Palliative Care Initiation in Patients With Advanced and Metastatic Renal Cell Carcinoma

By Robert Dillard - December 14, 2021

ALTHOUGH USE OF palliative interventions (PI) has increased moderately in patients with Stage IV renal cell carcinoma (RCC), an analysis of data from the US National Cancer Database (NCDB) has shown that use of PI has increased only minimally in these patients over a decade. The study also identified distinct clinical and sociodemographic factors that influence PI use, reported Hiren V. Patel, MD, PhD, resident physician at Rutgers- Robert Wood Johnson Medical School, New Brunswick, NJ, who presented the study findings at the 2021 annual meeting of the American Urological Association (AUA2021).

PIs are associated with decreased depression, pain, anxiety, and improved quality of life and, in some cases, overall survival, Dr Patel explained. PIs also reduce ICU admissions and overall cost during end-of-life care. Guidelines issued by the AUA, American Society of Clinical Oncology (ASCO), National Comprehensive Cancer Network (NCCN), and Kidney Cancer Association (KCA) recommend early integration of PI into oncologic care. Patients likely to benefit from this include RCC patients with metastatic disease who have had distant recurrence after extirpative surgery, Dr. Patel noted. However, PI usage for RCC is poorly understood and factors that influence its use are not known.

Using the NCDB data, Dr. Patel and his colleagues identified 42,014 patients with Stage IV (TanyNanyM1) RCC during the period 2004-2014, of whom 9,317 (18.8%) received PI. About 50% of these patients received radiation therapy as PI.

During this time, PI utilization in Stage IV RCC patients increased from 17% to 20%. Multivariable analysis adjusting for clinical and sociodemographic covariates identified a number of sociodemographic factors that influenced PI use in Stage IV RCC patients, notably income, education, and insurance status. Clinical factors that influenced PI use included prior treatment, which had a significant effect, Dr. Patel noted. Among patients receiving surgery for Stage IV RCC, those with sarcomatoid histology were more likely to receive PI compared with patients with clear cell histology. Patients receiving systemic therapy or surgery plus systemic therapy were more likely to receive PI if they had a contemporary diagnosis or sarcomatoid histology.

Among patients who received radiation for Stage IV RCC, those treated within a comprehensive community cancer program, were uninsured, or were of non-white or non-Black race, were more likely to receive PI. Black race was associated with decreased use of PI compared with white patients receiving radiation therapy.

The results of this study highlight the need for increased awareness of PI for Stage IV RCC, as well as a need for earlier initiation of PI in a more equitable and systematic way, Dr. Patel concluded. “Better coding practices are needed to identify PI usage in patients with urologic diseases,” he added.

References

Patel H, Kim S, Srivastava A, et al. Factors associated with palliative care utilization in advanced and metastatic renal cell carcinoma. J Urol. 2021;26(3S, suppl):e665-e666. Abstract PD38-09. DOI: https://doi.org/10.1097/JU.0000000000002048.09

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