Surgeon-specific factors affecting treatment decisions among Canadian urologists in the management of pT1a renal tumours

Abstract

Introduction: The ubiquitous use of diagnostic imaging has resulted in an increased incidental detection of small renal masses (SRM). Patient-and tumour-related factors affect treatment decisions greatly; however, with multiple treatment options available, surgeonspecific characteristics and biases may also influence treatment recommendations. We determine the impact of surgeon-specific factors on treatment decisions in the management of SRM in Canada. Methods: An online survey study was conducted among Canadian urologists currently registered with the Canadian Urological Association. The questionnaire collected demographic information and recommended treatments for 6 SRM index cases involving theoretical patients of various ages (51-80 years) and comorbidities. Results: A total of 110 urologists responded (17% response rate) to the survey. Of these, 18% were over 65 years old and 45% were from academic centres. With increasing patient age and comorbidity, active surveillance and thermal ablative therapies were more the recommended treatment. Laparoscopic/robotic surgery was more commonly recommended by academic urologists and those under 65. Recommending surgery (radical nephrectomy or partial nephrectomy) for both elderly (about 80 years old) index patients correlated with surgeon age (surgeons over 65, p < 0.001), surgeons with no oncologic fellowship training (p = 0.021), surgeons with a non-academic practice (p = 0.003), surgeons with a personal history of cancer (p = 0.038) and surgeons with a family history of cancer death in the last 10 years (p = 0.022). Conclusions: There are various factors that influence the management options offered to patients with SRMs. Our results suggest that surgeon age, personal history of cancer, practice-type and other surgeon-specific variables may affect treatments offered among urologists across Canada.

Pharmacogenetic landscape of Metabolic Syndrome components drug response in Tunisia and comparison with worldwide populations

“…The clinical implementation of pharmacogenetics in therapeutic approaches, aims to optimize specific drug regimens and drug dosage. This, may have a great advantage in, improving clinical outcomes and avoiding major clinical complication such as congestive heart failure, hepatic and renal disorders [ 10 , 11 ].…”

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“…For example, respondents to recent physician surveys from Canada and the United States indicate that age and comorbid status influence their choice of surgery. 15,16 Also, previous population-based and large single centre studies reported that factors, such as younger age, male gender, and lower Charlson comorbidity score, were associated with increased use of partial nephrectomy. 22,27 We believe these data indicate that Canadian urologists working at academic centres are performing partial nephrectomies when technically feasible irrespective of most patient factors.…”

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Local tumour ablation for localized kidney cancer: Practice patterns in Canada

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