Treatment decision making in localised kidney cancer

Kidney Cancer UK funded research on treatment decision making in localised kidney cancer.

by; Katharina Beyer, PhD student at King’s College London
There are many possible treatment options for localised kidney cancer. Due to the current absence of clear clinical guidance, there is a need to better understand how patients and health care professionals make treatment decisions.
There are several treatment options available for localised kidney cancer, but surgery has historically been the benchmark treatment. However, a shift has occurred towards treating localised kidney cancer with nephron-sparing treatments, i.e. ablation or active surveillance. Research currently suggests that these different treatments have similar oncological outcomes. In addition, some studies comparing health care systems in different regions suggest localised kidney cancer is significantly overtreated when the diagnosis is based on imaging alone, rather than pathology. A confirmed tissue diagnosis (biopsy) could improve clinicians’ and patients’ confidence, possibly reducing bias in treatment selection. To avoid this bias that causes inequality in treatment selection, we need to better understand the factors that influence treatment decision-making.
Most of the current urological literature exploring factors that influence treatment decision-making can be found in the context of prostate cancer. These were described and defined recently by our research group as covering six domains; (1) patient characteristics; (2) tumour characteristics; (3) family and social support; (4) provider; (5) healthcare organisation; and (6) health policy. However, as many of these suggestions were driven by quantitative research, further exploration of the relative influence of these factors requires a robust research strategy. Hence, the project employs a methodology directed at problem-solving, idea-generation, and determining priorities of patients, their families and health professionals.
With the support of Kidney Cancer UK, we aim improve our understanding of the decision-making process. Therefore, this project is set out to explore the outcomes, perceptions, views, and experiences related to the kidney cancer treatment decision-making process of patients and their families and of the healthcare professionals, that enable treatment decision-making.
 

Dr Ravi Barod, Consultant at the Specialist Kidney Cancer Center at the Royal Free Hospital said “A better understanding of the treatment decision-making process will help inform future guidelines on supportive care”. Dr Netty Kinsella, Uro Oncology Nurse Consultant at the Royal Marsden Hospital adds “The requirement for supportive care during treatment decision-making is often undervalued and poorly represented in both national and local healthcare policy. This work is incredibly important as it will inform and influence future kidney cancer guidelines on supportive care as required by patients and their families”.