Do Patient Demographics Influence Treatment Decisions in Kidney Cancer?
Posted: Friday, July 9, 2021
Vitaly Margulis, MD, of The University of Texas Southwestern Medical Center, Dallas, and colleagues conducted a retrospective study to determine whether patient demographics such as ethnicity/race, sex, and insurance status are associated with the administration of non–guideline-based kidney cancer treatment. Their results, published in JAMA Network Open, uncovered significant discrepancies in treatment decision-making based on ethnicity/race and sex, with increased instances of non–guideline-based treatment in patients who were Black, Hispanic, and female.
This study focused on 158,445 patients with clinical stage I to II kidney cancer from the National Cancer Database. The definition of guideline-based treatment was based on the National Comprehensive Cancer Network Clinical Practice Guidelines in Oncology for Kidney Cancer; it incorporated clinical stage and tumor size, treatment such as surveillance or surgery, and overtreatment or undertreatment.
Among the treated patients, 75.7% were White, 62.8% were men, and 57.6% had private insurance. Ultimately, 69.4% of participants received guideline-based treatment, and the remaining received non–guideline-based treatment; according to the study authors, 28.2% were overtreated, and 2.5% were undertreated.
A lower adjusted odds of undertreatment (odds ratio [OR] = 0.82) and higher adjusted odds of overtreatment (OR = 1.27) were observed in females, as they appeared to be treated more aggressively than males. Black patients and Hispanic patients, however, had higher adjusted odds of undertreatment (OR = 1.42 and 1.20) and overtreatment (OR = 1.09 and 1.06) compared with White patients.
Individuals who were uninsured had a statistically significant association with a higher adjusted odds of undertreatment (OR = 2.63, P < .001) and a lower adjusted odds of overtreatment (OR = 0.72, P < .001) compared with patients who had insurance. A similar pattern was observed for those who were on Medicaid, but participants on Medicare had statistically significantly higher adjusted odds of undertreatment (OR = 1.67, P < .001) and overtreatment (OR = 1.21, P < .001).
Disclosure: The study authors reported no conflicts of interest.