scholarly journals Preferences for Renal Cell Carcinoma Pharmacological Treatment: A Discrete Choice Experiment in Patients and Oncologists

2022 ◽  
Vol 11 ◽  
Author(s):  
Ovidio Fernández ◽  
Martín Lázaro-Quintela ◽  
Guillermo Crespo ◽  
Diego Soto de Prado ◽  
Álvaro Pinto ◽  
...  
Keyword(s):  
Renal Cell Carcinoma ◽  
Health System ◽  
Cell Carcinoma ◽  
Discrete Choice Experiment ◽  
Discrete Choice ◽  
Renal Cell ◽  
Choice Experiment ◽  
Serious Adverse Events ◽  
Cross Sectional ◽  
Survival Gain

IntroductionThe purpose of this investigation was to explore patients’ and oncologists’ preferences for the characteristics of a pharmacological regimen for patients with advanced renal cell carcinoma (aRCC).Material and MethodsCross-sectional observational study based on a discrete choice experiment (DCE) conducted in Spain. A literature review, a focus group with oncologists and interviews with patients informed the DCE design. Five attributes were included: progression survival gain, risk of serious adverse events (SAEs), health-related quality of life (HRQoL), administration mode, and treatment cost. Preferences were analyzed using a mixed-logit model to estimate relative importance (RI) of attributes (importance of an attribute in relation to all others), which was compared between aRCC patients and oncologists treating aRCC. Willingness to pay (WTP, payer: health system) for a benefit in survival or in risk reduction and maximum acceptable risk (MAR) in SAEs for improving survival were estimated from the DCE. Subgroup analyses were performed to identify factors that influence preference.ResultsA total of 105 patients with aRCC (77.1% male, mean age 65.9 years [SD: 10.4], mean time since RCC diagnosis 6.3 years [SD: 6.1]) and 67 oncologists (52.2% male, mean age 41.9 years [SD: 8.4], mean duration of experience in RCC 10.2 years [SD: 7.5]) participated in the study. The most important attribute for patients and oncologists was survival gain (RI: 43.6% vs. 54.7% respectively, p<0.05), followed by HRQoL (RI: 35.5% vs. 18.0%, respectively, p<0.05). MAR for SAEs was higher among oncologists than patients, while WTP (for the health system) was higher for patients. Differences in preferences were found according to time since diagnosis and education level (patients) or length of professional experience (oncologists).ConclusionPatients’ and oncologists’ preferences for aRCC treatment are determined mainly by the efficacy (survival gain) but also by the HRQoL provided. The results of the study can help to inform decision-making in the selection of appropriate aRCC treatment.

scholarly journals Correlation between radiological and histopathological findings in patients undergoing nephrectomy for presumed renal cell carcinoma on computed tomography scan at Grey’s Hospital

2018 ◽  
Vol 22 (1) ◽  
Author(s):  
Nompumelelo E. Mlambo ◽  
Nondumiso N.M. Dlamini ◽  
Ronald J. Urry
Keyword(s):  
Computed Tomography ◽  
Renal Cell Carcinoma ◽  
Ct Scan ◽  
Cell Carcinoma ◽  
South African ◽  
Renal Cell ◽  
Vascular Invasion ◽  
Retrospective Chart Review ◽  
Renal Masses ◽  
Cross Sectional

Background: The incidence of renal cell carcinoma (RCC) is increasing globally owing to the increased use of cross-sectional imaging. Computed tomography (CT) scan is the modality of choice in the diagnosis and pre-operative assessment of RCC. Nephrectomy is the standard treatment for RCC and pre-surgery biopsy is not routinely practised. The accuracy of CT diagnosis and staging in a South African population has not been established.Objectives: To determine the accuracy of CT scan in the diagnosis and pre-operative staging of RCC at Grey’s Hospital.Methods: A retrospective chart review was performed; CT scan reports and histopathological results of adult patients who underwent nephrectomy for presumed RCC on CT scan between January 2010 and December 2016 were compared.Results: Fifty patients met the inclusion criteria for the study. CT significantly overestimated the size of renal masses by 0.7 cm (p = 0.045) on average. The positive predictive value of CT for RCC was 81%. Cystic tumours and those 4 cm and smaller were more likely to be benign. CT demonstrated good specificity for extra-renal extension, vascular invasion and lymph node involvement, but poor sensitivity.Conclusion: In our South African study population, CT is accurate at diagnosing RCC, but false-positives do occur. Non-enhancing or poorly enhancing, cystic, fat-containing and small lesions (4 cm or smaller) are more likely to be benign and ultrasound-guided biopsy should be considered to avoid unnecessary surgery. CT assessment of extra-renal extension and vascular invasion is challenging and additional imaging modalities such as magnetic resonance imaging (MRI) venogram, duplex Doppler ultrasound or Positron emission tomography–computed tomography (PET/CT) may be beneficial.

scholarly journals Systematic Review of Contemporary Evidence for the Management of T1 Renal Cell Carcinoma: What IRs Need to Know for Kidney Cancer Tumor Boards

2019 ◽  
Vol 36 (03) ◽  
pp. 194-202 ◽  
Author(s):  
Julie Cronan ◽  
Sean Dariushnia ◽  
Zachary Bercu ◽  
Robert Mitchell Ermentrout ◽  
Bill Majdalany ◽  
...  
Keyword(s):  
Renal Cell Carcinoma ◽  
Cell Carcinoma ◽  
Renal Cell ◽  
Early Stage ◽  
The United States ◽  
Cross Sectional ◽  
Increased Risk ◽  
Tumor Boards ◽  
Cancer Tumor ◽  
Cross Sectional Imaging

AbstractRenal cell carcinoma is a relatively common malignancy, with 60 to 70 thousand cases a year in the United States alone. Increased utilization of cross-sectional imaging has led to an increase in the number of early renal cell cancers seen by the medical establishment. In addition, certain patient populations have an increased risk of developing kidney cancers which may mandate aggressive screening protocols. This article discusses the epidemiology of renal cell cancers; discusses the current management guidelines from multiple specialty societies; discusses some of the surgical and interventional techniques used in the treatment of such lesions; and provides a review of the literature regarding treatments of early-stage renal cell cancers.

Preoperative sodium concentration as a possible predictor of survival in patients with renal cell carcinoma

2007 ◽  
Vol 25 (18_suppl) ◽  
pp. 10601-10601
Author(s):  
N. S. Vasudev ◽  
J. E. Brown ◽  
S. R. Brown ◽  
K. Cocks ◽  
D. O'Donnell ◽  
...  
Keyword(s):  
Renal Cell Carcinoma ◽  
Cell Carcinoma ◽  
Renal Cell ◽  
Prognostic Significance ◽  
Disease Free Survival ◽  
Sodium Concentration ◽  
Continuous Variable ◽  
Related Factors ◽  
Cancer Specific Survival ◽  
Cross Sectional

10601 Background: Conventional renal cell carcinoma (RCC) has a variable natural history, and determining individual prognosis is important to guide management. In this cross-sectional study of RCC, a large number of parameters including hematological and biochemical as well as traditional tumor-related factors have been assessed for their prognostic significance. Methods: Consecutive, unselected patients undergoing nephrectomy for newly diagnosed RCC were invited to participate. Primary end-points were overall survival (OS), disease-free survival (DFS) and cancer-specific survival (CSS). A subset analysis of patients presenting with localized N0 disease was planned. Univariate and multivariate Cox's proportional hazards models were used. Results: 212 patients with RCC formed the study population. Tumor-related factors including grade, stage, presence of necrosis and vascular invasion were prognostic for survival on multivariate testing, in agreement with previous reports. In multivariate analyses pre-operative serum sodium (sNa) was found to be independently and significantly associated with OS and DFS when considered as a continuous variable (see table ). In a further exploratory analysis for all patients when sNa was dichotomized into above/below the median value (139 mmol/l; normal range: 135–145 mmol/l), 3-year OS estimates above and below the median were 74%, 95% CI [64%, 85%] and 54%, 95% CI [44%, 64%]; corresponding figures for 5 years were 68%, 95% CI [54%, 81%] and 44%, 95% CI [33%, 56%]. Conclusions: We have confirmed the prognostic value of traditional tumor-related factors but, to our knowledge, these are the first data to demonstrate that pre-operative sodium concentration may be an important factor associated with survival in patients with RCC. This result suggests that sNa should be considered with established prognostic parameters in modeling survival in RCC. [Table: see text] No significant financial relationships to disclose.

Everolimus in patients with metastatic renal cell carcinoma refractory to VEGF-targeted therapy: REACT subgroup analysis of prior therapy.

2012 ◽  
Vol 30 (5_suppl) ◽  
pp. 391-391
Author(s):  
James M. G. Larkin ◽  
Christian U. Blank ◽  
Petri Bono ◽  
Svetozar Gogov ◽  
Ashok Panneerselvam ◽  
...  
Keyword(s):  
Clinical Trial ◽  
Renal Cell Carcinoma ◽  
Cell Carcinoma ◽  
Metastatic Renal Cell Carcinoma ◽  
Renal Cell ◽  
Kinase Inhibitor ◽  
Prior Treatment ◽  
Serious Adverse Events ◽  
Expanded Access ◽  
Grade 3

391 Background: Efficacy of everolimus (EVE) in metastatic renal cell carcinoma (mRCC) refractory to vascular endothelial growth factor receptor-tyrosine kinase inhibitor (VEGFR-TKI) therapy is well established. The REACT (RAD001 Expanded Access Clinical Trial in RCC) study was initiated to provide patients with VEGFR-TKI-refractory mRCC access to EVE in advance of regulatory approval. Methods: REACT, an open-label, international, expanded-access clinical trial (Clinicaltrials.gov: NCT00655252 ) enrolled patients with measurable or nonmeasurable mRCC of any histology who were intolerant of, or progressed while on, VEGFR-TKI therapy. Long-term safety of EVE 10 mg/day in patients with mRCC, as determined by overall incidence of grade 3/4 and serious adverse events (AEs) was documented. RECIST-defined tumor response was also assessed by local investigator. Subgroup analyses evaluated effect of prior treatment on safety and efficacy of EVE. Results: Of 1367 patients enrolled, most (92.7%) had progressed on prior VEGFR-TKI therapy, and some (24.4%) were VEGFR-TKI intolerant. Across patient subgroups by prior VEGFR-TKI treatment, median EVE treatment duration was similar (Table). Best overall response rates were similar in the VEGFR-TKI-intolerant subgroup and overall populations: respectively, 1.8% and 1.7% had partial response (PR) while 53.5% and 51.6% had stable disease (SD). Incidence of grade 3/4 AEs across all prior treatment subgroups were similar to those of the overall population. (See table.) Conclusions: Patients enrolled in REACT derived benefit from EVE irrespective of prior VEGFR-TKI therapy, including VEGFR-TKI-intolerant patients. EVE is well tolerated and affords disease stabilization in the majority of patients with VEGFR-TKI-refractory mRCC, and is the standard of care in this patient population. [Table: see text]

Frustration and distress during treatment for advanced renal cell carcinoma.

2018 ◽  
Vol 36 (34_suppl) ◽  
pp. 47-47
Author(s):  
Cristiane Decat Bergerot ◽  
Dena Battle ◽  
Paulo Gustavo Bergerot ◽  
Daniel J. George ◽  
Hans J. Hammers ◽  
...  
Keyword(s):  
Renal Cell Carcinoma ◽  
Cell Carcinoma ◽  
Renal Cell ◽  
Online Survey ◽  
Clear Cell ◽  
Psychosocial Support ◽  
Qualitative Content Analysis ◽  
Advanced Renal Cell Carcinoma ◽  
Cross Sectional ◽  
Common Diagnosis

47 Background: Treatment strategies for advanced renal cell carcinoma (aRCC) have improved over the past 15 years. Durable responses are now achievable, giving rise to the possibility of cure in a small proportion of this population. However, it is not clear how patients are coping with more protracted courses of treatment. We sought to determine sources of frustration among patients diagnosed with aRCC. Methods: We performed a cross-sectional analysis of data derived from an online survey distributed via social media from April to June, 2017. We assessed source of frustration using an open-ended question: “In your own words, what has frustrated you most about your medical care related to your diagnosis?”. We assessed distress using the Distress Thermometer. Qualitative content analysis was performed to characterize responses related to frustration. Descriptive statistics was generated and the Kruskal-Wallis test was used to explore the relationship between clinical characteristics and sources of frustration. Results: We enrolled 217 patients with aRCC. The majority were male (52.3%), and white (93.5%). Clear cell histology (84.2%) was the most common diagnosis. Patients reported high levels of distress (M = 6.4; SD = 2.8). Sources of frustration were documented in 71.9% of patients, and were most commonly related to distrust of the cancer care system (12.4%), fear of progression (11.5%), lack of information (11.1%), financial concerns (9.7%), communication between patient and physician (7.8%), treatment side effects (4.6%), lack of available research (4.1%), mistrust of physician’s knowledge (4.1%), and access to supportive care (2.8%). Higher levels of frustration were associated with higher levels of distress (P = 0.01). Patients with non-clear cell RCC more commonly reported an emotional source of frustration (P = 0.02). Conclusions: Patients with aRCC report high levels of distress and frustration with their diagnosis and treatment. The most frequent drivers of frustration can suggest opportunities to maximize support to patients and their families. A better understanding of their disease and prognosis, addressing financial concerns and offering psychosocial support may alleviate frustration amongst patients with aRCC.

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