AN EMPIRICAL EVALUATION OF VARIATION IN INTENSITY OF SURVIVORSHIP CARE AND ITS EFFECT ON KIDNEY CANCER-SPECIFIC SURVIVAL

You have accessJournal of UrologyGeneral & Epidemiological Trends & Socioeconomics: Evidence-based Medicine & Outcomes I1 Apr 2015MP5-07 AN EMPIRICAL EVALUATION OF VARIATION IN INTENSITY OF SURVIVORSHIP CARE AND ITS EFFECT ON KIDNEY CANCER-SPECIFIC SURVIVAL William Sohn, Amy Graves, Sam Chang, Daniel Barocas, David Penson, and Matthew Resnick William SohnWilliam Sohn More articles by this author , Amy GravesAmy Graves More articles by this author , Sam ChangSam Chang More articles by this author , Daniel BarocasDaniel Barocas More articles by this author , David PensonDavid Penson More articles by this author , and Matthew ResnickMatthew Resnick More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2015.02.234AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES There remains little consensus surrounding the optimal frequency of surveillance after the surgical treatment of renal cell carcinoma (RCC) to maximize value in the survivorship phase of kidney cancer care. Additionally, there is no definitive evidence that earlier identification of recurrence translates into improvements in survival. The purpose of this study was to characterize the variation in intensity of follow-up imaging and evaluate the association between intensity of surveillance and disease specific survival (DSS). METHODS We identified incident cases of localized RCC treated with surgery in SEER-Medicare data from 2004–2009. Surveillance intervals were categorized as short and intermediate (0–15 and 15–36 months post-surgery, respectively) after which patients were followed until death or censoring. We identified counts of chest and abdominal imaging attributed to RCC within these periods, truncated 6 months before death or last follow-up to minimize the impact of increased end-of-life intensity of care. We used multivariable negative binomial models to assess associations between imaging counts and patient, disease, and treatment characteristics. Finally, using competing risks analysis, we evaluated the relationship between the intensity of follow-up with DSS. RESULTS Mean (SD) number of chest and abdominal images were 0.8 (1.0) and 1.0 (1.0) during the short interval and 0.8 (1.2) and 1.0 (1.2) during the intermediate interval. For each outcome and during each surveillance interval, black race and increasing age were associated with decreased imaging intensity (p<0.05). Adverse pathologic features (stage and grade) and operation type were associated with increased imaging intensity (p<0.05). Increased chest and abdomen imaging in either the short- and intermediate-term interval were not associated with any improvement in DSS and, in fact, were associated with increased hazard of kidney cancer-specific mortality (all p<0.001). This finding remained true in pathologic stage subgroups (Figure). CONCLUSIONS We identified wide variation in the intensity of follow-up during the early- and intermediate- survivorship experience for RCC. However, increased intensity of follow-up does not appear to be protective, rather DSS appears worse in patients undergoing more frequent imaging. While this may be explained in part due to reverse causality, with patients requiring more tests at end of life, these findings call into question the value of routine follow-up after surgery for RCC. © 2015 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 193 Issue 4S April 2015 Page: e47-e48 Advertisement Copyright & Permissions© 2015 by American Urological Association Education and Research, Inc.Metrics Author Information William Sohn More articles by this author Amy Graves More articles by this author Sam Chang More articles by this author Daniel Barocas More articles by this author David Penson More articles by this author Matthew Resnick More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...