S. Sigurdson1, and A. Swaminath2; 1Department of Radiation Oncology, Juravinski Cancer Centre, Hamilton, ON, Canada, 2Juravinski Cancer Centre, McMaster University, Hamilton, ON, Canada
Purpose/Objective(s): This study aimed to evaluate patient preferences regarding four treatment options for clinical stage I-II renal cell carcinoma (RCC): partial nephrectomy (surgery); radiofrequency/ microwave ablation or cryotherapy; stereotactic body radiotherapy (SBRT); and active surveillance (AS). Surgery remains the standard of care for localized disease, though many patients are unfit due to their advanced age and medical comorbidities. In these patients an active surveillance strategy or ablative therapies are offered. Worldwide there is a paucity of data on patients’ values and preferences for localized RCC treatment options. Understanding these preferences may increase patient satisfaction and adherence to follow up care; potentially leading to better long-term outcomes. Materials/
Methods: Patients with kidney cancer were recruited from one clinical site in Hamilton, Ontario, and via email invitation on the Kidney Cancer Canada newsletter, to complete a cross-sectional web-based survey. Preferences were quantified using object case best-worst scaling, where patients identified the best and worst among nine treatment features which includes descriptions for the 4 treatment methods and 5 risks; “dialysis”, “transfusion”, “nephrostomy”, “repeat treatment”, and “bowel toxicity”. Participants were asked to identify their preference between the 4 treatments (direct elicitation), and the likelihood of trying each on a 5-point Likert scale. Results: The response rate was 62% (121 started and 75 completed the survey), the mean age was 65 years (SD 7.9 years), and 52% were female. The mean time since RCC diagnosis was 9.0 +/- 10.0 years. The participants two most preferred treatment features were “surgery” and “ablation”, and least preferred features were “dialysis” and “bowel toxicity”. From the direct elicitation 49% most preferred surgery, 33% ablation, 12% SBRT, and 6% AS. Surgery compared to all other options was statistically significant (p<0.001), as well as ablation compared to SBRT (p=0.0413) but not surveillance (p=0.257), and there was no difference between preference for SBRT and surveillance (p=0.346). The mean likelihood of willingness to try each treatment was 87% for surgery, 54% ablation, 54% SBRT, and 26% AS. Conclusion: Treatment type, mode of action, and risks drive kidney cancer patients’ preferences. Patients who are not surgical candidates should be referred for discussion of ablative options, which includes radiofrequency/microwave ablation, cryotherapy, and SBRT. Our study results indicate features of all the available treatment options should be incorporated into shared decision-making discussions with early-stage kidney cancer patients.
