ASCO GU 2018: Effects of Patient Gender on Urologist Decision-Making Regarding Treatment of the Localized Renal Mass Introduction and Objective

San Francisco, CA ( Gender disparity in the proportion of patients receiving nephron sparing strategies (NSS) for the treatment of localized renal masses has been demonstrated in large population series as well as in single centers of excellence. However, the reasons for the gender discrepancy remains elusive. The authors aimed to assess urologist treatment patterns for localized renal masses in both genders to gauge the existence of provider-based gender biases. It was hypothesized that female patients may be recommended more aggressive treatment due to provider biases related to patient gender.

Urologists were randomly emailed 1 of 2 surveys including 6 vignettes of various patients with renal masses. Both surveys were identical other than the vignette patient gender (VPG) which was male in 50% and female in 50%. Self-selected respondents chose the single best treatment option from the following choices: 

  • Active surveillance (AS) 
  • Percutaneous or laparoscopic ablation (ABL) 
  • Partial nephrectomy (PN) 
  • Radical nephrectomy (RN)
Fisher’s exact test was used to assess differences in treatment recommended based on VPG. Nominal logistic regression was performed to assess the magnitude of differences.

Of the 423 urologists who completed the survey there was an even response to both surveys (210 vs. 213). Most respondents were male (93%), married (89%) and in private practice (44%). Age and time practicing were evenly distributed and the median number of nephrectomies done per year was 15. There were no significant differences in demographics between the respondents of the 2 surveys. When comparing AS, ABL, PN, and RN the only vignette that differed based on VPG was question 3 (p = 0.019). Comparison of any NSS vs. RN in question 3 (regarding a healthy 80 yo man/female with good exercise tolerance and normal kidney function, and a 5 cm exophytic lesion) showed male VPG was 1.67 times more likely to be recommended RN (p = 0.019). Urologist gender had no effect on these findings.

In this survey study of practicing urologists the authors found that male patient gender increased recommendations for radical surgery and less nephron sparing strategies in a hypothetical older patient with a localized renal mass. The authors concluded that provider biases do not appear to be solely responsible for gender disparities seen in the treatment of a localized renal mass.

Presented by: Ankur Shah, Albany Medical Center, USA

Written by: Hanan Goldberg, MD, Urologic Oncology Fellow (SUO), University of Toronto, Princess Margaret Cancer Centre @GoldbergHanan, at the 2018 American Society of Clinical Oncology Genitourinary (ASCO GU) Cancers Symposium, February 8-10, 2018 - San Francisco, CA