Demographic Factors Associated With Non-Guideline–Based Treatment of Kidney Cancer in the United States

Abstract

IMPORTANCE Significant demographic disparities have been found to exist in the delivery of health care. Demographic factors associated with clinical decision-making in kidney cancer have not been thoroughly studied. OBJECTIVE To determine whether demographic factors, including sex and race/ethnicity, are associated with receipt of non-guideline-based treatment for kidney cancer. DESIGN, SETTING, AND PARTICIPANTS This retrospective cohort study was conducted using data from the National Cancer Database for the years 2010 through 2017. Included patients were individuals aged 30 to 70 years with localized (ie, cT1-2, N0, M0) kidney cancer and no major medical comorbidities (ie, Charlson-Deyo Comorbidity Index score of 0 or 1) treated at Commission on Cancer-accredited health care institutions in the United States. Data were analyzed from November 2020 through March 2021. EXPOSURES Demographic factors, including sex, race/ethnicity, and insurance status. MAIN OUTCOMES AND MEASURES Receipt of non-guideline-based treatment (undertreatment or overtreatment) for kidney cancer, as defined by accepted clinical guidelines, was determined. RESULTS Among 158 445 patients treated for localized kidney cancer, 99 563 (62.8%) were men, 120 001 individuals (75.7%) were White, and 91 218 individuals (57.6%) had private insurance. The median (interquartile range) age was 58 (50-64) years. Of the study population, 48 544 individuals (30.6%) received non-guideline-based treatment.

Disparities in immune and targeted therapy utilization for older US patients with metastatic renal cell carcinoma

“…Notably, these disparities persisted in the era of targeted therapies and oral anticancer agents (OAAs) ( 5 ). Prior studies have highlighted potential drivers of these racial disparities, including inequitable access to health care ( 6 , 7 ), differences in disease biology ( 8 , 9 ), and variable adherence to guideline-based treatment ( 10 ). Sex- or gender-related disparities in RCC have also been described ( 11 ), with studies reporting differences in tumor biology at the time of presentation ( 9 , 12 , 13 ) and varying rates of treatment utilization ( 10 , 14 , 15 ) between males and females.…”

Sex and Gender Differences in Kidney Cancer: Clinical and Experimental Evidence

“…Similarly, in the setting of metastatic RCC, Patel et al, found that females were less likely to undergo a cytoreductive nephrectomy as compared to their male counterparts [137]. In a population-based cohort study using data from the National Cancer Database, females with localized renal masses were treated more aggressively than males, with consequent significantly higher risks of overtreatment [138]. Despite these data, there is no mention of any potential sex-related differences in access to care and type of treatment pattern by the latest international Guidelines [104].…”

Disparities in Clinical Care and Research in Renal Cell Carcinoma

“…Patients without health insurance were more likely to be undertreated (as compared to clinical consensus RCC treatment guidelines) relative to those with private insurance (OR 2.63, p < 0.001), potentially reflecting the limited availability of therapies in resource-scarce medical settings [31]. Notably, however, these differences in treatment access have carried over to even higher volume cancer hospitals with more diverse patient/payor populations.…”