Psychological distress associated with active surveillance in patients younger than 70 with a small renal mass

Goldberg, Hanan; Ajaj, Rami; Cáceres, Jaime Omar Herrera; Berlín, Alejandro; Chandrasekar, Thenappan; Klaassen, Zachary; Wallis, Christopher J.D.; Ahmad, Ardalan E.; Leão, Ricardo; Petrella, Anika; Kachura, John R.; Fleshner, Neil; Matthew, Andrew; Finelli, Antonio; Jewett, Michael A.S.; Hamilton, Robert J.

doi:10.1016/j.urolonc.2020.02.015

Cited by 17 publications

(15 citation statements)

References 31 publications

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“…A second criticism is RMBassociated anxiety: in a recent study by Goldberg et al, patients with a malignant biopsy were found to have the highest psychological distress in those selecting active surveillance versus treatment. 20 Intuitively, these match the findings of our cohort, explaining the high incidence of non-progression-driven treatment in SRM-RCC patients. Notably however, their psychological distress regression estimates contrasted with those of RMB or surveillance individually (nonsignificant to borderline significant) suggesting that this effect is not driven by the performance of biopsy alone or AS itself, rather by how patients respond to AS for a malignant diagnosis.…”

Section: Discussionsupporting

confidence: 86%

Treatment on active surveillance of small renal masses: Progression vs. preference

Cheung¹,

Frankel²,

Tut³

et al. 2021

CUAJ

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Introduction: Active surveillance (AS) of small renal masses (SRM) is increasingly recognized as a safe option. A recent U.S. study found that half of patients receiving treatment on AS were for preference, but these findings may not be generalizable to other jurisdictions and healthcare models. We aimed to investigate AS failure rates and causes among a contemporary biopsy-evaluated cohort in Canada. Methods: A retrospective review was performed of SRM patients on AS undergoing treatment at our tertiary care center (1999–2018). All patients had undergone renal biopsy and been diagnosed with renal cell carcinoma (RCC). Demographic and clinical parameters surrounding the decision to treat were extracted from chart review. Indications for treatment were dichotomized into clinical (radiographical) progression or preference. Qualitative assessment of clinic notes confirmed treatment indication. Ethics approval was obtained. Results: A total of 38 SRM-RCC patients who underwent treatment on AS were identified, of which 29 had been on AS ≥1 year. Most (75.9%) were male, and the mean age beginning AS was 65.9±9.0 years. Most patients had clear-cell RCC with low-grade disease. Seventeen of 29 (58.6%) patients experienced clinical progression after 3.82 (2.57–7.16) years, whereas preference accounted for 12/29 (41.4%) after 2.22 (1.69–3.53) years (time-to-treatment p=0.032). The longest duration on AS was 14.2 years prior to clinical progression. No patients had metastatic progression before treatment. Conclusions: Two-fifths of patients received treatment for preference and at a much higher rate vs. clinical progression. These findings suggest a clinical gap where effective patient counselling, prior to and during AS, may improve adherence.

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Section: Discussionsupporting

confidence: 86%

Treatment on active surveillance of small renal masses: Progression vs. preference

Cheung¹,

Frankel²,

Tut³

et al. 2021

CUAJ

Self Cite

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“…Some studies suggest increased rates of anxiety and depression [100] , while others suggest that these rates diminish over time [101] . Similar effects are noted within surveillance for small renal masses and biopsy-proven renal malignancies [102] , [103] . Research and tools are needed to understand how best to address psychological and behavioural issues resulting from a transition to a “less is more” approach.…”

Section: Evidence Synthesissupporting

confidence: 58%

The Impact of the COVID-19 Pandemic on Genitourinary Cancer Care: Re-envisioning the Future

et al. 2020

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Context The coronavirus disease 2019 (COVID-19) pandemic necessitated rapid changes in medical practice. Many of these changes may add value to care, creating opportunities going forward. Objective To provide an evidence-informed, expert-derived review of genitourinary cancer care moving forward following the initial COVID-19 pandemic. Evidence acquisition A collaborative narrative review was conducted using literature published through May 2020 (PubMed), which comprised three main topics: reduced in-person interactions arguing for increasing virtual and image-based care, optimisation of the delivery of care, and the effect of COVID-19 in health care facilities on decision-making by patients and their families. Evidence synthesis Patterns of care will evolve following the COVID-19 pandemic. Telemedicine, virtual care, and telemonitoring will increase and could offer broader access to multidisciplinary expertise without increasing costs. Comprehensive and integrative telehealth solutions will be necessary, and should consider patients’ mental health and access differences due to socioeconomic status. Investigations and treatments will need to maximise efficiency and minimise health care interactions. Solutions such as one stop clinics, day case surgery, hypofractionated radiotherapy, and oral or less frequent drug dosing will be preferred. The pandemic necessitated a triage of those patients whose treatment should be expedited, delayed, or avoided, and may persist with severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) in circulation. Patients whose demographic characteristics are at the highest risk of complications from COVID-19 may re-evaluate the benefit of intervention for less aggressive cancers. Clinical research will need to accommodate virtual care and trial participation. Research dissemination and medical education will increasingly utilise virtual platforms, limiting in-person professional engagement; ensure data dissemination; and aim to enhance patient engagement. Conclusions The COVID-19 pandemic will have lasting effects on the delivery of health care. These changes offer opportunities to improve access, delivery, and the value of care for patients with genitourinary cancers but raise concerns that physicians and health administrators must consider in order to ensure equitable access to care. Patient summary The coronavirus disease 2019 (COVID-19) pandemic has dramatically changed the care provided to many patients with genitourinary cancers. This has necessitated a transition to telemedicine, changes in threshold or delays in many treatments, and an opportunity to reimagine patient care to maintain safety and improve value moving forward.

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“…Recent work from the Princess Margaret Cancer Centre has provide insight into patient distress while being managed with active surveillance for a small renal mass. Among 217 patients less than 70 years of age on surveillance, those with biopsy proven malignancy had significantly worse psychological distress in multivariable models [10] . When this cohort was stratified by gender, psychological distress was significantly higher for women after diagnosis and after renal mass biopsy, but diminished over time with no gender differences at the date of last follow-up [11] .…”

Section: Patient Distress Secondary To Treatment Delaysmentioning

confidence: 99%

Assessing patient risk from cancer and COVID-19: Managing patient distress

Klaassen

Wallis

2021

Urologic Oncology: Seminars and Original Investigations

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Psychological distress associated with active surveillance in patients younger than 70 with a small renal mass

Cited by 17 publications

References 31 publications

Treatment on active surveillance of small renal masses: Progression vs. preference

Treatment on active surveillance of small renal masses: Progression vs. preference

The Impact of the COVID-19 Pandemic on Genitourinary Cancer Care: Re-envisioning the Future

Assessing patient risk from cancer and COVID-19: Managing patient distress

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