The Current Evidence for Factors that Influence Treatment Decision Making in Localized Kidney Cancer: A Mixed Methods Systematic Review

Abstract

Introduction: With a growing number of treatment options for localised kidney cancer, patients and health care professionals have both the opportunity and the burden of selecting the most suitable management option. This mixed method systematic review aims to understand the barriers and facilitators of the treatment decision-making process in localised kidney cancer. Methods: We searched PubMed, Embase, and Cochrane Central databases between 1st of January 2004 and 23rd of April 2020 using the JBI Manual for Evidence Synthesis and the Preferred Reporting Items for Systematic Review and Meta-analysis statement. We identified 553 unique citations, of these 511 were excluded resulting in 42 articles included for synthesis. The Purpose, Respondents, Explanation, Findings and Significance and the Strengthening the Reporting of Observational Studies in Epidemiology checklist were applied. Results: The key themes describing barriers and facilitators to treatment decisionmaking were identified and categorised into three domains: (1) kidney cancer specific characteristics; (2) decision-maker related criteria; and (3) contextual factors.The main facilitators identified within these domains were: size at diagnosis, age, comorbidities, BMI, gender, nephrometry scoring systems, biopsy, socio-economic status, family history of cancer, year of diagnosis, geographic region and practice pattern. The key barriers were race, gender, patient anxiety, low confidence in diagnostic and treatment options, cost of procedure and practice patterns.

Trends in health care spending on kidney cancer in the United States, 1996–2016

“…Another possible reason may lie in the fact that younger patients tend to receive more cost‐intensive care, according to an analysis of the French National Hospital Database from 2008 to 2013 24 . A similar trend was reported in a recent systematic review that suggested that younger patients are more likely to elect expensive surgical procedures (e.g., open or partial nephrectomy) rather than ablation or active surveillance 25 . All of these trends could contribute to faster expenditure growth among young patients given the higher incidence rates and more intensive medical services.…”

“…24 A similar trend was reported in a recent systematic review that suggested that younger patients are more likely to elect expensive surgical procedures (e.g., open or partial nephrectomy) rather than ablation or active surveillance. 25 All of these trends could contribute to faster expenditure growth among young patients given the higher incidence rates and more intensive medical services. Moreover, our data demonstrated that service utilization did not have as much impact on reduced health expenditures in younger age groups as in older age groups (Table 1), which implies that there still may be room for improvement in service utilization for younger patients.…”

A Systematic Review of Heterogeneity in Outcome Definition and Reporting in Localised Renal Cancer

“…Historically, surgery has been the standard of care for localised renal cancer, but international guidelines have more recently proposed ablative treatments and active surveillance as alternative options [5] , [6] . Currently, oncological outcomes across treatments are similar and treatment decision-making is multifactorial [7] .…”

“…COS in urology are needed because inconsistencies and variability cause not only frustration but also potentially problematic conclusions [9] . This issue is also clearly apparent for localised renal cancer, and ultimately results in barriers for the multifactorial process of decision-making [7] .…”

Editorial Commentary

“…2 In general, the decision process leading to the treatment of a renal tumor is multifactorial and multifaceted. 3 Accurate patient selection and counseling remain key to making the best “tailored” choice on a case-by-case basis. In referring centers managing renal masses, all these options should be available in the armamentarium of the treating physician.…”