AAPC). Finally, we compared management groups using multinomial logistic regression accounting for patient characteristics, cancer information, and county-level measures for health. ResultsFrom 2000 to 2010, we identified 41,645 adults diagnosed with T1aN0M0 kidney cancer. Overall incidence increased from 3.7 to 7.0 per 100,000 adults (AAPC = 7.0%, P<0.001). Over the study interval, rates of PN (AAPC = 13.1%, P<0.001) increased substantially, becoming the most used treatment by 2010. Among the elderly, rates of nonoperative management and ablation approached nephrectomy rates for those aged 75 to 84 years and became the predominant strategy for patients older than 84 years. Adjusting for clinical, oncological, and environmental factors, older patients less frequently underwent PN and more often received ablative or nonoperative management (P<0.001). ConclusionsAs the incidence of early-stage kidney cancer rises, patients are increasingly treated with nonoperative and nephron-sparing strategies, especially among the most elderly. The broader array of treatment options suggests opportunities to better personalize kidney cancer care for seniors.

Delivering kidney cancer care in rural Central and Southern Illinois: a telemedicine approach.

There is a growing body of experience and research suggesting that telemedicine (video conferencing, smart phones and online patient portals) could be the solution to addressing gaps in the provision of specialised healthcare in rural areas. The proposed role of telemedicine in providing needed services in hard to reach areas is not new. The United States Telecommunication Act of 1996 provided the initial traction for telemedicine by removing important economic and legal obstacles regarding the use of technology in healthcare delivery. This initial ruling has been supplemented by the availability of federal funding to support efforts aimed at developing telemedicine in underserved areas. In this paper, we explore one aspect of disease disparity pertinent to rural Illinois (kidney cancer incidence and mortality) and describe how we are planning to use an existing telemedicine program at Southern Illinois University School of Medicine (SIUSOM) to improve kidney cancer (Kca) care in rural Illinois. This represents an example of the possible role of telemedicine in addressing healthcare disparities in rural areas/communities and provides a description of general challenges and barriers to the implementation and maintenance of such systems.

Identification of quality improvement opportunities in kidney cancer surgery through a regional hospital-based urologic quality collaborative.

413 Background: Patient selection for radical (RN) and partial nephrectomy (PN) for suspicion of kidney cancer may depend more on provider factors than patient characteristics. Observational data suggests that patients with small renal tumors have better overall survival when managed with PN rather than RN. We prospectively evaluated perioperative processes of care for patients undergoing kidney cancer surgery at Washington State hospitals participating in a surgical collaborative to identify quality improvement opportunities in kidney cancer care. Methods: We developed a chart abstraction tool that captures potential quality concerns in kidney cancer surgical care. The abstraction tool was implemented at nine regional hospitals with data consolidated for review quarterly. A sampling of PN and RN cases was abstracted. Hospital-specific feedback reports were blinded to hospital identity; data were analyzed as aggregate rates and hospital-specific rates using descriptive statistics. Presented results were not risk-adjusted. Results: We identified 75 patients undergoing RN or PN at 9 area hospitals from 2011-2013. Staging evaluations were uncommon (preoperative chest x-ray and chest CT in 41% and 20%, respectively). 13% percent of patients had a preoperative renal mass biopsy. For renal tumors ≤ 4 cm, 16/32 (50%) underwent PN. Hospital-specific utilization of PN for small renal masses exhibited variation: in 2 hospitals, 100% of tumors ≤ 4 cm were treated with PN, while 1 hospital performed RN in all cases, and the remaining hospitals ranged from 33%-67% utilization of PN. PN was less common for tumors 4-7 cm in size (4/26 cases [15%]). Venous thromboembolic events occurred in 4% of kidney cancer surgeries. Conclusions: We identified substantial variation in selection of surgical technique and postoperative outcomes following PN and RN for kidney cancer. Patients with small renal masses appear to have variable access to PN, which could impact their long-term health outcomes. Better understanding of provider knowledge and attitudes toward management of small renal masses could inform quality improvement initiatives to address the variations in care identified.

Canadian Kidney Cancer Forum 2008

In Canada, at least 4500 people are diagnosed with kidney cancer, and 1 in 3 die of the disease. It is the most lethal genitourinary cancer, and its incidence is increasing. Unlike most human cancers, there is considerable knowledge about specific genetic changes in these cancers. Major advances in treatment are being made owing to new systemic targeted therapies as well as less morbid technologies for localized cancers. The first Canadian Kidney Cancer Forum was held Jan. 31–Feb. 2, 2008, in Mont Tremblant, Quebec, to review these developments and identify opportunities for Canadians. The primary meeting objectives were achieved and included: Achievement of consensus among expert professionals and patients on the management of patients with localized, locally advanced and metastatic renal cell carcinoma, as well as the in the areas of pathology and imaging. Over 3 days, a series of sessions were held to address the different stages of disease and issues. In this issue, we present the consensus statements. Key references in each area were provided by experts and were graded using a modified version of the Oxford Levels of Evidence. During the conference, experts in each area presented, followed by an opportunity for questions and discussion. At the end of the forum, overviews were presented, and participants voted on draft statements developed during the sessions. Stimulation of clinical research in kidney cancer including opportunities for national and international collaboration. To achieve this, the formation of a research network was proposed with the suggested name, Kidney Cancer Research Network Canada. Definition of educational needs to improve kidney cancer care in Canada. This included discussing a national kidney cancer database that will be developed. Initiating the development of a cancer control strategy for kidney cancer to ensure all Canadians have equal access to care to attempt to develop a national approach to the management of this cancer. The Forum was endorsed by the Canadian Urological Association, the Canadian Association of Medical Oncologists and the Canadian Association of Radiation Oncologists, and was supported by grants from the Canadian Institutes of Health Research, the National Cancer Institute of Canada, the Canadian Cancer Society, the Canadian Partnership Against Cancer, several provincial cancer agencies (Cancer Care Ontario, Cancer Care Manitoba, Cancer Care Nova Scotia, Alberta Cancer Foundation) and the Princess Margaret Hospital Foundation, and industry. These groups had been identified by the steering committee as ones that had demonstrated expertise, interest or experience in clinical or research aspects of kidney cancer. They were joined by a small number of invited participants from Europe and the United States to bring an international perspective to the process. Dr. George Browman, representing the Canadian Partnership Against Cancer, contributed expertise in the development and use of guidelines for cancer care. Overall, the participants believe that the forum will have a significant impact on the care of Canadians afflicted with kidney cancer. Given the enormous success of this first meeting, planning for a second meeting in 2009 has commenced.

Modest improvement in 20 years of kidney cancer care in the Netherlands

AimFor an evaluation of the progress achieved in the field of kidney cancer care in the Netherlands in the last decades, we described trends in incidence, treatment, mortality and relative survival. MethodsAll adult patients newly diagnosed with kidney cancer between 1989 and 2009 (N=32,545) were selected from the Netherlands Cancer Registry. Age-standardised incidence and mortality rates were calculated. Follow-up was completed until January 2010. In order to assess trends estimated annual percentages of change (EAPC) were estimated. ResultsThe incidence of kidney cancer has been fairly stable between 1989 and 2001 with a European Standardised Rate of approximately 11 per 100,000 person years (PY). Since 2001 the incidence increased to 13 per 100,000 PY in 2009 (EAPC: 2.4%; 95%confidence interval (CI): 1.5 to 3.4%). The mortality rate decreased slightly over time, from 6.2 per 100,000 PY in 1989 to 5.6 in 2010. No changes in treatment were observed, except for the introduction of targeted therapies for stage IV disease, since 2005. The 5-year relative survival improved from 51% in 1989–1994 to 58% in 2005–2009 (EAPC: 0.9%; 95%CI 0.7 to 1.2%). Improvement in survival was especially seen in males, younger age groups and low stages. ConclusionsThe incidence of kidney cancer has increased slightly, and survival improved modestly, resulting in a decreasing mortality. A positive effect of the introduction of targeted therapies for metastatic kidney cancer was observed in 1-year relative survival. For progress in kidney cancer care, effective prevention strategies and new therapies remain warranted.