The first annual State of the Nation Report from the National Kidney Cancer Audit (NKCA) highlights unwarranted variation in the quality of services for kidney cancer patients in England and Wales.

The report was published 12th September 2024 by the National Cancer Audit Collaborating Centre, Royal College of Surgeons of England. The report can be viewed here.

More renal biopsies should be carried out
The results show an overall low utilisation of renal biopsy in patients with small renal masses in England. Between 1st January 2019 and 31st December 2021, only 20% of patients with a small renal mass had a biopsy. At NHS trust level, the interquartile range (IQR) was 8-28%. Data were not available for Wales.

• The National Kidney Cancer Audit (NKCA) recommends that NHS hospitals should increase the number of patients with a small renal mass who receive a renal mass biopsy to confirm the histological diagnosis.

More patients should receive curative treatment within 31 days
Timely access to curative treatment for patients with high-risk, localised and locally advanced kidney cancer is a key objective for NHS services. NHS England’s national objective is to achieve this in 96% of patients within 31 days . In kidney cancer it was achieved in only 69% of patients in England. In Wales it was achieved in 78% of cases within 1 month prior and 12 months following diagnosis in 2022.

Kidney Cancer UK Accord Audit Report measured the quality of kidney cancer services in England between 2017 to 2018 and also emphasised the importance of prioritising curative surgery for localised, locally advanced kidney cancer if medically appropriate.

• The National Kidney Cancer Audit recommends providers treat patients within 31 days with localised and locally advanced kidney cancer at potentially high risk for recurrence and metastasis.

• In addition, they recommend NHS hospitals need to meet the demand for curative surgery for localised kidney cancer.

Nephron-sparing treatment should be used more frequently
In England, data were available on nephron-sparing treatment, showing that 67% of patients with a small localised tumour received partial nephrectomy and thermal ablation. The percentage of nephron-sparing treatment in Scotland reached 83.5% in 2020 according to data from NHS Scotland . This suggests nephron-sparing treatment is underutilised in England.

• The National Kidney Cancer Audit recommends that more patients with small, localised tumours should have nephron sparing treatment.

Metastatic kidney cancer should be treated with SACT within 12 months of diagnosis
Similarly, systemic anticancer therapy (SACT) for metastatic kidney cancer appeared to be underutilised in England, where 48% of patients with metastatic kidney cancer received initial SACT within 12 months of diagnosis. This is close to the percentage in England reported in the Kidney Cancer UK Accord paper (50%) in 2017-18.2 In Wales, 57% of patients with metastatic kidney cancer received initial SACT. By comparison, in 2020 62.2% of patients in Scotland with advanced and/or metastatic kidney cancer receiving initial SACT in the first year after diagnosis.

• The National Kidney Cancer Audit recommends that patients with metastatic kidney cancer should receive systemic anti-cancer therapy (SACT) within 12 months of diagnosis.

Professor Grant D. Stewart, Professor of Surgical Oncology, University of Cambridge, Honorary Consultant Urological Surgeon, Addenbrooke’s Hospital, Cambridge, and Surgical Lead for the National Kidney Cancer Audit said: “Optimising the treatment pathway for kidney cancer will improve efficiency and outcomes for patients. This audit will support such optimisation going forward, and these first results are benchmarks against which we will be able to measure progress in service quality improvement over the coming years.”

Malcolm Packer, Chief Executive Officer, Kidney Cancer UK added: “The National Kidney Cancer Audit is a major advance in the improvement of services for patients. It builds on the Kidney Cancer UK Accord audit, providing an ongoing driver towards better services. We welcome this first annual report and we look forward to playing our part in the changes it advocates.”